Full Text Available Abstract Background To compare medical students on a modern MBChB programme who did an optional intercalated degree with their peers who did not intercalate; in particular, to monitor performance in subsequent undergraduate degree exams. Methods This was a retrospective, observational study of anonymised databases of medical student assessment outcomes. Data were accessed for graduates, University of Aberdeen Medical School, Scotland, UK, from the years 2003 to 2007 (n = 861. The main outcome measure was marks for summative degree assessments taken after intercalating. Results Of 861 medical students, 154 (17.9% students did an intercalated degree. After adjustment for cohort, maturity, gender and baseline (3rd year performance in matching exam type, having done an IC degree was significantly associated with attaining high (18–20 common assessment scale (CAS marks in three of the six degree assessments occurring after the IC students rejoined the course: the 4th year written exam (p th year OSCE (p = 0.001 and the 5th year Elective project (p = 0.010. Conclusion Intercalating was associated with improved performance in Years 4 and 5 of the MBChB. This improved performance will further contribute to higher academic ranking for Foundation Year posts. Long-term follow-up is required to identify if doing an optional intercalated degree as part of a modern medical degree is associated with following a career in academic medicine.
Crowell, Debra L.
The American Nurse Association's (ANA) provisions outline the commitment expected of nurses to protect the community from harm. Medication administration coincides with patient safety as a compelling obligation in nursing practice. The study's purpose was to examine retention of medication safety knowledge among first year nursing students, after…
Cleland, Jennifer A; Milne, Andrew; Sinclair, Hazel; Lee, Amanda J
Abstract Background To compare medical students on a modern MBChB programme who did an optional intercalated degree with their peers who did not intercalate; in particular, to monitor performance in subsequent undergraduate degree exams. Methods This was a retrospective, observational study of anonymised databases of medical student assessment outcomes. Data were accessed for graduates, University of Aberdeen Medical School, Scotland, UK, from the years 2003 to 2007 (n = 861). The main outcom...
Wang, You-Min; Zhang, Qin-Chu
To found the quantifiable index of "The severe degree of negligence" in describing the general severity degree of medical malpractice or medical dispute. "The severe degree of negligence" can be calculated by the way of multiplying the coefficient of medical malpractice's grade by the coefficient of responsibility degree. There are 15 grades of "The severe degree of negligence" through calculation, from the severest degree of 1 to the lightest degree of 20. "The severe degree of negligence" can give an order of severe degree to different grade and different responsibility of medical malpractice. According to this order, the operation of medical malpractice and medical dispute settle will be easier and more rationality.
Wu, Lijuan; Wang, Youxin; Peng, Xiaoxia; Song, Manshu; Guo, Xiuhua; Nelson, Hugh; Wang, Wei
The Chinese government launched a comprehensive healthcare reform to tackle challenges to health equities. Medical education will become the key for successful healthcare reform. We describe the current status of the Chinese medical degree system and its evolution over the last 80 years. Progress has been uneven, historically punctuated most dramatically by the Cultural Revolution. There is a great regional disparity. Doctors with limited tertiary education may be licensed to practice, whereas medical graduates with advanced doctorates may have limited clinical skills. There are undefined relationships between competing tertiary training streams, the academic professional degree, and the clinical residency training programme (RTP). The perceived quality of training in both streams varies widely across China. As the degrees of master or doctor of academic medicine is seen as instrumental in career advancement, including employability in urban hospitals, attainment of this degree is sought after, yet is often unrelated to a role in health care, or is seen as superior to clinical experience. Meanwhile, the practical experience gained in some prestigious academic institutions is deprecated by the RTP and must be repeated before accreditation for clinical practice. This complexity is confusing both for students seeking the most appropriate training, and also for clinics, hospitals and universities seeking to recruit the most appropriate applicants. The future education reforms might include: 1) a domestic system of 'credits' that gives weight to quality clinical experience vs. academic publications in career advancement, enhanced harmonisation between the competing streams of the professional degree and the RTP, and promotion of mobility of staff between areas of excellence and areas of need; 2) International - a mutual professional and academic recognition between China and other countries by reference to the Bologna Accord, setting up a system of easily comparable and
O'Sullivan, Belinda; McGrail, Matthew; Russell, Deborah; Walker, Judi; Chambers, Helen; Major, Laura; Langham, Robyn
Providing year-long rural immersion as part of the medical degree is commonly used to increase the number of doctors with an interest in rural practice. However, the optimal duration and setting of immersion has not been fully established. This paper explores associations between various durations and settings of rural immersion during the medical degree and whether doctors work in rural areas after graduation. Eligible participants were medical graduates of Monash University between 2008 and 2016 in postgraduate years 1-9, whose characteristics, rural immersion information and work location had been prospectively collected. Separate multiple logistic regression and multinomial logit regression models tested associations between the duration and setting of any rural immersion they did during the medical degree and (i) working in a rural area and (ii) working in large or smaller rural towns, in 2017. The adjusted odds of working in a rural area were significantly increased if students were immersed for one full year (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.15-2.79), for between 1 and 2 years (OR, 2.26; 95% CI, 1.54-3.32) and for 2 or more years (OR, 4.43; 95% CI, 3.03-6.47) relative to no rural immersion. The strongest association was for immersion in a mix of both regional hospitals and rural general practice (OR, 3.26; 95% CI, 2.31-4.61), followed by immersion in regional hospitals only (OR, 1.94; 95% CI, 1.39-2.70) and rural general practice only (OR, 1.91; 95% CI, 1.06-3.45). More than 1 year's immersion in a mix of regional hospitals and rural general practices was associated with working in smaller regional or rural towns (immersion programmes. Longer rural immersion and immersion in both regional hospitals and rural general practices are likely to increase rural work and rural distribution of early career doctors. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.
Davó-Blanes, M Carmen; Vives-Cases, Carmen; Barrio-Fernández, José Luis; Porta, Miquel; Benavides, Fernando G; de Miguel, Ángel Gil
To reach a consensus among public health faculty from various Spanish universities about the core public health competencies that should be integrated into undergraduate medical degrees. The 2nd Forum of University Teachers was held at the Rey Juan Carlos University (Madrid, 11-12 December 2014). Twenty-four university professors and lecturers from 19 Spanish universities imparting medical degrees participated in the forum. They were distributed in three working groups during three working sessions. In the first session, they were asked to identify and classify core public health competencies for medical degrees. In the second, they were asked to propose public health contents for the identified competencies. In the third session, the participants organized these contents in thematic blocks. The results were discussed in distinct plenary sessions. The highest number of core competencies was identified in the activities related to the public health functions «Assessment of the population's health needs» and «Developing health policies». The final programme included basic contents organised into five units: Concept of health, public health and its determinants; Epidemiology and health research; Determinants and health problems; Strategies, interventions and policies; and health systems, clinical and healthcare management. The public health core competencies and contents identified in this Forum may be considered as a starting point to improve and update public health training programmes for future medical professionals. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.
Blackstone, Elaine Grant
This study was designed to ascertain current trends in associate degree nursing programs and to discover innovative ideas and techniques which could be applied to the existing program at Miami-Dade Community College (Florida). Data was compiled from interviews with representatives of ten associate degree nursing programs in six states. Information…
Ohio State Univ., Columbus. Center on Education and Training for Employment.
This document, which is designed for use in developing a tech prep competency profile for the occupation of registered nurse (with an associate degree), lists technical competencies and competency builders for 19 units pertinent to the health technologies cluster in general and 5 units specific to the occupation of registered nurse. The following…
Orsolini-Hain, Liana; Waters, Verle
Exploring the inception and growth of associate degree nursing education informs our understanding of what led to such explosive growth so that most of the nursing workforce is currently educated at the associate degree level. The success of associate degree nursing programs led to many divisive years in nursing education of differentiation of practice debates that were hardly productive. Work world practices and patient needs are creating pressures on community colleges to join forces with universities to increase the percentage of baccalaureate-educated nurses. Associate degree nursing education continues to evolve to meet the demands of a higher educated nursing workforce.
Mejia, Christian R; Inga-Berrospi, Fiorella; Mayta-Tristán, Percy
We surveyed physicians who obtained their medical degree with a thesis in 2011 from the seven medical schools in Lima to know the characteristics of the degree by thesis process, as well as participants motivations and perceptions of that process. We included 98 students who did a thesis (87% of total); 99% conducted observational thesis, 30% did so in groups of three. The main motivation was that it was good for their curriculum vitae (94%). At the university where the thesis is compulsory, the process began with the choice of topic and adviser. Perceived greatest and least difficulty in the process was the completion of administrative procedures (53%) and selection of their advisor (11%), respectively. Administrative timeliness and processes should be reviewed so as not to impede the completion of thesis, since the new University Act requires the completion of a thesis to graduate.
Reys-Nickel, Lynsey L.
The purpose of this ex post facto study was to describe completers and non-completers of associate's degree programs in engineering and engineering technologies and determine whether and to what extent completion in these programs is a function of selected student-related variables and institutional variables. Data from the 2004/2009 Beginning Postsecondary Students Longitudinal Study (BPS: 04/09) of associate's degree completers and non-completers in engineering and engineering technologies were accessed and analyzed through PowerStats, a web-based data analysis tool from National Center for Education Statistics (NCES). Descriptive data indicated that, proportionally, engineering and engineering technologies completers were mostly White, married, middle income, employed part-time, enrolled full-time, did not hold a high school diploma or certificate, completed Trigonometry/Algebra II, had a father who's highest education level was an associate's degree, but did not know their mother's highest level of education, completed remedial coursework, and started college with the goal of earning an associate's degree. While more males enrolled in the programs, males and females demonstrated similar completion rates, proportionally--with females showing a slightly higher percentage of completion. Results from the logistic regression further indicated that the variables significant to completion in associate's degree programs in engineering and engineering technologies were gender and enrollment size. Findings suggested that female students were more likely to earn the degree, and that the larger the institution, the more likely the student would become a completer. However, since a major limitation of the study was the small weighted sample size, the results of the study are inconclusive in terms of the extent to which the findings can be generalized to the population of students in associate's degree programs in engineering and engineering technologies. This study fills a
Taylor, Frederick R
Medications administered long term, such as those used for migraine prophylaxis, are often associated with weight change as a side effect. Such effects may compromise general health status, exacerbate coexisting medical conditions, and affect medication adherence. Weight gain should be of particular concern in patients with migraine, as there is evidence that overweight and obese patients with migraine are at risk for an increased frequency and severity of migraine attacks. This article reviews weight-change data from recent clinical studies of migraine-preventive medications in children, adolescents, and adults with migraine. A PubMed search was conducted for English-language articles published between January 1970 and November 2007. Among the search terms were migraine prevention, migraine prophylaxis, migraine treatment, antidepressant drug, beta-adrenergic-receptor blockers, antiepileptic drug, anticonvulsant drug, weight gain, and weight loss. Studies that reported weight-change data (gain, loss, or neutral) were included. When available, double-blind, placebo-controlled studies were selected for review. Open-label, retrospective or prospective trials may also have been included. Most of the migraine-preventive medications classified by the United States Headache Consortium as group 1 based on the high level of evidence for their efficacy--for instance, amitriptyline, propranolol, and divalproex sodium-have been associated with varying degrees of weight gain. The exceptions are timolol, which is weight neutral, and topiramate, which is associated with weight loss. Among the drugs that have been associated with weight gain, a higher incidence of weight gain was observed with amitriptyline and divalproex sodium than with propranolol. Weight-change effects require careful consideration when selecting migraine-preventive medications, and weight should be monitored carefully over the course of any migraine treatment plan.
The association between overt hypothyroidism (OH) and altered lipid profile is well known, however the significance of dyslipidemia in subclinical hypothyroidism (SCH) remain controversial. Therefore, this study was conducted to determine any association between lipid profile and different degrees of thyroid dysfunction.
Galvin, William F
After years of discussion, debate, and study, the respiratory care curriculum has evolved to a minimum of an associate degree for entry into practice. Although programs are at liberty to offer the entry-level or advanced level associate degree, most are at the advanced level. The most popular site for sponsorship of the associate degree in respiratory care is the community college. The basis for community college sponsorship seems to be its comprehensive curriculum, which focuses on a strong academic foundation in writing, communication, and the basic sciences as well as supporting a career-directed focus in respiratory care. Issues facing the community college are tied to literacy, outcomes, assessment, placement,cooperation with the community, partnerships with industry, and articulation arrangements with granting institutions granting baccalaureate degrees. Community colleges must produce a literate graduate capable of thriving in an information-saturated society. Assessment and placement will intensify as the laissez-faire attitudes toward attendance and allowing students to select courses without any accountability and evaluation of outcome become less acceptable. Students will be required to demonstrate steady progress toward established outcomes. Maintaining relations and cooperation with the local community and the health care industry will continue to be a prominent role for the community college. The challenge facing associate degree education in respiratory care at the community college level is the ability to continue to meet the needs of an expanding professional scope of practice and to provide a strong liberal arts or general education core curriculum. The needs for a more demanding and expanding respiratory care curriculum and for a rich general education core curriculum have led to increased interest in baccalaureate and graduate degree education. The value of associate degree education at the community college level is well established. It is
Shek, Daniel T L; Shek, Moses M W
Although collaborative learning has been widely researched in Western contexts, no study has been carried out to understand how associate degree students look at collaborative learning in Hong Kong. In this study, perceptions of and attitudes to collaborative learning among associate degree students were studied. A total of 44 associate degree students completed an online questionnaire including measures of perceived benefits and attitudes to collaborative learning, and social-emotional competence. Results showed that there were no significant differences between male and female students on perceived benefits of and attitudes towards collaborative learning. Social-emotional competence was related to perceived benefits of and attitudes to collaborative learning. Attitudes were also related to perceived benefits of collaborative learning. This paper is the first known study looking at the relationships among perceived benefits and attitudes to collaborative learning and social-emotional competence in Chinese associate degree students in different Chinese contexts.
A Gadamerian Phenomenological Study Examining the Meaning of Having a Bachelor's Degree Expressed by Associate Degree Nurses (ADN) Who Educationally Transitioned to a Baccalaureate Degree in Nursing (BSN)
Sauld, Jill Pierpont
Since the inception of associate degree nursing programs, professional nursing conversations and debate have grappled with reckoning differences between the associate degree in nursing (ADN) and the bachelor's degree in nursing (BSN). Research reporting better patient outcomes with more baccalaureate prepared nurses has been a driving force for…
Shapiro, Doug; Dundar, Afet; Wakhungu, Phoebe Khasiala; Yuan, Xin; Nathan, Angel; Hwang, Youngsik
This report examines time to degree completion for a cohort of students who earned an associate degree as their first and only postsecondary degree or a bachelor's degree as their first four-year degree between July 1, 2014, and June 30, 2015. Overall, the average time enrolled for associate and bachelor's degree earners was 3.3 years and 5.1…
Discusses the nature, importance, and future of the Tech Prep/Associate Degree program. Suggests that these programs must move beyond simple articulation and become aggressive in jointly examining, developing, and sustaining high quality educational programs. (JOW)
Schneider, Roberta L.
The Internet has the potential to reshape college recruiting; however, little research has been done to see the impact of the Internet on marketing graduate programs, including medical schools. This paper explores the Web sites of 20 different medical schools, including traditional four-year and bachelor's-M.D. degree programs, to ascertain…
Pak, JuGeon; Park, KeeHyun
We propose a smart medication dispenser having a high degree of scalability and remote manageability. We construct the dispenser to have extensible hardware architecture for achieving scalability, and we install an agent program in it for achieving remote manageability. The dispenser operates as follows: when the real-time clock reaches the predetermined medication time and the user presses the dispense button at that time, the predetermined medication is dispensed from the medication dispensing tray (MDT). In the proposed dispenser, the medication for each patient is stored in an MDT. One smart medication dispenser contains mainly one MDT; however, the dispenser can be extended to include more MDTs in order to support multiple users using one dispenser. For remote management, the proposed dispenser transmits the medication status and the system configurations to the monitoring server. In the case of a specific event such as a shortage of medication, memory overload, software error, or non-adherence, the event is transmitted immediately. All these operations are performed automatically without the intervention of patients, through the agent program installed in the dispenser. Results of implementation and verification show that the proposed dispenser operates normally and performs the management operations from the medication monitoring server suitably.
Full Text Available We propose a smart medication dispenser having a high degree of scalability and remote manageability. We construct the dispenser to have extensible hardware architecture for achieving scalability, and we install an agent program in it for achieving remote manageability. The dispenser operates as follows: when the real-time clock reaches the predetermined medication time and the user presses the dispense button at that time, the predetermined medication is dispensed from the medication dispensing tray (MDT. In the proposed dispenser, the medication for each patient is stored in an MDT. One smart medication dispenser contains mainly one MDT; however, the dispenser can be extended to include more MDTs in order to support multiple users using one dispenser. For remote management, the proposed dispenser transmits the medication status and the system configurations to the monitoring server. In the case of a specific event such as a shortage of medication, memory overload, software error, or non-adherence, the event is transmitted immediately. All these operations are performed automatically without the intervention of patients, through the agent program installed in the dispenser. Results of implementation and verification show that the proposed dispenser operates normally and performs the management operations from the medication monitoring server suitably.
Toroser, Dikran; DeTora, Lisa; Cairns, Angela; Juneja, Renu; Georgieva, Anna; Weigel, Al; Pepitone, Kim
To review guidance from professional medical associations to physicians on the Sunshine Act, with a focus on industry support for medical publications. Using 'Sunshine Act' as a search term, we searched PubMed (dates February 2013 to November 2014) and the 'grey literature' using Google and Google Scholar. Online information was extracted from websites of pre-identified professional medical associations. Some professional medical associations have published peer-reviewed recommendations, position statements or general advice on their websites and in journals around the Sunshine Act. Associations also provided broad online educational resources for physicians. There was universal agreement between peer-reviewed publications, including guidelines, for the need for full transparency and disclosure of industry support. Surveys by some professional associations showed variance in opinion on the forecasted impact of the Sunshine Act on physician-industry relationships. There was scarce information specifically related to reporting requirements for industry-supported medical publications. There is a shortage of information for physicians from professional associations regarding the Sunshine Act and support for medical publications. Due to the lack of clear guidance regarding support for publications, there are presently varying interpretations of the Sunshine Act. The literature debates the potential impact of the Sunshine Act and expresses some concerns that physician-enabled innovation in drug development may be hindered.
Mello, Michael J; Feller, Edward; George, Paul; Borkan, Jeffrey
Additional knowledge, attitudes and skills are required for the next generation of medical students as they expand the traditional focus on individual patients to include population-based health and scholarly investigation. The Warren Alpert Medical School of Brown University (AMS) is initiating a master's degree program as a key component of the new Primary Care-Population Medicine program at AMS leading to both a Doctorate in Medicine (MD) and Master of Science in Population Medicine (ScM) degrees in four years. The ScM is composed of a series of nine courses, integrated into the four-year MD curriculum, as well as a thesis. Additional attention will be given to leadership and quality improvement training. The goal is to produce graduates competent in the care of individual patients, panels, communities, and populations.
... Next Generation Data Sciences Challenges in Health and Biomedicine Fri November 3, 2017 The Medical Library Association ... Next Generation Data Science Challenges in Health and Biomedicine. MLA's comments and recommendations will help formulate strategic ...
Hertzman, Jean; Ackerman, Robert
Purpose: The purpose of this study is to determine which categories and indicators of quality are best suited to evaluating associate degree culinary arts programs (ADCAP). Design/methodology/approach: The researchers surveyed a national sample of culinary educators and industry chefs in the USA. The instrument asked the participants to rate the…
Henninger, Debra E.; Whitson, Heather E.; Cohen, Harvey J.; Ariely, Dan
OBJECTIVES Locus of control (LOC) is a psychological construct reflecting the degree to which one perceives circumstances to be controlled by personal actions (internal LOC) versus outside factors (external LOC). Because LOC could influence a patient's medical decision-making and health behaviors, our objective is to describe the association between an increasing number of co-existing conditions and LOC in older adults. DESIGN Cross-sectional study using survey data from the North Carolina Established Population for Epidemiologic Studies of the Elderly (NC EPESE) dataset. SETTING and PARTICIPANTS Community-dwelling older adults aged 68 and older (N=3,212). MEASUREMENTS Nine common medical conditions were assessed by self-report. LOC was measured by standard questionnaire. Analyses adjusted for demographics, functional status (self-reported activities of daily living), cognition (Short Portable Mental Status Questionnaire), and depression score (Center for Epidemiologic Studies Depression Scale). RESULTS A higher number of chronic conditions was associated with external LOC (β=0.37, p<0.001). This relationship persisted after adjustment for age, race, sex, functional status, cognition, and depression (β=0.17, p <0.0001). Most individual conditions were not associated with LOC, although vision impairment (p<0.001) and arthritis (p<0.05) were associated with more internal LOC. CONCLUSION These results suggest that medically complex patients tend to exhibit a more external LOC, meaning that they perceive little personal control over circumstances and environment. Clinicians should be aware of this tendency, as external LOC may impede an older adult's willingness to engage in the considerable task of managing multiple chronic conditions. PMID:22458257
Heun, Xenia; Eisenlöffel, Christian; Barann, Bastian; Müller-Hilke, Brigitte
To obtain the German Medical Degree "Dr.med." candidates are required to write a scientific thesis which is usually accomplished during Medical school education. This extra work load for the students amongst a lack of standardization and an M.D. awarded upon graduation in other European and Anglo-Saxon countries leads repeatedly to criticism of the German system. However, a systematic survey on the perception and acceptance of the German doctoral thesis among those affected is overdue. Using an online questionnaire, medical students as well as licensed doctors were asked for the status of their medical degree, their motivation, personal benefit, time and effort, scientific output, its meaningfulness and alternatives concerning their thesis. Patients were asked, how important they value their general practitioner's title "Dr. med.". The resulting data were evaluated performing basic statistic analyses. The title "Dr. med." does not seem to be obsolete, but there is room for improvement. The scientific output is good and only a mere 15.1% of the candidates do not publish their results at all. Moreover, while at an early stage motivation, appreciation and recognition of personal benefits from the medical degree are considered as independent aspects, they merge to a general view at later stages. The current practice is considered most meaningful by the ones who have already finished their thesis. However, there are discrepancies between the expected and the actual length as well as the type of the thesis indicating that mentoring and educational advertising need improvement. As for the patients, their educational level seems to correlate with the significance attributed to the title "Dr. med." held by their physician.
Krupat, Edward; Dienstag, Jules L; Kester, W Carl; Finkelstein, Stan N
Increasingly, health care is being delivered in large, complex organizations, and physicians must learn to function effectively in them. As a result, several medical and business schools have developed joint programs to train physician leaders who receive both medical degree (MD) and master of business administration (MBA) degrees. We examined several themes in relation to these programs, revolving around concerns about who is attracted to them and whether exposure to the differing cultures of medicine and business have an impact on the professional identities of their graduates as manifested in their motivations, aspirations, and careers. We addressed these issues by studying students in the joint MD/MBA program at Harvard Medical School (HMS) and Harvard Business School (HBS). Our data came from several internal sources and a survey of all students enrolled in the joint program in spring 2013. We found relatively few differences between joint program students and equivalent cohorts of HMS students in terms of personal characteristics, preadmission performance, and performance at HMS and HBS. Contrary to the concerns that such programs may draw students away from medicine, the vast majority embraced careers involving extensive postgraduate medical training, with long-term plans that leveraged their new perspectives and skills to improve health care delivery. © The Author(s) 2016.
P. Anusha Devi
Full Text Available An ecard of a graph $G$ is a subgraph formed by deleting an edge. A da-ecard specifies the degree of the deleted edge along with the ecard. The degree associated edge reconstruction number of a graph $G,~dern(G,$ is the minimum number of da-ecards that uniquely determines $G.$ The adversary degree associated edge reconstruction number of a graph $G, adern(G,$ is the minimum number $k$ such that every collection of $k$ da-ecards of $G$ uniquely determines $G.$ The maximal subgraph without end vertices of a graph $G$ which is not a tree is the pruned graph of $G.$ It is shown that $dern$ of complete multipartite graphs and some connected graphs with regular pruned graph is $1$ or $2.$ We also determine $dern$ and $adern$ of corona product of standard graphs.
Jenkins, Carol G; Bader, Shelley A
The Association of Academic Health Sciences Libraries has made collaboration with other organizations a fundamental success strategy throughout its twenty-five year history. From the beginning its relationships with Association of American Medical Colleges and with the Medical Library Association have shaped its mission and influenced its success at promoting academic health sciences libraries' roles in their institutions. This article describes and evaluates those relationships. It also describes evolving relationships with other organizations including the National Library of Medicine and the Association of Research Libraries.
Full Text Available Different people choose which undergraduate degree to study at the university for different reasons. To date, there have been limited attempts to identify individual differences in motivation that drive the undergraduate degree choice. We identified that people choose university degrees for four reasons: career concerns (Career, intrinsic interest (Interest in the subject, an opportunity to help others (Helping and because they are looking for an easy option into higher education (Loafing. We investigated whether these motivation apply to the choice of undergraduate degree in two samples: (1 undergraduate (N = 989 and (2 prospective (N = 896 students. We developed the Motivations Influencing Course Choice (MICC questionnaire to measure these motivations. Scales of Helping, Career, Loafing and Interest showed good psychometric properties, showed validity with respect to general life goals and personality traits, and predicted actual and prospective degree choices. We demonstrated that medical degrees were chosen due to a mixture of Helping and Career, while engineering degrees were associated with Career and low interest in the degree. The choice of art and humanities degrees was driven by Interest and low concern about future career, accompanied with high Loafing. We also demonstrated gender differences: females were high in Helping (both samples and Interest (only in undergraduate sample motivation, while males scored higher in Career (only in undergraduate sample and Loafing (both samples. The findings can feed into both theoretical accounts of proximal motivation as well as help to improve degree programmes at universities and provide better career advice.
Skatova, Anya; Ferguson, Eamonn
Different people choose undergraduate degrees to study at university for different reasons. To date, there have been limited attempts to identify individual differences in motivation that drive undergraduate degree choice. We identified that people choose university degrees for four reasons: career concerns (Career), intrinsic interest in the subject (Interest), an opportunity to help others (Helping) and because they are looking for an easy option to get into higher education (Loafing). We investigated whether these motivations apply to the choice of undergraduate degree in two samples: (1) undergraduate (N = 989) and (2) prospective (N = 896) students. We developed the Motivations Influencing Course Choice (MICC) questionnaire to measure these motivations. Scales of Helping, Career, Loafing, and Interest showed good psychometric properties, showed validity with respect to general life goals and personality traits, and predicted actual and prospective degree choices. We demonstrated that medical degrees were chosen due to a mixture of Helping and Career, while engineering degrees were associated with Career and low Interest in the degree. The choice of arts and humanities degrees was driven by Interest and low concern about future career, accompanied with high Loafing. We also demonstrated gender differences: females were high in Helping (both samples) and Interest (only in the undergraduate sample) motivation, while males scored higher in Career (only in the undergraduate sample) and Loafing (both samples). The findings can feed into both theoretical accounts of proximal motivation as well as provide help to improve degree programmes at universities and support better career advice.
According to European and German law, the medical education of physicians must take place in a scientific degree program at a university or under the supervision of a university. To keep up the ideal of a scientific degree program, various organizations and associations, such as the German Research Foundation, the German Council of Science and Humanities and the German Medical Faculty Association, see the need for an even stronger anchoring of academic learning content in the course of study. Traditionally, a scientific project, which is carried out during the studies, provides the basis for the Doctor of Medicine (Dr. med.) after graduation, although the research projects as a basis for medical degrees are currently not obligatory parts of the curricula. The number of medical students performing such research projects is significantly decreasing, thus they are missing major skills for working in science. To counteract these developments, faculties of medicine are currently developing model curricula including deepened scientific education. Despite these efforts, the German Association of Faculties of Medicine argues that the performance of research projects leading to the doctoral degree is most suitable for obtaining expertise in scientific work. According to recommendations by the German Council of Science on the requirements for quality assurance of graduation doctoral degree programs have been introduced. This and further measures, like MD/PhD programs or research-based additional study programs serving the scientific qualification of medical students, are the subject of this article.
Full Text Available Introduction. Medicine is one of the most stressful fields of education because of its highly demanding professional and academic requirements. Psychological stress, anxiety, depression and sleep disturbances are highly prevalent in medical students.Methods. This cross-sectional study was undertaken at the Combined Military Hospital Lahore Medical College and the Institute of Dentistry in Lahore (CMH LMC, Pakistan. Students enrolled in all yearly courses for the Bachelor of Medicine and Bachelor of Surgery (MBBS degree were included. The questionnaire consisted of four sections: (1 demographics (2 a table listing 34 potential stressors, (3 the 14-item Perceived Stress Scale (PSS-14, and (4 the Pittsburgh Quality of Sleep Index (PSQI. Logistic regression was run to identify associations between group of stressors, gender, year of study, student’s background, stress and quality of sleep.Results. Total response rate was 93.9% (263/280 respondents returned the questionnaire. The mean (SD PSS-14 score was 30 (6.97. Logistic regression analysis showed that cases of high-level stress were associated with year of study and academic-related stressors only. Univariate analysis identified 157 cases with high stress levels (59.7%. The mean (SD PSQI score was 8.1 (3.12. According to PSQI score, 203/263 respondents (77% were poor sleepers. Logistic regression showed that mean PSS-14 score was a significant predictor of PSQI score (OR 1.99, P < 0.05.Conclusion. We found a very high prevalence of academic stress and poor sleep quality among medical students. Many medical students reported using sedatives more than once a week. Academic stressors contributed significantly to stress and sleep disorders in medical students.
OBJECTIVE--To examine the requirements and opportunities for obtaining a doctor of medicine or master of surgery degree from a university in the United Kingdom other than the graduate's own, particularly in the case of foreign graduates. DESIGN--Review of regulations governing the award of doctor of medicine and master of surgery degrees in British universities. SETTING--All 19 universities in the United Kingdom offering clinical courses. MAIN OUTCOME MEASURE--Availability of degrees to gradu...
Kaić, Zvonimir; Sain, Snjezana; Gulić, Mirjana; Mahovlić, Vjekoslav; Krznarić, Zeljko
The available literature shows us that "Druztvo ljeciteljah u Zagrebus (the Society of Healers in Zagreb) was founded as far back as the year 1845 by a total of thirteen members. This data allows us to follow the role of doctors and health workers in Zagreb through their everyday profession, research, organizational and social work as well as management through a period of over one hundred to seventy years. The Branch Zagreb was active before the official establishment of subsidiaries of CMA which is evident from the minutes of the regular annual assembly of the Croatian Medical Association on 21 March 1948. Until the end of 1956, there was no clear division of labor, functions and competencies between the Branch and the Main Board. Their actions were instead consolidated and the Branch operated within and under the name of Croatian Medical Association. In that year the Branch became independent. The Branch Zagreb is the largest and one of the most active branches of the Croatian Medical Association. At the moment, the Branch brings together 3621 members, regular members--doctors of medicine (2497), doctors of dental medicine (384), retired physicians (710), and associate members (30 specialists with higher education who are not doctors). The Branch is especially accomplished in its activities in the area of professional development of its members and therefore organizes a series of scientific conferences in the framework of continuous education of physicians, allowing its members to acquire necessary points for the extension of their operating license. The choir "Zagrebacki lijecnici pjevaci" (Zagreb Physicians' Choir) of the Croatian Medical Music Society of the CMA and its activities are inseparable from the Branch Zagreb. The Branch is firmly linked to the parent body, the CMA, and thus has a visible impact on the strategy and the activities of the Association as a whole. Most professional societies of the CMA have their headquarters in Zagreb and this is
Lee, Wincy W. S.
Associate (community college) degrees have expanded rapidly in the past decade in Hong Kong, but their value has been questioned due to the limited number of government-funded articulation opportunities available. This paper argues that associate degrees in Hong Kong are not valued solely for articulation purposes, but also for nurturing students'…
Andriole, Dorothy A; Jeffe, Donna B; Hageman, Heather L; Klingensmith, Mary E; McAlister, Rebecca P; Whelan, Alison J
To identify predictors of attrition during graduate medical education (GME) in a single medical school cohort of contemporary US medical school graduates. Retrospective cohort study. Single medical institution. Recent US allopathic medical school graduates. Attrition from initial GME program. Forty-seven of 795 graduates (6%) did not complete the GME in their initial specialty of choice. At bivariate analysis, attrition was associated with election to the Alpha Omega Alpha Honor Medical Society, being an MD-PhD degree holder, and specialty choice (all P PhD degree holder (odds ratio, 3.43; 95% confidence interval, 1.27-9.26; P = .02), election to Alpha Omega Alpha (2.19; 1.04-4.66; P = .04), choice of general surgery for GME (5.32; 1.98-14.27; P < .001), and choice of 5-year surgical specialty including those surgical specialties with a GME training requirement of 5 years or longer (2.74; 1.16-6.44; P = .02) each independently predicted greater likelihood of attrition. Academically highly qualified graduates and graduates who chose training in general surgery or in a 5-year surgical specialty were at increased risk of attrition during GME.
Full Text Available Introduction: Recognition of the multiple positive effects of the physical activity confirms its influence on human’s health. Undertaking of the health oriented conducts plays an important role in the promotion of the health and in the creating of the healthier future. Academic youth should be aware of the influence of certain activities on health. The aim of the research was to analyse the physical activity performed by the full-time students of the medical and nonmedical degree courses. Material and methods: The research was conducted at the turn of 2012 and 2013. The research group, containing 553 person (n4553, consisted of the students from six Polish, both medical and non-medical, university colleges. The research utilizes the method of the diagnostic survey. Technique of the research based on the poll whose questionnaire had been created by the authors for the purpose of the research. Accuracy of the research tool was established within the method of objective judges, splithalf method was used to determine reliability (according to Spearman-Brown result 0.86. In order to define the existence of the differences or correlations between analysed immeasurable parameters chi-squared and Fisher’s exact tests were used. Results: The substantial majority of the respondents – 79,5% (n4439 described themselves as physically active. The forms of activity that are performed most often among the students are: cycling – 40,5% (n4220, team sport – 27,1% (n4147, dog walking – 27,1% (n4147, group activities (aerobics, zumba, salsa – 21,2% (n4115 and swimming – 20,8% (n4113. The sex and the faculty of the studies are both important variables that have got statistically significant impact on the choice of the form of activity. Majority of the respondents – 78,3% (n4432 chooses the type of the physical activity basing on their likings and the amount of the spare time – 42,9% (n4237. Exercising of the physical activity is regarded as a
Becker, Ellen A; Nguyen, Xuan T
Transitioning from an associate degree to a baccalaureate degree for respiratory therapists has been suggested as a new entry-level educational standard. One potential risk for this change is that it may limit the diversity of potential applicants for entry-level education. A diverse workforce is important to achieve the goal of reducing healthcare disparities. This study evaluated characteristics of therapists who completed associate and baccalaureate degree entry-level education. A secondary analysis of data collected from the 2009 AARC Respiratory Therapist Human Resource Survey explored relationships between the choice of entry-level associate or baccalaureate education and variables of gender, race, salary, career advancement, and job satisfaction. There were no differences between therapists with entry-level associate and baccalaureate degrees in gender, race, number of additional healthcare credentials, numbers of life support credentials, wages, delivering respiratory care by protocol, and job satisfaction. There were significantly higher percentages of advanced academic degrees, desire to pursue a higher academic degree, registered respiratory therapist credentials, total National Board for Respiratory Care credentials, and leadership roles for therapists with baccalaureate entry-level degrees. Current entry-level associate and baccalaureate degree graduates have similar gender and race proportions. This finding challenges concerns that an entry-level baccalaureate degree would decrease the diversity of the respiratory therapist workforce. Copyright © 2014 by Daedalus Enterprises.
Gregory, Paul J; Robbins, Benjamin; Schwaitzberg, Steven D; Harmon, Larry
The current research evaluated the potential utility of a 360-degree survey feedback program for measuring leadership quality in potential committee leaders of a professional medical association (PMA). Emotional intelligence as measured by the extent to which self-other agreement existed in the 360-degree survey ratings was explored as a key predictor of leadership quality in the potential leaders. A non-experimental correlational survey design was implemented to assess the variation in leadership quality scores across the sample of potential leaders. A total of 63 of 86 (76%) of those invited to participate did so. All potential leaders received feedback from PMA Leadership, PMA Colleagues, and PMA Staff and were asked to complete self-ratings regarding their behavior. Analyses of variance revealed a consistent pattern of results as Under-Estimators and Accurate Estimators-Favorable were rated significantly higher than Over-Estimators in several leadership behaviors. Emotional intelligence as conceptualized in this study was positively related to overall performance ratings of potential leaders. The ever-increasing roles and potential responsibilities for PMAs suggest that these organizations should consider multisource performance reviews as these potential future PMA executives rise through their organizations to assume leadership positions with profound potential impact on healthcare. The current findings support the notion that potential leaders who demonstrated a humble pattern or an accurate pattern of self-rating scored significantly higher in their leadership, teamwork, and interpersonal/communication skills than those with an aggrandizing self-rating.
Peterson-Graziose, Virginia; Bryer, Jennifer; Nikolaidou, Maria
There is a serious and growing shortage of nurses in the United States, and the high rate of student attrition from nursing programs has further added to this problem. The challenge for schools of nursing is to recruit increased numbers of qualified candidates into their programs and to determine ways to decrease the rate of student attrition. The purpose of this study was to determine whether self-esteem, self-efficacy, and life stressors were significantly related to student attrition in first-semester associate degree nursing students. A descriptive correlational design and nonprobability convenience sample of first-semester associate degree nursing students was used. Data were gathered using the Rosenberg Self-Esteem Scale, the General Self-Efficacy Scale, and the Holmes and Rahe Social Readjustment Rating Scale. Findings indicated that self-esteem was significantly associated with student attrition. Results from this study provide the basis for targeted interventions designed to decrease student attrition rates in associate degree nursing programs. Copyright 2013, SLACK Incorporated.
Siregar, G. A.; Sari, D. K.; Sungkar, T.
The main pathogenesis of gastritis is inflammation that closely related to free radicals. Malondialdehyde (MDA) is a free radical biomarker and is found to increase in gastritis patients. However, these studies are generally performed on experimental animals as well as MDA examination in gastric mucosa. This study aim was to determine the association of degrees of gastritis (degree of lymphocyte infiltration, neutrophil activity, atrophy, and intestinal metaplasia) with plasma MDA level. A cross-sectional study of 80 consecutive gastritis patients who came to an endoscopic unit of Adam Malik General Hospital in Medan, Indonesia, from May–September 2017. Assessed for severity of chronic inflammatory, neutrophil activity, atrophy, and intestinal metaplasia refers to Updated Sydney System. Plasma MDA levels were examined using an HPLC MDA kit. Univariate analysis, bivariate (chi-square and Fisher exact test), and multivariate (binary logistic regression test) were programmed with SPSS version 22. There was no significant association between degree of lymphocyte infiltration with MDA level. There were significant associations between degree of neutrophil activity, atrophy, and intestinal metaplasia with MDA level (p=0.039, 0.003, 0.021; respectively). The moderate+severe degree of neutrophil activity, atrophy, and intestinal metaplasia were associated with high level of MDA.
Casas, Rachel S; Xuan, Ziming; Jackson, Angela H; Stanfield, Lorraine E; Harvey, Nanette C; Chen, Daniel C
Empathy is a crucial skill for medical students that can be difficult to evaluate. We examined if self-reported empathy in medical students was associated with clinical competence. This study combined cross-sectional data from four consecutive years of medical students (N=590) from the Boston University School of Medicine. We used regression analysis to evaluate if self-reported empathy (Jefferson Scale of Physician Empathy (JSPE)) predicted scores in clinical clerkships, United States Medical Licensing Examinations, and OBJECTIVE: Structured Clinical Examinations (OSCEs). We separately analyzed overall and OSCE communication scores based on interpersonal skills reported by standardized patients. We controlled for age, gender, debt, and specialty affinity. JSPE scores of medical students were positively associated with OSCE communication scores, and remained significant when controlling for demographics. We found that JSPE score was also predictive of overall OSCE scores, but this relationship was confounded by gender and age. JSPE scores were associated with performance in the Pediatrics clerkship, but not other clerkships or standardized tests. JSPE scores were positively associated with OSCE communication scores in medical students. This study supports that self-reported empathy may predict OSCE performance, but further research is needed to examine differences by gender and age. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
The primary purpose of this study was to identify those competencies needed by Associate Degree Radiographers when they assume employment as entry-level practitioners. A second purpose of the study was to rank order the identified competencies within the role delineations recognized by the Essentials and Guidelines of an Accredited Educational Program for the Radiographer. These role delineations include: radiation protection, exercise discretion and judgment, emergency and life saving techniques, patient care and interpersonal communication, and role as professional member. A third purpose of the study was to examine the degree of consensus on role definition of entry-level competencies needed by Associate Degree Radiographers as perceived by primary role definers (such as employers, employees, and educators), and by other selected variables: age, sex, length of experience in radiologic technology, level of formal education, and place of employment. A major finding of this study was that respondents did not differ significantly in their ranking of entry-level competencies needed by Associate Degree Radiographers when the responses were analyzed according to position, age, sex, length of experience, level of education, or place of employment. Another important finding was that respondents considered all of the 63 competencies as important and needed by Associate Degree Radiographers upon initial employment.A major conclusion and recommendation of this study, in view of the high agreement on the rank ordering of competencies, was that these competencies should be included in a competency-based education model. It was further recommended that a three-way system of communication between employers, employees, and educators be considered in order to pool resources and to increase understanding of each position group's contribution and influence on entry-level Associate Degree Radiographers
Phillips, Brad C.; Spurling, Steven; Armstrong, William A.
California faces a severe nursing shortage, with the number of registered nurses far below what is required to avert a potential state health care crisis. The Associate Degree Nursing (ADN) Project is a joint project involving scholars, educational researchers, and analysts from the Center for Student Success (CSS) housed at City College of San…
Mitchell, Kathy Jessee
Nursing is facing a critical shortage and retention of nursing students is of paramount importance. Much research has been completed related to retention in nursing education and student success, but there is very little in current literature related to issues associated with the transition from high school to associate degree nursing (ADN)…
McGhie-Anderson, Rose Lavine
The purpose of this study was to gain an understanding of the social processes associated with the decision of diploma and associate degree nurses to advance academically. Advanced nursing education needs to be pursued along the continuum of the nursing career path. This education process is indispensable to the role of nurses as educator, manager, nurse leader, and researcher who will effect policy changes, assume leadership roles as revolutionary thinkers, and implement paradigmatic shifts. Data were collected from two groups of participants using face-to-face, semistructured interviews. Group 1 consisted of diploma and associate degree nurses; Group 2 consisted of baccalaureate, masters, and doctoral degree nurses who have progressed academically. Emerging from the thick, rich data were core categories of rewarding, motivating, and supporting as critical factors that influence professional advancement. This qualitative study elucidated that professional advancement was the social process that grounds. The emergent theory was the theory of professional advancement.
Wagoner, Richard L.; Kisker, Carrie B.
The previous six chapters have focused on particular aspects of the processes involved in implementing transfer associate degrees in various states. In this chapter, the authors synthesize that information by presenting an ideal state-level organizational model for implementing these degrees and describing the various constituencies involved in…
Lumadue, Richard T.
Graduate degrees prostitute the educational process when they are sold to consumers by unaccredited degree/diploma mills as being equivalent to legitimate, bona-fide degrees awarded by accredited graduate schools. This article carefully analyzes the serious problems of bogus degrees and their association with the religious higher education…
Eley, Diann S; Leung, Janni K; Campbell, Narelle; Cloninger, C Robert
Resilience, coping with uncertainty and learning from mistakes are vital characteristics for all medical disciplines - particularly rural practice. Levels of coping constructs were examined in medical students with and without a rural background or an interest in rural practice. Cross-sectional surveys identified two personality profiles, and their association with levels of Tolerance of Ambiguity, Resilience, Perfectionism-High Standards and Concern over mistakes as constructs indicative of coping. Medical students (N = 797) were stratified by rural background and degree of rural interest. Mediation analysis tested the effect of personality profile on levels of the coping constructs. More (72%) rural background students had Profile 1 which was associated with higher levels of Tolerance of Ambiguity, High standards, and Resilience, but lower Concern over mistakes. Non-rural background students reporting a strong rural interest also had Profile 1 (64%) and similar levels of coping constructs. Personality profile mediated the association between rural interest and levels of coping constructs regardless of background. Having a rural background or strong rural interest are associated with a personality profile that indicates a better capacity for coping. Personality may play a part in an individual's interest in rural practice. Rural workforce initiatives through education should encourage and nurture students with a genuine interest in rural practice - regardless of background.
Nault, Andre J.
Veterinary medical libraries and librarians are unique. There are now 33 veterinary colleges in North America, and in accordance with American Veterinary Medical Association accreditation, each has a library managed by an accredited librarian. Colleges with veterinary programs often maintain specialized branch libraries to support the degree,…
Gontar A Siregar
Full Text Available Aim: to investigate the serum levels of TNF-α, IL-8, VEGF in Helicobacter pylori infection, and their association with the degrees of gastritis histopathology. Methods: a cross-sectional study was done on 80 consecutive gastritis patients admitted to endoscopy units at Adam Malik General Hospital and Permata Bunda Hospital, Medan, Indonesia from July-December 2014. The Rapid Urease test was used for the diagnosis of H. pylori infection. The severity of chronic inflammation, neutrophil infiltration, atrophy, and intestinal metaplasia were assessed. Serum samples were obtained to determine circulating TNF-α, IL-8, and VEGF. Univariate and bivariate analysis (chi square, fisher’s exact, and mann-whitney test were done using SPSS version-22. Results: there were 41.25% of 80 patients infected with Helicobacter pylori. Serum TNF-α and VEGF levels in the infected group were significantly higher compared to H. pylori negative, but there were no significant differences between serum levels of IL-8 in H. pylori positive and negative. There were significant associations between serum level of TNF-α and IL-8 with degree of chronic inflammation, and also between serum level of IL-8 and degree of neutrophil infiltration. There were significant associations between serum level of VEGF and degree of atrophy, and also between serum level of VEGF and degree of intestinal metaplasia. Conclusion: High levels of TNF-α were associated with severe degree of chronic inflammation, high levels of IL-8 associated with severe degree of chronic inflammation and neutrophil infiltration, and high levels of VEGF associated with severe degree of premalignant gastric lesion. Key words: cytokine, neoangiogenesis, Helicobacter pylori, atrophic gastritis, intestinal metaplasia.
van der Veen, Willem; van den Bemt, Patricia M L A; Wouters, Hans; Bates, David W; Twisk, Jos W R; de Gier, Johan J; Taxis, Katja
Objective: To study the association of workarounds with medication administration errors using barcode-assisted medication administration (BCMA), and to determine the frequency and types of workarounds and medication administration errors. Materials and Methods: A prospective observational study in
Full Text Available Introduction: Learning styles influence the methods and ways of obtaining information and lead to the variety of information seeking behaviors from the searchers. This study aimed to investigate the relationship between learning styles and information seeking behavior in master degree students of medical science in Shahid Sadoughi University of Medical Sciences in Yazd. Methods: This study was a cross-sectional analytic study. The population of the study was 601 master degree students of Shahid Sadoughi University of Medical Sciences in Yazd in 2013-2015. They were all freshmen. The sample size of 234 students was determined using Cochran formula. Data were collected by two questionnaires (Kolb questionnaire and researcher-made seeking behavior questionnaire. The validity of questionnaires was confirmed by a panel of experts and their reliability was confirmed by Cronbach`s alpha. Data analysis was done by inferential statistics and statistical software SPSS (version 18. Measuring the significant relationship between learning styles and information seeking behavior was done with Pierson correlation coefficient. The significant difference between learning styles and information seeking behavior in terms of gender and faculty was examined by Fisher`s test. Results: Learning styles had effect on information seeking behavior; also correlation coefficients between the learning styles and information seeking behavior had significant difference, but there was no difference in terms of faculty. Conclution: Recognition of learning styles and including it into designing of information systems may increase system`s interactivity that it may lead to have better and faster accessibility to information resources.
Fraher, Erin; Belsky, Daniel W; Gaul, Katie; Carpenter, Jessica
Projected nursing shortfalls have spurred the state of North Carolina to initiate a series of strategies to increase the number of graduates from pre-licensure Registered Nurse (RN) programs. These efforts have been largely successful, but attrition rates from Associate Degree Nursing (ADN) programs remain high. Only 58% of students entering ADN programs complete the degree. While policy makers are keenly aware that attrition from ADN programs is problematic, there is a lack of empirical evidence to identify the specific factors contributing to student attrition. In late 2007, the North Carolina Community College System (NCCCS) asked the Cecil G. Sheps Center for Health Services Research to conduct a study of Associate Degree Nursing program attrition and its causes. This paper summarizes the findings from that study and identifies the student- and program-level characteristics associated with more and less successful ADN programs. While this study was conducted in a single state in the US, the substantive findings--as well as the methodological approach--may be useful to other states and other countries. The study revealed that socioeconomically disadvantaged students (those with GEDs and those who received Pell Grants), non-white students, and younger and older students were less likely to graduate on-time. When programs were grouped into high and low performance categories on the basis of risk adjusted graduation rates, high performing programs were distinguished by more stringent admissions policies and better educated faculties. Nursing shortages have garnered significant attention and resources from state and national workforce planners in recent years. But to date, investments in expanding program capacity have not been matched by attention to program completion rates, with the result that we have enlarged the pipeline without fixing the leaks. Faculty shortages and recession-induced resource constraints limit further program expansion. Addressing attrition
Fetisov, V A; Gusarov, A A; Kuprina, T A
The objective of the present study was to analyze the results of research reported in the theses for the degree in "forensic medicine" defended in different dissertation committees during the 5 year period (from 2010 till 2014) and to summarize and compartmentalize the main research areas in which the authors carried out their study and thereby make the data obtained more readily available for the wide circles of readers. A total of 55 theses for the scientific degree in "forensic medicine" (14.03.05) were defended during the period from 2010 till 2014 including 18 (32.7%) ones for the degree in two disciplines, the second being either "pathological anatomy" (n=6) or "stomatology" (n=4). Despite the great variety of the problems resolved in the studies conducted during the five year period, the subject matter of most research was on the whole consistent with the main lines of activities of the institutions with which the degree-seeking workers were affiliated. The same refers to the choice of the tutors and scientific advisers. the authors emphasize the necessity of centralized planning of research in compliance with the list of priority investigations having practical significance and coordination of cooperative studies carried out based on the state bureau of forensic medical expertise (SBFME) and departments of forensic medical expertise of medical universities.
Full Text Available Hanneke E Zwikker,1,2 Sandra van Dulmen,3–5 Alfons A den Broeder,1,2 Bart J van den Bemt,1,2,6 Cornelia H van den Ende1,2 1Department of Rheumatology, 2Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands; 3Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands; 4NIVEL (Netherlands Institute for Health Services Research, Utrecht, the Netherlands; 5Department of Health Science, Buskerud and Vestfold University College, Drammen, Norway; 6Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands Background: This is the first cross-sectional study that aims to examine associations between beliefs about medication and non-adherence in patients with rheumatoid arthritis (RA using disease-modifying antirheumatic drugs, taking potential psychological confounders into account.Methods: Eligible patients (diagnosed with RA for ≥1 year or ≥18 years, using greater than or equal to one disease-modifying antirheumatic drug were included by their rheumatologist during regular outpatient visits between September 2009 and September 2010. Included patients received questionnaires. The Beliefs about Medicines Questionnaire was used to measure the perceived need to take medication (necessity beliefs, the concerns about taking medication (concern beliefs, general medication beliefs, and attitudes toward taking medication. Medication non-adherence (no/yes was measured using the Compliance Questionnaire Rheumatology (CQR. Associations between beliefs and non-adherence, and the influence of demographical, clinical, and psychological factors (symptoms of anxiety/depression, illness cognitions, self-efficacy were assessed using logistic regression.Results: A total of 580 of the 820 eligible patients willing to participate were included in the analyses (68% female, mean age 63 years, 30% non-adherent to their medication. Weaker necessity beliefs (OR [odds ratio]: 0.8, 95% CI
Jang, Sou Hyun
This study examined factors associated with first-generation Korean immigrants' medical tours to the homeland, which has emerged as a field of study in immigrant medical transnationalism and immigrant healthcare behaviors. This paper reports survey data from 507 Korean immigrants and indepth interviews with 120 Korean immigrants in the New York-New Jersey area. About one-fourth of survey respondents have visited their home country for medical care since their migration to the US. Of those with relatives in Korea, 29% have experienced at least one medical tour, compared to only 9.2% of those without relatives in Korea. Having frequent contacts with relatives in the home country was positively associated with the number of medical tour visits. Except for social transnational ties, other types of transnational ties with the home country were marginally related to Korean immigrants' medical tourism. Surprisingly, their health insurance status itself, which is assumed to be important, was not statistically associated with medical tourism. Although this study has the limitation of analyzing a convenience sample, it contributes to the literature on immigrant transnationalism and immigrant healthcare behaviors by using a mixed-methods approach to focus on one ethnic group's medical transnationalism.
Objective: To study headache associated disability in a group of medical students at the Kenyatta National Hospital. Study design: Cross sectional survey. Results: Between October 1994 and January 1995 we conducted a survey on headache characteristics on medical students at both the Kenya Medical Training Centre ...
Lee, Wincy Wing Sze
The present study examined the relationships among grit, academic performance, perceived academic failure, and stress levels of Hong Kong associate degree students using path analysis. Three hundred and forty-five students from a community college in Hong Kong voluntarily participated in the study. They completed a questionnaire that measured their grit (operationalized as interest and perseverance) and stress levels. The students also provided their actual academic performance and evaluated their perception of their academic performance as a success or a failure. The results of the path analysis showed that interest and perseverance were negatively associated with stress, and only perceived academic failure was positively associated with stress. These findings suggest that psychological appraisal and resources are more important antecedents of stress than objective negative events. Therefore, fostering students' psychological resilience may alleviate the stress experienced by associate degree students or college students in general. Copyright © 2017 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.
Rebar, Cherie R.
Registered Nurses (RNs), when educated in an Associate Degree (AD) program, learn in a face-to-face environment. Today's preferred standard of education for RNs is to achieve a minimum of a Bachelor's degree. For convenience while they continue working, numerous AD-prepared nurses seek online education to complete their Bachelor of Science in…
Nitschke, J E; Nattrass, C L; Disler, P B; Chou, M J; Ooi, K T
Repeated measures design for intra- and interrater reliability. To determine the intra- and interrater reliability of the lumbar spine range of motion measured with a dual inclinometer, and the thoracolumbar spine range of motion measured with a long-arm goniometer, as recommended in the American Medical Association Guides. The American Medical Association Guides (2nd and 4th editions) recommend using measurements of thoracolumbar and lumbar range of movement, respectively, to estimate the percentage of permanent impairment in patients with chronic low back pain. However, the reliability of this method of estimating impairment has not been determined. In all, 34 subjects participated in the study, 21 women with a mean age of 40.1 years (SD, +/- 11.1) and 13 men with a mean age of 47.7 years (SD, +/- 12.1). Measures of thoracolumbar flexion, extension, lateral flexion, and rotation were obtained with a long-arm goniometer. Lumbar flexion, extension, and lateral flexion were measured with a dual inclinometer. Measurements were taken by two examiners on one occasion and by one examiner on two occasions approximately 1 week apart. The results showed poor intra- and interrater reliability for all measurements taken with both instruments. Measurement error expressed in degrees showed that measurements taken by different raters exhibited systematic as well as random differences. As a result, subjects measured by two different examiners on the same day, with either instrument, could give impairment ratings ranging between 0% and 18% of the whole person (excluding rotation), in which percentage impairment is calculated using the average range of motion and the average systematic and random error in degrees for the group for each movement (flexion, extension, and lateral flexion). The poor reliability of the American Medical Association Guides' spinal range of motion model can result in marked variation in the percentage of whole-body impairment. These findings have
It has been pointed out that currently, Iwaki City faces an insufficiency of doctors working at hospitals, compared with before. Such an insufficiency became more remarkable after the 2011 Tohoku Earthquake and Fukushima Nuclear Disaster, as about 30,000 people relocated to Iwaki City from the evacuation areas. In this regard, the Iwaki Medical Association conducted a questionnaire survey to investigate the problems of medical cooperation and utilize the data to improve medical cooperation within hospitals and clinics. A total of 159 doctors answered the questionnaires: 64% were community physicians, 36% were doctors working at hospitals, and 42% were physicians. About 60% of the doctors were satisfied with the present medical cooperation. Home health care was performed by 25% of the doctors working at hospitals and 45% of the community physicians. Approximately 80% of the doctors felt the need for additional physicians to perform home health care, although more than half of the doctors answered that they do not perform it. Various problems exist in the context of medical cooperation, but many doctors still hope for its improvement, according to the answers in the questionnaires. Efforts have to be exerted further in order to enhance medical cooperation among the health care team. (author)
It has been pointed out that currently, Iwaki City faces an insufficiency of doctors working at hospitals, compared with before. Such an insufficiency became more remarkable after the 2011 Tohoku Earthquake and Fukushima Nuclear Disaster, as about 30,000 people relocated to Iwaki City from the evacuation areas. In this regard, the Iwaki Medical Association conducted a questionnaire survey to investigate the problems of medical cooperation and utilize the data to improve medical cooperation within hospitals and clinics. A total of 159 doctors answered the questionnaires: 64% were community physicians, 36% were doctors working at hospitals, and 42% were physicians. About 60% of the doctors were satisfied with the present medical cooperation. Home health care was performed by 25% of the doctors working at hospitals and 45% of the community physicians. Approximately 80% of the doctors felt the need for additional physicians to perform home health care, although more than half of the doctors answered that they do not perform it. Various problems exist in the context of medical cooperation, but many doctors still hope for its improvement, according to the answers in the questionnaires. Efforts have to be exerted further in order to enhance medical cooperation among the health care team.
Financial relationships among the biomedical industries, physicians, and professional medical associations (PMAs) can be professional, ethical, mutually beneficial, and, most importantly, can lead to improved medical care. However, such relationships, by their very nature, present conflicts of interest (COIs). One of the greatest concerns regarding COI is continuing medical education (CME), especially because currently industry funds 40-60% of CME. COIs have the potential to bias physicians in practice, educators, and those in leadership positions of PMAs and well as the staff of a PMA. These conflicts lead to the potential to bias the content and type of CME presentations and thereby influence physicians' practice patterns and patient care. Physicians are generally aware of the potential for bias when industry contributes funding for CME, but they are most often unable to detect the bias. This may because it is very subtle and/or the educators themselves may not realize that they have been influenced by their relationships with industry. Following Accreditation Council for Continuing Medical Education guidelines and mandating disclosure that is transparent and complete have become the fallback positions to manage COIs, but such disclosure does not really mitigate the conflict. The eventual and best solutions to ensure evidence-based education are complete divestment by educators and leaders of PMAs, minimal and highly controlled industry funding of PMAs, blind pooling of any industry contributions to PMAs and CME, strict verification of disclosures, clear separation of marketing from education at CME events, and strict oversight of presentations for the presence of bias. Wiley Periodicals, Inc.
Serletis, Anna; Rose, Sarah; Sheldon, Aaron G; Sheldon, Robert S
To determine the effect of family history on the likelihood of vasovagal syncope. Sixty-two medical students and 228 first-degree relatives were studied. Vasovagal syncope was ascertained with the Calgary syncope symptom score. The effects of the sex of the subject and parental syncope history on the likelihood of offspring fainting were described using Kaplan-Meier estimates and analysed using proportional hazards regression. The prevalence of vasovagal syncope was 32% and the median age of first faint in those who fainted was 14 years. More females than males fainted [42 vs. 31%; P=0.02; hazard ratio (HR) 1.34 (95% CI 1.07-1.68)]. An individual with two fainting parents was more likely to faint than one with no fainting parents [P<0.0001; HR 3.4 (95% CI 1.7-7.03)]. In the proportional hazards model, offspring of either sex whose mother faints are more likely to faint than those whose mother does not faint [HR 2.86 (95% CI 1.54-5.31)]. Having a father who faints significantly increases the risk of syncope in sons [HR 4.12 (95%CI 1.39-12.31)], but not in daughters [HR 1.18 (95% CI 0.56-3.34)]. Family history and sex of subject are important predictors of vasovagal syncope in offspring.
Seo, Ji-Hyun; Kim, Hye Jung; Kim, Bong-Jo; Lee, So-Jin; Bae, Hwa-Ok
This study aimed to examine whether educational stressors and relational stressors are associated with burnout in medical students and to test social support as a moderator between stressors and burnout. A total of 263 medical students attending Gyeongsang National University composed the study sample. A standardized questionnaire was used to investigate educational and relational stressors, three dimensions of burnout, and social support of medical students. The findings showed that overall burnout is very high among Korean medical students, with 9.9% totally burned out. Educational and relational stressors were significantly associated with the risk of burnout in medical students after controlling for socio-demographics and health behaviors. Social support moderated educational and relational stressors on personal accomplishment, but did not moderate stressors on emotional exhaustion and depersonalization. Burnout level is substantially high among Korean medical students. Educational and relational stressors are significantly associated with burnout risk in Korean medical students. Social support had moderated educational and relational stressors on personal accomplishment. The results suggest that more social support for medical students is needed to buffer stressors on and burnout.
Salehi, Alireza; Hashemi, Neda; Saber, Mahboobeh; Imanieh, Mohammad Hadi
Many studies have focused on the need of health systems to educated physicians in the clinical prevention, research methodology, epidemiology and health care management and emphasize the important role of this training in the public health promotion. On this basis, Shiraz University of Medical Sciences (SUMS) has established MD/MPH dual degree program since the year 2012. In the current study, Delphi technique was used. Both qualitative and quantitative methods were applied in the Delphi process. The Delphi team members including experts with extensive experience in teaching, research and administration in the field of educational management and health/medical education reached consensus in almost 86% of the questionnaire items through three Delphi rounds. MD/MPH program for SUMS was designed based on the items agreed and thematic analysis used in these rounds. The goals, values, mission and program requirements including the period, the entrance condition, and the number of units, and certification were determined. Accordingly, the courses of the program are presented in parallel with the MD education period. MPH courses consist of 35 units including 16 obligatory and 15 voluntary ones. Designing MD/MPH program in SUMS based on the existent models in the universities in different countries, compatible with educational program of this university and needs of national health system in Iran, can be a beneficial measure towards promoting the students' knowledge and theoretical/practical skills in both individual and social level. Performing some additional research to assess the MD/MPH program and some cohort studies to evaluate the effect of this program on the students' future professional life is recommended.
Included is a detailed outline of the content of each course required or offered as an elective in the associate degree program. With an 18 or 19 unit load each semester the program requires two years, and includes 64 hours at sea every semester. In addition to chemistry, physics, biology, and oceanography courses, there is a required course in…
Full Text Available Amol D Dhamane,1 Phil Schwab,2 Sari Hopson,2 Chad Moretz,2 Srinivas Annavarapu,2 Kate Burslem,1 Andrew Renda,3 Shuchita Kaila1 1Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT, 2Comprehensive Health Insights Inc, Louisville, 3Humana Inc, Louisville, KY, USA Background: Patients with COPD often have multiple comorbidities requiring use of multiple medications, and adherence rates for maintenance COPD (mCOPD medications are already known to be suboptimal. Presence of comorbidities in COPD patients, and use of medications used to treat those comorbidities (non-COPD medications, may have an adverse impact on adherence to mCOPD medications. Objective: The objective of the study was to evaluate the association between non-adherence to mCOPD medications and non-COPD medications in COPD patients. Methods: COPD patients were identified using a large administrative claims database. Selected patients were 40–89 years old and continuously enrolled for 12 months prior to and 24 months after the first identified COPD diagnosis (index date during January 1, 2009 to December 31, 2010. Patients were required to have ≥1 prescription for a mCOPD medication within 365 days of the index date and ≥1 prescription for one of 12 non-COPD medication classes within ±30 days of the first COPD prescription. Adherence (proportion of days covered [PDC] was measured during 365 days following the first COPD prescription. The association between non-adherence (PDC <0.8 to mCOPD and non-adherence to non-COPD medications was determined using logistic regression, controlling for baseline patient characteristics. Results: A total of 14,117 patients, with a mean age of 69.9 years, met study criteria. Of these, 40.9% were males and 79.2% were non-adherent to mCOPD medications with a mean PDC of 0.47. Non-adherence to mCOPD medications was associated with non-adherence to 10 of 12 non-COPD medication classes (odds ratio 1.38–1
Increasingly, physicians gravitating toward the fields of quality improvement and healthcare management are seeking MBA degrees to supplement their medical training. Approximately half of all U.S. medical schools offer combined MD-MBA degrees, and numerous executive MBA programs exist for physicians in practice. Physicians who enter management are considered change agents for healthcare improvement, yet they receive little support and encouragement from their medical teachers and practicing colleagues. This situation can be rectified by placing greater value on the role of business-trained physicians and subsidizing their tuition for business school.
Barsky, A J; Wyshak, G; Latham, K S; Klerman, G L
Forty-one Diagnostic and Statistical Manual of Mental Disorders-III-Revised hypochondriacs were accrued from a primary care practice. Seventy-five control subjects were selected at random from among the remainder of the patients in the same clinic. All subjects completed a structured diagnostic interview and standardized self-report questionnaires. Medical morbidity was assessed with a medical record audit and with primary physicians' ratings. The hypochondriacal and comparison samples did not differ in aggregate medical morbidity, although the hypochondriacal sample had more undiagnosed complaints and nonspecific findings in their medical records. Within the comparison sample, higher levels of medical morbidity were associated with higher levels of hypochondriacal symptoms. This occurred primarily because the most serious medical disorders were associated with more bodily preoccupation, disease conviction, and somatization. Within the hypochondriacal sample, no correlation was found between the degree of hypochondriasis and the extent of medical morbidity.
Singh, Amanpreet; Singla, Ekta; Soni, Sanjeev; Singla, Ashish
The prime objective of this work is to deal with the kinematics of spatial hybrid manipulators. In this direction, in 1955, Denavit and Hartenberg proposed a consistent and concise method, known as D-H parameters method, to deal with kinematics of open serial chains. From literature review, it is found that D-H parameter method is widely used to model manipulators consisting of lower pairs. However, the method leads to ambiguities when applied to closed-loop, tree-like and hybrid manipulators. Furthermore, in the dearth of any direct method to model closed-loop, tree-like and hybrid manipulators, revisions of this method have been proposed from time-to-time by different researchers. One such kind of revision using the concept of dummy frames has successfully been proposed and implemented by the authors on spatial hybrid manipulators. In that work, authors have addressed the orientational inconsistency of the D-H parameter method, restricted to body-attached frames only. In the current work, the condition of body-attached frames is relaxed and spatial frame attachment is considered to derive the kinematic model of a 7-degree of freedom spatial hybrid robotic arm, along with the development of closed-loop constraints. The validation of the new kinematic model has been performed with the help of a prototype of this 7-degree of freedom arm, which is being developed at Council of Scientific & Industrial Research-Central Scientific Instruments Organisation Chandigarh to aid the surgeon during a medical surgical task. Furthermore, the developed kinematic model is used to develop the first column of the Jacobian matrix, which helps in providing the estimate of the tip velocity of the 7-degree of freedom manipulator when the first joint velocity is known.
Papadakis, Maxine A; Hodgson, Carol S; Teherani, Arianne; Kohatsu, Neal D
To determine if medical students who demonstrate unprofessional behavior in medical school are more likely to have subsequent state board disciplinary action. A case-control study was conducted of all University of California, San Francisco, School of Medicine graduates disciplined by the Medical Board of California from 1990-2000 (68). Control graduates (196) were matched by medical school graduation year and specialty choice. Predictor variables were male gender, undergraduate grade point average, Medical College Admission Test scores, medical school grades, National Board of Medical Examiner Part 1 scores, and negative excerpts describing unprofessional behavior from course evaluation forms, dean's letter of recommendation for residencies, and administrative correspondence. Negative excerpts were scored for severity (Good/Trace versus Concern/Problem/Extreme). The outcome variable was state board disciplinary action. The alumni graduated between 1943 and 1989. Ninety-five percent of the disciplinary actions were for deficiencies in professionalism. The prevalence of Concern/Problem/Extreme excerpts in the cases was 38% and 19% in controls. Logistic regression analysis showed that disciplined physicians were more likely to have Concern/Problem/Extreme excerpts in their medical school file (odds ratio, 2.15; 95% confidence interval, 1.15-4.02; p =.02). The remaining variables were not associated with disciplinary action. Problematic behavior in medical school is associated with subsequent disciplinary action by a state medical board. Professionalism is an essential competency that must be demonstrated for a student to graduate from medical school.
Tanaka, Masaaki; Mizuno, Kei; Fukuda, Sanae; Tajima, Seiki; Watanabe, Yasuyoshi
Motivation is one of the most important psychological concepts in education and is related to academic outcomes in medical students. In this study, the relationships between personality traits and intrinsic academic motivation were examined in medical students. The study group consisted of 119 Year 2 medical students at Osaka City University Graduate School of Medicine. They completed questionnaires dealing with intrinsic academic motivation (the Intrinsic Motivation Scale toward Learning) and personality (the Temperament and Character Inventory [TCI]). On simple regression analyses, the TCI dimensions of persistence, self-directedness, co-operativeness and self-transcendence were positively associated with intrinsic academic motivation. On multiple regression analysis adjusted for age and gender, the TCI dimensions of persistence, self-directedness and self-transcendence were positively associated with intrinsic academic motivation. The temperament dimension of persistence and the character dimensions of self-directedness and self-transcendence are associated with intrinsic academic motivation in medical students.
Arokiasamy, J.; Ball, M.; Barnett, D.; Bearman, M.; Bemmel van, J.; Douglas, J.; Fisher, P.; Garrie, R.; Gatewood, L.; Goossen, W.; Grant, A.; Hales, J.; Hasman, A.; Haux, R.; Hovenga, E.; Johns, M.; Knaup, P.; Leven, F. J.; Lorenzi, N.; Murray, P.; Neame, R.; Protti, D.; Power, M.; Richard, J.; Schuster, E.; Swinkels, W.; Yang, J.; Zelmer, L.; Zvárová, Jana
Roč. 40, č. 5 (2001), s. 267-277 ISSN 0026-1270 Institutional research plan: AV0Z1030915 Keywords : health informatics * medical informatics * education * recommendations * International Medical Informatics Association * IMIA Subject RIV: BB - Applied Statistics, Operational Research Impact factor: 1.254, year: 2001
Chouhdari, Arezoo; Yavari, Parvin; Pourhoseingholi, Mohammad Amin; Sohrabi, Mohammad-Reza
Approximately 15% to 25% of colorectal cancer (CRC) cases have positive family history for disease. Colonoscopy screening test is the best way for prevention and early diagnosis. Studies have found that first degree relatives (FDRs) with low socioeconomic status are less likely to participate in colonoscopy screening program. The aim of this study is to determine the association between socioeconomic status and participation in colonoscopy screening program in FDRs. This descriptive cross-sectional, study has been conducted on 200 FDRs who were consulted for undergoing colonoscopy screening program between 2007 and 2013 in research institute for gastroenterology and liver disease of Shahid Beheshti University of Medical Sciences, Tehran, Iran. They were interviewed via phone by a valid questionnaire about socioeconomic status. For data analysis, chi-square, exact fisher and multiple logistic regression were executed by SPSS 19. The results indicated 58.5% participants underwent colonoscopy screening test at least once to the time of the interview. There was not an association between participation in colonoscopy screening program and socioeconomic status to the time of the interview in binomial analysis. But statistical significance between intention to participate and educational and income level were found. We found, in logistic regression analysis, that high educational level (Diploma and University degree in this survey) was a predictor to participate in colonoscopy screening program in FDRs. According to this survey low socioeconomic status is an important factor to hinder participation of FDRs in colonoscopy screening program. Therefore, planned interventions for elevation knowledge and attitude in FDRs with low educational level are necessary. Also, reducing colonoscopy test costs should be a major priority for policy makers.
In 2015, National Medical Association of China, now being called the Chinese Medical Association, celebrates its centennial and Boji Hospital in Guangzhou ( also known as Canton Hospital, or the Canton Pok Tsai Hospital, and now Sun Yat-sen Memorial Hospital of Sun Yat-sen University ) marks its 180th anniversary. Three major historical events establish the role of Boji Hospital in the founding and development of the National Medical Association of China during the last 100 years, viz.: ①hosting and participating in the establishment of the Medical Missionary Association of China and its official journal: the China Medical Missionary Journal; ②holding the 11th scientific sessions of the National Medical Association of China; ③nominating Dr. Wu Lien-teh as a candidate for the Nobel Prize in Physiology or Medicine in 1935 by William Warder Cadbury, the president of Boji Hospital.
Selwitz, Jason Lawrence
Research was undertaken to develop and evaluate an associate degree-level technical education program in Plant Operations oriented towards training students in applied science, technology, engineering, and mathematics (STEM) skills and knowledge relevant to a spectrum of processing industries. This work focuses on four aspects of the curriculum…
Vansteenkiste, Maarten; Soenens, Bart; Van Petegem, Stijn; Duriez, Bart
This study examined associations between perceived degree and style of parental prohibition and adolescents' internalization of and oppositional defiance against parental rules in the friendship and moral domain. Relations were investigated in 2 longitudinal adolescent samples (total N = 532). Results indicated that perceived style but not degree of prohibition related to overtime changes in internalization and oppositional defiance. Specifically, in line with self-determination theory, autonomy-supportive and controlling styles of prohibiting were found to relate differentially to quality of internalization and oppositional defiance. Cross-lagged analyses indicated that several of these associations were reciprocal. The discussion focuses on the critical role of perceived parental style for communicating prohibitions. PsycINFO Database Record (c) 2014 APA, all rights reserved.
Selwitz, Jason Lawrence
Research was undertaken to develop and evaluate an associate degree-level technical education program in Plant Operations oriented towards training students in applied science, technology, engineering, and mathematics (STEM) skills and knowledge relevant to a spectrum of processing industries. This work focuses on four aspects of the curriculum and course development and evaluation research. First, the context of, and impetus for, what was formerly called vocational education, now referred to as technical or workforce education, is provided. Second, the research that was undertaken to design and evaluate an associate degree-level STEM workforce education program is described. Third, the adaptation of a student self-assessment of learning gains instrument is reviewed, and an analysis of the resulting data using an adapted logic model is provided, to evaluate the extent to which instructional approaches, in two process control/improvement-focused courses, were effective in meeting course-level intended learning outcomes. Finally, eight integrative multiscale exercises were designed from two example process systems, wastewater treatment and fast pyrolysis. The integrative exercises are intended for use as tools to accelerate the formation of an operator-technician's multiscale vision of systems, unit operations, underlying processes, and fundamental reactions relevant to multiple industries. Community and technical colleges serve a vital function in STEM education by training workers for medium- and high-skilled technical careers and providing employers the labor necessary to operate and maintain thriving business ventures. Through development of the curricular, course, and assessment-related instruments and tools, this research helps ensure associate degree-level technical education programs can engage in a continual process of program evaluation and improvement.
Majumdar Sumit R
Full Text Available Abstract Background Diabetes is a chronic medical condition accompanied by a considerable health-related quality of life (HRQL burden. The purpose of this analysis was to use generic measures of HRQL to describe HRQL deficits associated with varying degrees of severity of type 2 diabetes. Methods The RAND-12 physical and mental health composites (PHC and MHC, respectively and Health Utilities Index Mark 3 (HUI3 were self-completed by 372 subjects enrolled in a prospective, controlled study of an intervention to improve care for individuals with type 2 diabetes in rural communities. Analysis of covariance was used to assess differences in HRQL according to disease severity and control of blood glucose. Disease severity was defined in terms of treatment intensity, emergency room visits and absenteeism from work specifically attributable to diabetes. To control for potential confounding, the analysis was adjusted for important sociodemographic and clinical characteristics. Results The PHC and MHC were significantly lower for individuals treated with insulin as compared to diet alone (PHC: 41.01 vs 45.11, MHC: 43.23 vs 47.00, p Conclusions We concluded that generic measures of HRQL captured deficits associated with more severe disease in type 2 diabetes.
Möller, Riitta; Shoshan, Maria; Ponzer, Sari
In Sweden degree projects have a central role in evaluation of higher education, wherefore significant resources are spent on developing students' research competence. The undergraduate medical program at Karolinska Institutet introduced its degree project course in 2010. This paper gives an overview of the course and summarizes experiences from the first seven terms. In order to finalize their projects within one term, most students need substantial support. A highly structured course and frequent progress monitoring are advantageous. Other crucial factors are the quality of the supervision and students' verbal skills as well as support in scientific writing. In addition, increased awareness of the learning outcomes already at the beginning of the course may help students to achieve the expected results. Finally, students need to recognize their own responsibility for learning.
Spormann R, Camila; Pérez V, Cristhian; Fasce H, Eduardo; Ortega B, Javiera; Bastías V, Nancy; Bustamante D, Carolina; Ibáñez G, Pilar
Self-directed learning is a skill that must be taught and evaluated in future physicians. To analyze the association between self-directed learning, self-esteem, self-efficacy, time management and academic commitment among medical students. The self-directed learning, Rosemberg self-esteem, general self- efficacy, time management and Utrecht work engagement scales were applied to 297 first year medical students. A multiple regression analysis showed a significant association between self-efficacy, time management and academic commitment with self-directed learning. Self-esteem and satisfaction with studies did not enter in the model. self-esteem, academic commitment and a good time management were associated with self-directed learning in these students.
De Leon, John E.
A study examined the perceptions of four key constituent groups from the Southeast College Associate Degree Nursing (ADN) program regarding institutional goal priorities. (Southeast College manages the ADN program for the Houston Community College System.) The study involved 23 ADN faculty, 13 college administrators, 128 ADN students, and 5 ADN…
Salehi, A; Harris, N; Lotfi, F; Hashemi, N; Kojouri, J; Amini, M
Despite the strengths in the Iranian medical and health sciences educational system, areas in need of improvement have been noted. The purpose of this study was to understand the views of faculty members at Shiraz University of Medical Sciences about current and future needs for medical and health sciences education, with the goal of improving the quality of the educational system. The data were collected using a Delphi consensus method. Analysis of the findings identified the following key themes among the factors likely to contribute to medical and health sciences education and training: adding and/or increasing student numbers in higher degrees in preference to associate degrees; providing more interactive, student-centred teaching methods; improving the educational content with more practical and research-based courses tailored to society's needs; and an emphasis on outcome-based student evaluation techniques. These changes aim to respond to health trends in society and enhance the close relationship between medical education and the needs of the Iranian society.
Katon, Wayne; Lin, Elizabeth H B; Kroenke, Kurt
Primary care patients with anxiety and depression often describe multiple physical symptoms, but no systematic review has studied the effect of anxiety and depressive comorbidity in patients with chronic medical illnesses. MEDLINE databases were searched from 1966 through 2006 using the combined search terms diabetes, coronary artery disease (CAD), congestive heart failure (CHF), asthma, COPD, osteoarthritis (OA), rheumatoid arthritis (RA), with depression, anxiety and symptoms. Cross-sectional and longitudinal studies with >100 patients were included as were all randomized controlled trials that measure the impact of improving anxiety and depressive symptoms on medical symptom outcomes. Thirty-one studies involving 16,922 patients met our inclusion criteria. Patients with chronic medical illness and comorbid depression or anxiety compared to those with chronic medical illness alone reported significantly higher numbers of medical symptoms when controlling for severity of medical disorder. Across the four categories of common medical disorders examined (diabetes, pulmonary disease, heart disease, arthritis), somatic symptoms were at least as strongly associated with depression and anxiety as were objective physiologic measures. Two treatment studies also showed that improvement in depression outcome was associated with decreased somatic symptoms without improvement in physiologic measures. Accurate diagnosis of comorbid depressive and anxiety disorders in patients with chronic medical illness is essential in understanding the cause and in optimizing the management of somatic symptom burden.
Gillette, Chris; Blalock, Susan J; Rao, Jaya K; Williams, Dennis; Loughlin, Ceila E; Sleath, Betsy
The objectives of this study were to: (1) describe the extent to which general pediatric providers discuss risks associated with asthma control medications with families, and (2) examine factors that are associated with risk discussions. This study was a cross-sectional secondary analysis of audio taped medical visits involving 35 pediatric providers and 248 children with asthma with their caregivers. Transcripts of the visits were coded for discussions about asthma medication risks. Generalized estimating equations were used to analyze the data. Providers discussed asthma control medication risks during 23% of visits. Risks were more likely to be discussed when the visit was longer and when the provider prescribed a new asthma control medication. When providers discussed asthma control medication risks, they were most likely to ask the family general questions and make general statements. Across all of the visits, caregivers asked a total of 16 questions and made a total of 20 statements about risks associated with asthma medications; children asked a total of 3 questions and made two statements about risks associated with asthma control medications. Providers discussed risks associated with asthma control medications in less than one-quarter of medical visits. Providers should involve families in discussions about risks associated with medications during every visit to assess potential barriers to medication adherence. © 2013 Wiley Periodicals, Inc.
Schofferman, Jerome A; Eskay-Auerbach, Marjorie L; Sawyer, Laura S; Herring, Stanley A; Arnold, Paul M; Muehlbauer, Eric J
Recently the financial relationships between industry and professional medical associations have come under increased scrutiny because of the concern that industry ties may create real or perceived conflicts of interest. Professional medical associations pursue public advocacy as well as promote medical education, develop clinical practice guidelines, fund research, and regulate professional conduct. Therefore, the conflicts of interest of a professional medical association and its leadership can have more far-reaching effects on patient care than those of an individual physician. Few if any professional medical associations have reported their experience with implementing strict divestment and disclosure policies, and among the policies that have been issued, there is little uniformity. We describe the experience of the North American Spine Society (NASS) in implementing comprehensive conflicts of interest policies. A special feature article. We discuss financial conflicts of interest as they apply to professional medical associations rather than to individual physicians. We describe the current policies of disclosure and divestment adopted by the NASS and how these policies have evolved, been refined, and have had no detrimental impact on membership, attendance at annual meetings, finances, or leadership recruitment. No funding was received for this work. The authors report no potential conflict-of-interest-associated biases in the text. The NASS has shown that a professional medical association can manage its financial relationships with industry in a manner that minimizes influence and bias. The NASS experience can provide a template for other professional medical associations to help manage their own possible conflicts of interest issues. Copyright © 2013 Elsevier Inc. All rights reserved.
Keith, L; Hollar, D
This study assessed the impact of a pre-medical pipeline program on successful completion of medical school and the capacity of this program to address achievement gaps experienced by disadvantaged students. The University of North Carolina (USA) Medical Education Development (MED) program provides intensive academic and test skills preparation for admission to medical, dental, and other allied health professions schools. This retrospective study evaluated the academic progress of a longitudinal sample of 1738 disadvantaged college students who completed MED between 1974 and 2001. Data sources included MED participant data, medical school admissions data for the host school, aggregate data from the Association of American Medical Colleges (AAMC), and individual MED participant data from AAMC. Methods of analysis utilized Chi-square, independent samples t test, and logistic regression to examine associations between factors. Of the 935 students in MED from 1974 to 2001, who had indicated an interest in medical school, 887 (94.9%) successfully matriculated and 801 (85.7%) successfully earned the MD degree. Using logistic regression, factors that were significantly correlated with earning the medical degree included the student's race, college undergraduate total and science grade point averages, with Hispanic, African American, and Native American participants earning the medical degree at rates comparable to Caucasian participants. MED students successfully earned the MD degree despite having significantly lower Medical College Admissions Test (MCAT) scores and undergraduate grade point averages compared to all United States medical school applicants: MCAT scores had little relationship with student's success. These findings suggest that an intensive, nine-week, pre-medical academic enrichment program that incorporates confidence-building and small-group tutoring and peer support activities can build a foundation on which disadvantaged students can successfully earn
In 1970 the medical associations of South Africa and Rhodesia (now, Zimbabwe) were expelled from the Commonwealth Medical Association. The latter had been set up, as the British Medical Commonwealth Medical Conference, in the late 1940s by the British Medical Association (BMA). These expulsions, and the events leading up to them, are the central focus of this article. The BMA's original intention was to establish an organisation bringing together the medical associations of the constituent parts of the expanding Commonwealth. Among the new body's preoccupations was the relationship between the medical profession and the state in the associations' respective countries. It thus has to be seen as primarily a medico-political organisation rather than one concerned with medicine per se. Although, there were also tensions from the outset regarding the membership of the Southern African medical associations. Such stresses notwithstanding, these two organisations remained in the BMA-sponsored body even after South Africa and Rhodesia had left the Commonwealth. This was not, however, a situation which could outlast the growing number of African associations which joined in the wake of decolonisation; and hardening attitudes towards apartheid. The article therefore considers: why the BMA set up this Commonwealth body in the first place and what it hoped to achieve; the history of the problems associated with South African and Rhodesian membership; and how their associations came to be expelled.
Al-Naggar, Redhwan A; Bobryshev, Yuri V
The aim of the study was to determine the prevalence of shisha smoking and associated factors among medical students in Malaysia. A cross-sectional study was conducted at the Management and Science University from December 2011 until March 2012. The questionnaire consisted of five sections including socio-demographic, social environment, knowledge about shisha, psychosocial factors, and personal shisha smoking behavior. Obtained data were analyzed using Statistical Package for the Social Sciences (SPSS 13). T-test was used to determine the relationships between shisha smoking and socio-demographic characteristic. A total number of 300 medical students participated in this study. Mean age was 22.5±2.5 years. The majority were female, Malay, single, from urban areas (67%, 54%, 97%, 73%; respectively). The prevalence of shisha smoking among medical students was found to be 20%. The study revealed that many students believed that shisha does not contains nicotine, carbon monoxide, does not lead to lung cancer, dental problems and does not lead to cardiovascular diseases (25%, 20.7%, 22.3%, 29%, 26.7%; respectively). Age and sex were found to be significantly associated with smoking shisha status among medical students (p=0.029, pparents, siblings and friends smokers of shisha were found to be significantly associated with shisha smoking status (pproblems, problems with friends, financial problems and university life were found to significantly associated with shisha smoking status among medical students (pstudents. More attention is needed to focus on medical education in this regard. The policies that are currently employed in order to reduce the cigarettes smoking should be applied to shisha smoking and shisha products.
Full Text Available While self-medication is common, inappropriate self-medication has potential risks. This study assesses inappropriate self-medication among adolescents and examines the relationships among medication literacy, substance use, and inappropriate self-medication.In 2016, a national representative sample of 6,226 students from 99 primary, middle, and high schools completed an online self-administered questionnaire. Multiple logistic regression analysis was used to examine factors related to inappropriate self-medication.The prevalence of self-medication in the past year among the adolescents surveyed was 45.8%, and the most frequently reported drugs for self-medication included nonsteroidal anti-inflammatory drugs or pain relievers (prevalence = 31.1%, cold or cough medicines (prevalence = 21.6%, analgesics (prevalence = 19.3%, and antacids (prevalence = 17.3%. Of the participants who practiced self-medication, the prevalence of inappropriate self-medication behaviors included not reading drug labels or instructions (10.1%, using excessive dosages (21.6%, and using prescription and nonprescription medicine simultaneously without advice from a health provider (polypharmacy (30.3%. The results of multiple logistic regression analysis showed that after controlling for school level, gender, and chronic diseases, the participants with lower medication knowledge, lower self-efficacy, lower medication literacy, and who consumed tobacco or alcohol were more likely to engage in inappropriate self-medication.Lower medication literacy and substance use were associated with inappropriate self-medication among adolescents.
Miner, Patricia Johnson; Alexander, Jeffrey; Ewing, Helen; Gerace, Laina
The purpose of this study was to determine the association between adherence to prescribed antiepileptic medication in a convenience sample of caregivers (n = 100) of children diagnosed with epilepsy, ages 2-14 years, and caregivers' beliefs about the medication. Using the Beliefs about Medication Questionnaire and Medication Adherence Report Scale, caregivers were questioned about beliefs of necessity and concerns associated with medication adherence. Using bivariate linear regression, no significant correlation was found between necessity for antiepileptic drug treatment or caregiver's concerns and medication adherence. Nevertheless, although only 28% of the respondents reported complete adherence, the majority of caregivers perceived their child's medication was necessary to maintain good health. Educational aspects and social desirability in this setting may have contributed to the discordance between adherence and caregivers' beliefs.
Voigt, Herbert F
The future challenges to medical and biological engineering, sometimes referred to as biomedical engineering or simply bioengineering, are many. Some of these are identifiable now and others will emerge from time to time as new technologies are introduced and harnessed. There is a fundamental issue regarding "Branding the bio/biomedical engineering degree" that requires a common understanding of what is meant by a B.S. degree in Biomedical Engineering, Bioengineering, or Biological Engineering. In this paper we address some of the issues involved in branding the Bio/Biomedical Engineering degree, with the aim of clarifying the Bio/Biomedical Engineering brand.
Jankovic, Joseph; Stacy, Mark
monitoring for hepatotoxicity. Amantadine is a noncompetitive NMDA receptor antagonist shown to lower dyskinesia scores and improve motor complications in patients with Parkinson's disease when given adjunctively with levodopa. Dopamine agonists, also used as initial and adjunctive therapy in Parkinson's disease, improve motor response and decrease 'off' time purportedly through direct stimulation of dopamine receptors. Current dopamine agonists include bromocriptine, pergolide, cabergoline, lisuride, apomorphine, pramipexole, ropinirole and rotigotine. Although effective, this class of medications can be associated with cardiovascular and psychiatric adverse effects that can limit their utility. All medications used to manage levodopa-associated motor complications in patients with Parkinson's disease have had differing degrees of success. Although head-to-head comparisons of drugs within classes are rare, some differences have emerged related to effects on motor fluctuations, dyskinesias and on/off times, as well as to adverse effects. When choosing a drug to treat levodopa-induced complications, it is important to consider the risks and benefits of the different classes and of the specific agents within each class, given the different efficacy and safety profiles of each.
Connor, Jennifer J
Centralized exchanges of scientific materials existed by the late nineteenth century, but they did not include medical publications. North American medical leaders therefore formed an association of institutions to run their own exchange: the Medical Library Association (MLA). After providing background to the exchange concept and the importance of institutional members for MLA, this article examines archival MLA correspondence to consider the role of its Exchange in the association's professional development before the 1950s. MLA's membership policy admitted only libraries open to the medical profession with a large number of volumes. But the correspondence of the MLA Executive Committee reveals that the committee constantly adjusted the definition of library membership: personal, public, sectarian, commercial, allied science, and the then-termed "colored" medical school libraries all were denied membership. Study of these decisions, using commercial and sectarian libraries as a focus, uncovers the primary justification for membership exclusions: a goal of operating a scientific exchange. Also, it shows that in this way, MLA shadowed policies and actions of the American Medical Association. Finally, the study suggests that the medical profession enforced its policies of exclusion through MLA, despite a proclaimed altruistic sharing of medical literature.
Montalvo-Javé, Eduardo Esteban; Mendoza-Barrera, Germán Eduardo; Valderrama-Treviño, Alan Isaac; Alcántara-Medina, Stefany; Macías-Huerta, Nain Abraham; Tapia-Jurado, Jesús
The Doctor of Philosophy is the highest academic degree that can be obtained in universities. Graduate Education Program in Medicine in Mexico is divided into 2 major categories: Medical Specialty and Master studies/Doctor of Philosophy. The objective of this study was to demonstrate the importance of master's degrees and Doctor of Philosophy in general surgery. A literature search in PubMed and Medline among others, from 1970 to 2015 with subsequent analysis of the literature reviews found. The physicians who conducted doctoral studies stand out as leaders in research, teaching and academic activities. Dual training with a doctorate medical specialty is a significant predictor for active participation in research projects within the best educational institutions. It is important to study a PhD in the education of doctors specialising in surgery, who show more training in teaching, research and development of academic activities. Currently, although there is a little proportion of students who do not finish the doctoral program, the ones who do are expected to play an important role in the future of medical scientific staff. It has been shown that most doctors with Doctor of Philosophy have wide range of career options. The importance of doctoral studies in the formation of general surgery is due to various reasons; the main one being comprehensively training physician scientists who can develop in clinical, teaching and research. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.
The purpose of this non-experimental cross-sectional quantitative study was to examine the relationship between mental health and academic performance among associate degree nursing (ADN) students at a Midwest technical college by identifying incidence of positive mental health, mental illness symptoms/distress, and mental illness; the…
O'Neill, Lotte Dyhrberg; Wallstedt, Birgitta; Eika, Berit; Hartvigsen, Jan
Medical school dropout may have negative consequences for society, patients, the profession, schools and dropouts. To our knowledge, the literature dealing with dropout from medical school has never been systematically and critically appraised. This review aimed to systematically and critically review studies dealing with factors found to be associated with dropping out of medical school. A systematic critical literature review of the international peer-reviewed research literature on medical education was performed. A primary search was conducted and subsequently supplemented with ancestry and descendancy searches. The population of interest was medical students and the outcome was dropout. Abstract/title screening and quality assessment were performed by two independent researchers. Studies were assessed on six domains of quality: study participation; study attrition; predictor measurement; measurement of and accounting for confounders; outcome measurement, and analysis. Only studies that accounted for confounding were included in the final analysis. Of 625 studies found, 48 were quality-assessed and 13 of these were eventually included based on their fulfilment of our quality-related criteria. A range of entry qualifications seemed to be associated with greater chances of a student dropping out (odds ratio [OR] = 1.65-4.00). Struggling academically in medical school may be strongly associated with dropout. By contrast, no specific pattern of demographic variables was particularly important in relation to dropout. The effects of socio-economic, psychological and educational variables on dropout were not well investigated. More research into causal models and theory testing, which considers the effects of education, organisation and institution, is necessary if we are to learn more about how we can actively prevent medical student withdrawal. © Blackwell Publishing Ltd 2011.
Yeh, James S; Austad, Kirsten E; Franklin, Jessica M; Chimonas, Susan; Campbell, Eric G; Avorn, Jerry; Kesselheim, Aaron S
Professional societies use metrics to evaluate medical schools' policies regarding interactions of students and faculty with the pharmaceutical and medical device industries. We compared these metrics and determined which US medical schools' industry interaction policies were associated with student behaviors. Using survey responses from a national sample of 1,610 US medical students, we compared their reported industry interactions with their schools' American Medical Student Association (AMSA) PharmFree Scorecard and average Institute on Medicine as a Profession (IMAP) Conflicts of Interest Policy Database score. We used hierarchical logistic regression models to determine the association between policies and students' gift acceptance, interactions with marketing representatives, and perceived adequacy of faculty-industry separation. We adjusted for year in training, medical school size, and level of US National Institutes of Health (NIH) funding. We used LASSO regression models to identify specific policies associated with the outcomes. We found that IMAP and AMSA scores had similar median values (1.75 [interquartile range 1.50-2.00] versus 1.77 [1.50-2.18], adjusted to compare scores on the same scale). Scores on AMSA and IMAP shared policy dimensions were not closely correlated (gift policies, r = 0.28, 95% CI 0.11-0.44; marketing representative access policies, r = 0.51, 95% CI 0.36-0.63). Students from schools with the most stringent industry interaction policies were less likely to report receiving gifts (AMSA score, odds ratio [OR]: 0.37, 95% CI 0.19-0.72; IMAP score, OR 0.45, 95% CI 0.19-1.04) and less likely to interact with marketing representatives (AMSA score, OR 0.33, 95% CI 0.15-0.69; IMAP score, OR 0.37, 95% CI 0.14-0.95) than students from schools with the lowest ranked policy scores. The association became nonsignificant when fully adjusted for NIH funding level, whereas adjusting for year of education, size of school, and publicly versus
James S Yeh
Full Text Available Professional societies use metrics to evaluate medical schools' policies regarding interactions of students and faculty with the pharmaceutical and medical device industries. We compared these metrics and determined which US medical schools' industry interaction policies were associated with student behaviors.Using survey responses from a national sample of 1,610 US medical students, we compared their reported industry interactions with their schools' American Medical Student Association (AMSA PharmFree Scorecard and average Institute on Medicine as a Profession (IMAP Conflicts of Interest Policy Database score. We used hierarchical logistic regression models to determine the association between policies and students' gift acceptance, interactions with marketing representatives, and perceived adequacy of faculty-industry separation. We adjusted for year in training, medical school size, and level of US National Institutes of Health (NIH funding. We used LASSO regression models to identify specific policies associated with the outcomes. We found that IMAP and AMSA scores had similar median values (1.75 [interquartile range 1.50-2.00] versus 1.77 [1.50-2.18], adjusted to compare scores on the same scale. Scores on AMSA and IMAP shared policy dimensions were not closely correlated (gift policies, r = 0.28, 95% CI 0.11-0.44; marketing representative access policies, r = 0.51, 95% CI 0.36-0.63. Students from schools with the most stringent industry interaction policies were less likely to report receiving gifts (AMSA score, odds ratio [OR]: 0.37, 95% CI 0.19-0.72; IMAP score, OR 0.45, 95% CI 0.19-1.04 and less likely to interact with marketing representatives (AMSA score, OR 0.33, 95% CI 0.15-0.69; IMAP score, OR 0.37, 95% CI 0.14-0.95 than students from schools with the lowest ranked policy scores. The association became nonsignificant when fully adjusted for NIH funding level, whereas adjusting for year of education, size of school, and publicly
Zeger, Scott L.; Kolars, Joseph C.
BACKGROUND Knowledge acquisition is a goal of residency and is measurable by in-training exams. Little is known about factors associated with medical knowledge acquisition. OBJECTIVE To examine associations of learning habits on medical knowledge acquisition. DESIGN, PARTICIPANTS Cohort study of all 195 residents who took the Internal Medicine In-Training Examination (IM-ITE) 421 times over 4 years while enrolled in the Internal Medicine Residency, Mayo Clinic, Rochester, MN. MEASUREMENTS Score (percent questions correct) on the IM-ITE adjusted for variables known or hypothesized to be associated with score using a random effects model. RESULTS When adjusting for demographic, training, and prior achievement variables, yearly advancement within residency was associated with an IM-ITE score increase of 5.1% per year (95%CI 4.1%, 6.2%; p international medical school graduation, −3.4% (95%CI −6.5%, −0.36%; p = .03). CONCLUSIONS Conference attendance and self-directed reading of an electronic knowledge resource had statistically and educationally significant independent associations with knowledge acquisition that were comparable to the benefit of a year in residency training. PMID:17468889
Wang, Z W; Cai, H X
The library of Chinese Medical Association was founded in 1925. The source of books and periodicals in the library are mainly from purchasing and donation. The library provides services such as lending, exchanging books, translating and publishing the contents and abstracts of medical journals in Chinese and other languages. It has played an active and important role in promoting medical development in the period of Republic of China.
Cook, Alyssa F; Arora, Vineet M; Rasinski, Kenneth A; Curlin, Farr A; Yoon, John D
Medical student mistreatment has been recognized for decades and is known to adversely impact students personally and professionally. Similarly, burnout has been shown to negatively impact students. This study assesses the prevalence of student mistreatment across multiple medical schools and characterizes the association between mistreatment and burnout. In 2011, the authors surveyed a nation ally representative sample of third-year medical students. Students reported the frequency of experiencing mistreatment by attending faculty and residents since the beginning of their clinical rotations. Burnout was measured using a validated two-item version of the Maslach Burnout Inventory. Of 960 potential respondents from 24 different medical schools, 605 (63%) completed the survey, but 41 were excluded because they were not currently in their third year of medical school. Of the eligible students, the majority reported experiencing at least one incident of mistreatment by faculty (64% [361/562]) and by residents (76% [426/562]). A minority of students reported experiencing recurrent mistreatment, defined as occurring "several" or "numerous" times: 10% [59/562] by faculty and 13% [71/562] by residents. Recurrent mistreatment (compared with no or infrequent mistreatment) was associated with high burnout: 57% versus 33% (P student mistreatment remains prevalent. Recurrent mistreatment by faculty and residents is associated with medical student burnout. Although further investigation is needed to assess causality, these data provide impetus for medical schools to address student mistreatment to mitigate its adverse consequences.
Full Text Available Introduction: Self-medication is an important aspect of self-care. It is a common practice in society and medical students are no exception. The aim of this study was to explore the knowledge and practice of self-medication among students of a medical school in Western Nepal. Methods: A cross sectional study was conducted among basic science and clinical students after obtaining prior consent from those willing to participate. Respondents’ degree of agreement with a set of 25 statements was noted using Likert scale to assess their knowledge. The practice of self-medication was studied by asking about the use of selected groups of medicines during the past one-year period and noting the pattern of use. Results: Three hundred and thirty of the 356 students (92.6% participated in the study. Mean knowledge score was 93.2 (SD = 8.1. Self-medication was practiced by 83.3% (n = 275 of respondents. Knowledge about self-medication differed among respondents according to gender (p = 0.03 and nationality (p = 0.04 but not other variables. Practice of self-medication was associated with father’s profession (p = 0.03 and nationality of the respondents (p = 0.04. Conclusions: Students’ knowledge about self-medication was good and they commonly practiced self-medication. Pain-killers were the most commonly used drug.
Iqbal, A.; Intikhab, K.; Saeed, K.
Objective: To find out major non-medial factors associated with psychological disorders in cancer patients. Design: An observational study conducted on adult cancer patients. Place and Duration of Study: The study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center Lahore Pakistan from January 1999. Patients and Methods: Two hundred and twenty-four newly-diagnosed adult cancer patients were interviewed by the clinical psychologist and data was collected regarding non-medical causal factors, patients age, gender family support system, general home atmosphere and marital status. Collected data was analyzed by utilizing. SPSS for windows version 10.0. Results: Of the 224 patients 142 (63.4%) reported non-medical factors causing psychological distress and 82 (36.6%) reported that medical sources are the most distressing. Ten most common non-medical sources of developing psychological disorders were identified. It was observed that family support system and general home atmosphere were significantly associated with the development of psychological disorders whereas the other variables such as age, gender and marital status had no significant relationship with the non Medical factors. Conclusion: It was concluded that non-medical factors causing psychological problems are significant in cancer patients. The results suggest that we should identify these factors and target psychosocial intervention for those patients most at risk. (author)
Rubio, Joaquín Salmerón; García-Delgado, Pilar; Ferreira, Paula Iglésias; Santos, Henrique Mateus; Martínez-Martínez, Fernando
The scope of this study was the validation of a cross-culturally adapted questionnaire into Portuguese in five community pharmacies in Portugal. The discriminatory power of items, content and construct validity and factor analysis of the main components and their reliability and stability were determined. A high degree of semantic equivalence between the original questionnaire and the cross-culturally adapted questionnaire into Portuguese was observed. A Kaiser-Meyer-Olkin index of 0.550 was obtained and the Bartlett sphericity test confirmed the adequacy of the data for the application of factor analysis (p <0.0001). Three factors which accounted for 52.6% of the total variability were considered. With respect to reliability the following results were obtained: 0.519 for Cronbach's alpha test; 0.89 for Cohen's kappa coefficient; and 0.756 (IC=0.598-0.963) for the CCI exam. In this work, the first adaptation for the Portuguese culture of a specific questionnaire was produced to measure the degree of knowledge patients have about their medication.
Ben Loubir, Dalal; Serhier, Zeineb; Diouny, Samir; Battas, Omar; Agoub, Mohamed; Othmani, Mohammed Bennani
Introduction Recently, an important literature data has reported that medical students experience stress more than students in other disciplines. In contrast, there is a significant shortage of the stress impact on the academic performance. The primary purpose of our study was to determine the prevalence of stress among Casablanca Medical students and to investigate if there is an association between stress and academic skills. Methods A total of 275 participants studying at Casablanca Medical School were included. The study was conducted using a self-administered, anonymous questionnaire, which included four subscales on academic skills perception (Academic competence, Test competence, Time management and Strategic study habits) and a Test Anxiety scale to assess the degree of stress related to exams among medical students. Results The overall findings showed that 52.7% of respondents were stressed by examinations, and the highest stress prevalence was among the fifth-year medical students. Measures of comparative stress degrees between male and female students did not show any statistical significant differences (p=0.34). Correlation analysis revealed negative association between stress and academic competence (-0.394), test competence (-0.426), time management (-0.240), strategic study (-0.183) respectively (peducators and psychologists have to increase clinical awareness of stress among medical students, by establishing strategies for stress management. PMID:25767668
Song, Yang; Shi, Meng
Empathy promotes positive physician-patient communication and is associated with improved patient satisfaction, treatment adherence and clinical outcomes. It has been suggested that personality traits should be taken into consideration in programs designed to enhance empathy in medical education due to the association found between personality and empathy among medical students. However, the associations between empathy and big five personality traits in medical education are still underrepresented in the existing literature and relevant studies have not been conducted among medical students in China, where tensions in the physician-patient relationship have been reported as outstanding problems in the context of China's current medical reform. Thus, the main objective of this study was to examine the associations between empathy and big five personality traits among Chinese medical students. A cross-sectional study was conducted in a medical university in Northeast China in June 2016. Self-reported questionnaires including the Interpersonal Reactivity Index (IRI) and Big Five Inventory (BFI) and demographic characteristics were distributed. A total of 530 clinical medical students became our final subjects. Hierarchical regression analysis was performed to explore the effects of big five personality traits on empathy. Results of this study showed that big five personality traits accounted for 19.4%, 18.1%, 30.2% of the variance in three dimensions of empathy, namely, perspective taking, empathic concern and personal distress, respectively. Specifically, agreeableness had a strong positive association with empathic concern (β = 0.477, Ppersonal distress (β = 0.526, Ppersonal distress (β = -0.160, Pbig five personality traits were important predictors of self-reported measures of both cognitive and affective empathy among Chinese medical students. Therefore, individualized intervention strategies based on personality traits could be integrated into programs to
Muzafar, Yumna; Khan, Hibbah H; Ashraf, Huma; Hussain, Waqas; Sajid, Hifsa; Tahir, Marium; Rehman, Abdul; Sohail, Aleena; Waqas, Ahmed; Ahmad, Waqas
Burnout is a widely known phenomenon. It is defined as a state of prolonged physical and psychological exhaustion and is experienced virtually by every medical student due to the highly demanding nature of medical education. This study probes into the prevalence and psychosocial determinants of burnout in Pakistani medical students. A descriptive, cross-sectional study design and convenience (non-probability) sampling technique were employed in undergraduate medical students from years 1-5. A total of 777 medical students from two medical colleges were included in the study from May-August, 2014. An English version of the Copenhagen Burnout Inventory (CBI) and a series of demographic questions, intermixed with questions from other topics, were included in the questionnaire. Data was analysed by using SPSS ver.21. The majority of students were females and enrolled in the third year of MBBS. Of the medical students involved, 30.6% were found to have high/very high levels of burnout (Kristenson's burnout scoring). Although 38.7% of students said that they did not feel burned out after reading the definition of burnout given in the questionnaire, 35.9% out of these students actually had high levels of burnout according to CBI. According to the multiple regression analysis, burnout in medical students was significantly associated with age, gender, doctor parents, no help or no supportive resources (e.g., from colleagues), lack of time off, lack of belief in what you do, fear of big consequences of failure, family responsibilities, and uncertain future. Perception of teachers lacking leadership skills and doing too much study with little balance was associated with low burnout scores. There is a high prevalence of burnout in Pakistani medical students. The present study identifies several factors associated with burnout in Pakistani medical students. Although these factors are a part of daily life of medical students, their identification should prompt the use of
Irwin, Nigel; Burnett, Kathryn M; McCarron, Paul A
As the higher education (HE) classroom begins to adopt newer internet-based technologies, the relationship between attendance and performance needs to be re-evaluated, particularly for professional degree courses such as pharmacy. In the present study, we aimed to establish if an association exists between attendance at all timetabled classes and academic performance, in a Clinical Pharmacology and Therapeutics (CPT) module, as part of the Master of Pharmacy (MPharm) degree course at Ulster University. Data on attendance, final examination and coursework performance were collected over two academic years (2013-14 and 2014-15) of the CPT module at Ulster. In total 67 students were analysed. The MPharm degree at Ulster University implements an attendance policy, both as a pastoral support tool and to reinforce the need for professional conduct as a pharmacist. Student (2013-14 and 2014-15, n = 35 and 32, respectively) attendance on the module across both year groups was approximately 80%. We observed positive, and statistically significant relationships between attendance and performance on the examination, and especially in the coursework elements of the module. Student failure (below 40%) in the final examination was linked to attendance below an 80% threshold in nine of 12 cases. Reasons for not attending class varied, but illness was unquestionably the most commonly cited extenuation. Taken together, these data confirm a convincing association between student attendance and academic achievement. Our studies promote the use of attendance monitoring policies for professional degree courses such as pharmacy. Copyright © 2017 Elsevier Inc. All rights reserved.
Cherkil, Sandhya; Gardens, Seby J; Soman, Deepak Kuttikatt
The two ubiquitous factors that have been identified in medical courses to underlie mental health are stress and different coping styles adopted to combat stress. To find the association between coping styles and stress in undergraduate medical students. A medical college in Central Kerala. A cross-sectional study design was adopted. Source and Severity of Stress Scale, Medical Student Version, was used to assess the source and nature of stress. Brief Cope was used to find out the coping styles adopted. The statistical analysis was done using Statistical Package for Social Sciences version 20 and SAS. Chi-square analysis was used to find the association between coping styles and stress domains and with the overall stress score. There is a significant positive association between overall stress score and coping styles (P=0.001) of 'Negative cope', 'Blame', and 'Humor'. 'Positive cope' and 'Religion' has significant positive association with 'Academics' (P=0.047) and 'self Expectations' (P=0.009). 'Blame' (Pmanagement techniques in the medical school.
Pinzón-Amado, Alexander; Guerrero, Sonia; Moreno, Katherine; Landínez, Carolina; Pinzón, Julie
It is well documented that physicians have higher rates of suicide than the general population. This risk tends to increase even from the beginning of undergraduate training in medicine. There are few studies evaluating the frequency of suicidal behaviors in undergraduate medical students, particularly in Latin America. To determine the lifetime prevalence and the variables associated with suicidal ideation and suicide attempts in a sample of medical students from the city of Bucaramanga, Colombia. An analytical cross-sectional observational study was conducted to determine the lifetime prevalence of suicidal ideation and suicide attempts in a non-random sample of medical students enrolled in three medical schools in Bucaramanga. A self-administered questionnaire was voluntarily and anonymously answered by the participants. Validated versions of the CES-D and CAGE scales were used to assess the presence of depressive symptoms and problematic alcohol use, respectively. A multivariate logistic regression model was generated in order to adjust the estimates of variables associated with the outcome «suicidal ideation in life». The study sample consisted of 963 medical students, of which 57% (n=549) of the participants were women. The average age was 20.3 years (SD=2.3 years). Having had at least one episode of serious suicidal ideation in their lifetime was reported by 15.7% (n=149) of the students, with 5% (n=47) of the students reported having made at least one suicide attempt. Having taken antidepressants during their medical training was reported by 13.9% (n=131) of the students. The variables associated with the presence of suicidal ideation in the logistic regression model were: clinically significant depressive symptoms (OR: 6.9, 95% CI; 4.54-10.4), history of illicit psychoactive substance use (OR 2.8, 95% CI; 1.6-4.8), and perception of poor academic performance over the past year (OR: 2.2, 95% CI; 1.4-3.6). The logistic regression model correctly classified
Jennifer Felicia Scheel
Full Text Available IntroductionNon-adherence to immunosuppressive medication is regarded as an important factor for graft rejection and loss after successful renal transplantation. Yet, results on prevalence and relationship with psychosocial parameters are heterogeneous. The main aim of this study was to investigate the association of immunosuppressive medication non-adherence and psychosocial factors.MethodsIn 330 adult renal transplant recipients (≥12 months posttransplantation, health-related quality of life, depression, anxiety, social support, and subjective medication experiences were assessed, and their associations with patient-reported non-adherence was evaluated.Results33.6% of the patients admitted to be partially non-adherent. Non-adherence was associated with younger age, poorer social support, lower mental, but higher physical health-related quality of life. There was no association with depression and anxiety. However, high proportions of clinically relevant depression and anxiety symptoms were apparent in both adherent and non-adherent patients.ConclusionIn the posttransplant follow-up, kidney recipients with lower perceived social support, lower mental and higher physical health-related quality of life, and younger age can be regarded as a risk group for immunosuppressive medication non-adherence. In follow-up contacts with kidney transplant patients, physicians may pay attention to these factors. Furthermore, psychosocial interventions to optimize immunosuppressive medication adherence can be designed on the basis of this information, especially including subjectively perceived physical health-related quality of life and fostering social support seems to be of importance.
Cook, Alyssa F.; Arora, Vineet M.; Rasinski, Kenneth A.; Curlin, Farr A.; Yoon, John D.
Purpose Medical student mistreatment has been recognized for decades and is known to adversely impact students both personally and professionally. Similarly, burnout has been shown to negatively impact students. This study assesses the prevalence of student mistreatment across multiple medical schools and characterizes the association between mistreatment and burnout. Method In 2011, the authors surveyed a nationally representative sample of third-year medical students. Students reported the frequency of mistreatment by attending faculty and residents since the beginning of their clinical rotations. Burnout was measured using a validated two-item version of the Maslach Burnout Inventory. Results Of 919 eligible students from 24 different medical schools, 564 (61%) completed the survey. The majority reported at least one incident of mistreatment by faculty (64% [361/562]) and by residents (75.5% [426/562]). Notable minorities experienced recurrent mistreatment, defined as mistreatment categorized as “several” or “numerous” times by student self-report (10.7% [59/562] by faculty and 12.6% [71/562] by residents). Recurrent mistreatment was associated with high burnout (57.4% vs. 31.5%; p<0.01 for recurrent mistreatment by faculty; 49.1% vs. 32.1%; p<0.01 for recurrent mistreatment by residents). Conclusions Medical student mistreatment remains prevalent. Recurrent mistreatment by faculty and residents is associated with medical student burnout. Although further investigation is needed to assess causality, these data provide additional impetus for medical schools to address student mistreatment to mitigate its adverse consequences on their personal and professional well-being. PMID:24667503
Gruppen, Larry D; Yoder, Ernie; Frye, Ann; Perkowski, Linda C; Mavis, Brian
The quality of the medical education research (MER) reported in the literature has been frequently criticized. Numerous reasons have been provided for these shortcomings, including the level of research training and experience of many medical school faculty. The faculty development required to improve MER can take various forms. This article describes the Medical Education Research Certificate (MERC) program, a national faculty development program that focuses exclusively on MER. Sponsored by the Association of American Medical Colleges and led by a committee of established medical education researchers from across the United States, the MERC program is built on a set of 11 interactive workshops offered at various times and places across the United States. MERC participants can customize the program by selecting six workshops from this set to fulfill requirements for certification. This article describes the history, operations, current organization, and evaluation of the program. Key elements of the program's success include alignment of program content and focus with needs identified by prospective users, flexibility in program organization and logistics to fit participant schedules, an emphasis on practical application of MER principles in the context of the participants' activities and interests, consistency in program content and format to ensure standards of quality, and a sustainable financial model. The relationship between the national MERC program and local faculty development initiatives is also described. The success of the MERC program suggests that it may be a possible model for nationally disseminated faculty development programs in other domains.
Full Text Available Background and Objectives: Self medication is an important concern for health authorities at global level. This study was aimed to find the prevalence of self medication for allopathic drugs and associated factors among households of urban community. This study was also aimed at assessing the attitude of respondents who had experienced self-medication. Materials and Methods: This cross-sectional study was done in field practice area attached to a medical institution in urban Puducherry. A total of 352 subjects from 124 households were selected by random sampling. With pretested interview schedule, information regarding self-medication use in the past three months and associated sociodemographic factors, purpose, source of drug procurement, attitude toward self-medication use were collected. Results: Prevalence of self-medication was found to be 11.9%. Males, age >40 years and involving in moderate level activity of occupation, were found to be significantly associated with higher self-medication usage (P < 0.05. Fever (31%, headache (19%, and abdominal pain (16.7% are most common illnesses where self-medication is being used. Telling the symptoms to pharmacist (38.1% was the commonest method adopted to procure drugs by the users. Majority of the self-medication users expressed that self-medication is harmless (66.6% and they are going to use (90% and advice others also (73.8% to use self-medication drugs. Conclusion: Self-medication is an important health issue in this area. Health education of the public and regulation of pharmacies may help in limiting the self-medication practices.
Feleke, Senafikish Amsalu; Mulatu, Muluadam Abebe; Yesmaw, Yeshaneh Seyoum
The significant impact of medication administration errors affect patients in terms of morbidity, mortality, adverse drug events, and increased length of hospital stay. It also increases costs for clinicians and healthcare systems. Due to this, assessing the magnitude and associated factors of medication administration error has a significant contribution for improving the quality of patient care. The aim of this study was to assess the magnitude and associated factors of medication administration errors among nurses at the Felege Hiwot Referral Hospital inpatient department. A prospective, observation-based, cross-sectional study was conducted from March 24-April 7, 2014 at the Felege Hiwot Referral Hospital inpatient department. A total of 82 nurses were interviewed using a pre-tested structured questionnaire, and observed while administering 360 medications by using a checklist supplemented with a review of medication charts. Data were analyzed by using SPSS version 20 software package and logistic regression was done to identify possible factors associated with medication administration error. The incidence of medication administration error was 199 (56.4 %). The majority (87.5 %) of the medications have documentation error, followed by technique error 263 (73.1 %) and time error 193 (53.6 %). Variables which were significantly associated with medication administration error include nurses between the ages of 18-25 years [Adjusted Odds Ratio (AOR) = 2.9, 95 % CI (1.65,6.38)], 26-30 years [AOR = 2.3, 95 % CI (1.55, 7.26)] and 31-40 years [AOR = 2.1, 95 % CI (1.07, 4.12)], work experience of less than or equal to 10 years [AOR = 1.7, 95 % CI (1.33, 4.99)], nurse to patient ratio of 7-10 [AOR = 1.6, 95 % CI (1.44, 3.19)] and greater than 10 [AOR = 1.5, 95 % CI (1.38, 3.89)], interruption of the respondent at the time of medication administration [AOR = 1.5, 95 % CI (1.14, 3.21)], night shift of medication administration
Teunissen, R.; Bos, J.; Pot, H.; Pluim, M.; Kramers, C.
PURPOSE: The clinical relevance of and risk factors associated with errors related to medication administration time were studied. METHODS: In this explorative study, 66 medication administration rounds were studied on two wards (surgery and neurology) of a hospital. Data on medication errors were
Enoch, Lindsey; Chibnall, John T; Schindler, Debra L; Slavin, Stuart J
Given the trend among medical students away from primary care medicine and toward specialties that allow for more controllable lifestyles, the identification of factors associated with specialty choice is important. Burnout is one such factor. The purpose of this study was to examine the associations between burnout and residency specialty choice in terms of provision for a less versus more controllable lifestyle (e.g. internal medicine versus dermatology) and a lower versus higher income (e.g. paediatrics versus anaesthesiology). A survey was sent to 165 Year 4 medical students who had entered the residency matching system. Students answered questions about specialty choice, motivating factors (lifestyle, patient care and prestige) and perceptions of medicine as a profession. They completed the Maslach Burnout Inventory-Human Services (MBI), which defines burnout in relation to emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). Burnout and other variables were tested for associations with specialty lifestyle controllability and income. A response rate of 88% (n = 145) was achieved. Experiences of MBI-EE, MBI-DP and MBI-PA burnout were reported by 42 (29%), 26 (18%) and 30 (21%) students, respectively. Specialties with less controllable lifestyles were chosen by 87 (60%) students and lower-income specialties by 81 (56%). Adjusted odds ratios (ORs) indicated that the choice of a specialty with a more controllable lifestyle was associated with higher MBI-EE burnout (OR = 1.77, 95% confidence interval [CI] 1.06-2.96), as well as stronger lifestyle- and prestige-related motivation, and weaker patient care-related motivation. The choice of a higher-income specialty was associated with lower MBI-PA burnout (OR = 0.56, 95% CI 0.32-0.98), weaker lifestyle- and patient care-related motivation, and stronger prestige-related motivation. Specialty choices regarding lifestyle controllability and income were associated with the amount and type of
Grierson, Lawrence E M; Mercuri, Mathew; Brailovsky, Carlos; Cole, Gary; Abrahams, Caroline; Archibald, Douglas; Bandiera, Glen; Phillips, Susan P; Stirrett, Glenna; Walton, J Mark; Wong, Eric; Schabort, Inge
The failure rate on certification examinations of The College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) is significantly higher for international medical graduates than for Canadian medical school graduates. The purpose of the current study was to generate evidence that supports or refutes the validity of hypotheses proposed to explain the lower success rates. We conducted retrospective analyses of admissions and certification data to determine the factors associated with success of international medical graduate residents on the certification examinations. International medical graduates who entered an Ontario residency program between 2005 and 2012 and had written a certification examination by the time of the analysis (2015) were included in the study. Data available at the time of admission for each resident, including demographic characteristics, previous experiences and previous professional experiences, were collected from each of the 6 Ontario medical schools and matched with certification examination results provided by The CFPC and the RCPSC. We developed logistic regression models to determine the association of each factor with success on the examinations. Data for 900 residents were analyzed. The models revealed resident age to be strongly associated with performance across all examinations. Fluency in English, female sex and the Human Development Index value associated with the country of medical school training had differential associations across the examinations. The findings should contribute to an improved understanding of certification success by international medical graduates, help residency programs identify at-risk residents and underpin the development of specific educational and remedial interventions. In considering the results, it should be kept in mind that some variables are not amenable to changes in selection criteria. Copyright 2017, Joule Inc. or its licensors.
Vansteenkiste, Maarten; Soenens, Bart; Van Petegem, Stijn; Duriez, Bart
This study examined associations between perceived degree and style of parental prohibition and adolescents' internalization of and oppositional defiance against parental rules in the friendship and moral domain. Relations were investigated in 2 longitudinal adolescent samples (total N = 532). Results indicated that perceived style but not…
In 1970 the medical associations of South Africa and Rhodesia (now, Zimbabwe) were expelled from the Commonwealth Medical Association. The latter had been set up, as the British Medical Commonwealth Medical Conference, in the late 1940s by the British Medical Association (BMA). These expulsions, and the events leading up to them, are the central focus of this article. The BMA’s original intention was to establish an organisation bringing together the medical associations of the constituent parts of the expanding Commonwealth. Among the new body’s preoccupations was the relationship between the medical profession and the state in the associations’ respective countries. It thus has to be seen as primarily a medico-political organisation rather than one concerned with medicine per se. Although, there were also tensions from the outset regarding the membership of the Southern African medical associations. Such stresses notwithstanding, these two organisations remained in the BMA-sponsored body even after South Africa and Rhodesia had left the Commonwealth. This was not, however, a situation which could outlast the growing number of African associations which joined in the wake of decolonisation; and hardening attitudes towards apartheid. The article therefore considers: why the BMA set up this Commonwealth body in the first place and what it hoped to achieve; the history of the problems associated with South African and Rhodesian membership; and how their associations came to be expelled. PMID:28901869
Bacchi, Stephen; Licinio, Julio
The purpose of this study is to review studies published in English between 1 January 2000 and 16 June 2014, in peer-reviewed journals, that have assessed the prevalence of depression, comparing medical students and non-medical students with a single evaluation method. The databases PubMed, Medline, EMBASE, PsycINFO, and Scopus were searched for eligible articles. Searches used combinations of the Medical Subject Headings medical student and depression. Titles and abstracts were reviewed to determine eligibility before full-text articles were retrieved, which were then also reviewed. Twelve studies met eligibility criteria. Non-medical groups surveyed included dentistry, business, humanities, nursing, pharmacy, and architecture students. One study found statistically significant results suggesting that medical students had a higher prevalence of depression than groups of non-medical students; five studies found statistically significant results indicating that the prevalence of depression in medical students was less than that in groups of non-medical students; four studies found no statistically significant difference, and two studies did not report on the statistical significance of their findings. One study was longitudinal, and 11 studies were cross-sectional. While there are limitations to these comparisons, in the main, the reviewed literature suggests that medical students have similar or lower rates of depression compared to certain groups of non-medical students. A lack of longitudinal studies meant that potential common underlying causes could not be discerned, highlighting the need for further research in this area. The high rates of depression among medical students indicate the continuing need for interventions to reduce depression.
Mahroon, Zaid A; Borgan, Saif M; Kamel, Charlotte; Maddison, Wendy; Royston, Maeve; Donnellan, Claire
Medical training can be a stressful experience and may negatively impact mental health for some students. The purpose of this study was to identify the prevalence of depressive and anxiety symptoms among medical students in one international medical university in the Kingdom of Bahrain and to determine associations between these symptoms, the students' characteristics, and their satisfaction with life. This is a cross sectional study using a self-administered questionnaire, distributed to 350 enrolled medical students. We used Beck's Depression Inventory (BDI-II) and Beck's Anxiety Inventory (BAI) instruments to assess depressive and anxiety symptoms. The Satisfaction With Life Scale (SWLS) was used to measure global cognitive judgments of one's life satisfaction. Sociodemographic details including social background and academic information were also documented. Forty percent (n = 124) of the participants had depressive symptoms, of which 18.9% (n = 58) met the criteria for mild, 13% (n = 40) for moderate, and 8.5% (n = 26) for severe depressive symptoms. Depressive symptoms were associated with Arab ethnicity (χ 2 = 5.66, p = .017), female gender (χ 2 = 3.97, p = .046), relationship with peers (p Anxiety symptoms were present in 51% (n = 158) of students. Anxiety symptoms were associated with female gender (χ 2 = 11.35, p anxiety symptoms among medical students was high. Medical universities in the Middle East may need to allocate more resources into monitoring and early detection of medical student distress. Medical education providers are encouraged to provide adequate pastoral and psychological support for medical students, including culturally appropriate self-care programs within the curriculum.
Yanes, Tatiane; Humphreys, Linda; McInerney-Leo, Aideen; Biesecker, Barbara
Little is known about the adaptive process and experiences of parents raising a child with an undiagnosed medical condition. The present study aims to assess how uncertainty, hope, social support, and coping efficacy contributes to adaptation among parents of children with an undiagnosed medical condition. Sixty-two parents of child affected by an undiagnosed medical condition for at least two years completed an electronically self-administered survey. Descriptive analysis suggested parents in this population had significantly lower adaptation scores when compared to other parents of children with undiagnosed medical conditions, and parents of children with a diagnosed intellectual and/or physical disability. Similarly, parents in this population had significantly lower hope, perceived social support and coping efficacy when compared to parents of children with a diagnosed medical condition. Multiple linear regression was used to identify relationships between independent variables and domains of adaptation. Positive stress response was negatively associated with emotional support (B = −0.045, p ≤ 0.05), and positively associated with coping efficacy (B = 0.009, p ≤ 0.05). Adaptive self-esteem was negatively associated with uncertainty towards one's social support (B = −0.248, p ≤ 0.05), and positively associated with coping efficacy (B = 0.007, p ≤ 0.05). Adaptive social integration was negatively associated with uncertainty towards one's social support (B-0.273, p ≤ 0.05), and positively associated with uncertainty towards child's health (B = 0.323, p ≤ 0.001), and affectionate support (B = 0.110, p ≤ 0.001). Finally, adaptive spiritual wellbeing was negatively associated with uncertainty towards one's family (B = −0.221, p ≤ 0.05). Findings from this study have highlighted the areas where parents believed additional support was required, and provided insight into factors that contribute to parental adaptation. PMID:28039658
Choung, Rok Seon; Locke, G. Richard.; Schleck, Cathy D.; Zinsmeister, Alan R.; Talley, Nicholas J.
Background Functional GI syndromes are known to be very prevalent but this may be associated with unrecognized medications use. We aimed to estimate the prevalence of PPI, antidepressant, and narcotic use in the general population, and evaluate the association between each medication and functional GI syndromes adjusting for potential confounders. Methods In 2008 and 2009, newly revised versions of a validated bowel disease questionnaire were mailed to a community based cohort (total mailed=8006) of Olmsted County, MN residents; 3831 returned the questionnaire (response rate=48.0%). Medication usage, specifically PPIs, narcotics, and antidepressants in the last year, was elicited via three separate questions on the questionnaire. The association between each medication and GI symptom complexes was assessed using multiple variable logistic regression models. Results A total of 3515 of the respondents (92%) had complete data (mean age: 61±15; 54% female). The overall proportion reporting PPI use was 20% (95% CI: 19, 22), narcotic use 12% (95% CI: 11, 13), and antidepressant use 15% (95% CI: 14, 16). PPI use was significantly associated with IBS status (OR=1.4, 95% CI 1.1, 1.7) as well as with GERD (OR=3.5, 95% CI 2.7, 4.4) and dyspepsia (OR=2.0, 95% CI 1.5, 2.7). The association of PPI use with IBS was not explained by coexistent GERD or dyspepsia. Antidepressant use was significantly associated only with bloating (OR=1.6, 1.1, 2.2). Conclusions Some medications that may alter intestinal transit or bowel flora are commonly utilized by the general population, and PPI use appears to be linked to IBS. PMID:23360217
The Bachelor of Clinical Medical Practice (BCMP) is a new degree at the University of Pretoria (UP), designed to create a new category of mid-level medical workers, namely clinical associates. UP produced its first 44 graduates in 2011. The BCMP created the opportunity to innovate learning and teaching through ...
Shields, Richard K; Pizzimenti, Marc A; Dudley-Javoroski, Shauna; Schwinn, Debra A
The purpose of this report is to describe student satisfaction with a near-peer interprofessional education (IPE) session for physical therapy and medical students. Ten senior physical therapy students worked in peer-groups to develop a musculoskeletal anatomy demonstration for first-semester medical students. Together with their classmates, they demonstrated observation, palpation, and musculoskeletal assessment of the shoulder and scapular-thoracic articulation to medical student dissection groups in the Gross Anatomy laboratory. The medical students were encouraged to consider the synergistic function of shoulder structures and the potential impact of a selected pathology: rotator cuff injury. The session provided the medical students with an opportunity to integrate their new anatomical knowledge into a framework for clinical musculoskeletal evaluation. The experience offered senior physical therapy students an opportunity to work in teams with their peers, internalize and adapt to constructive feedback, and seek common ground with members of another profession. Both student groups reported a high degree of satisfaction with the sessions and expressed a desire for further interaction. These positive perceptions by student stakeholders have prompted us to consider additional IPE exchanges for the anatomy course in the upcoming school year. Given the positive outcome of this descriptive study, we now plan to systematically test whether near-peer IPE interactions can enhance the degree that students learn key anatomical concepts. © 2014 American Association of Anatomists.
Baker, Jamie; Tucker, Debra; Raynes, Edilberto; Aitken, Florence; Allen, Pamela
Medical dosimetry education occupies a specialized branch of allied health higher education. Noted international shortages of health care workers, reduced university funding, limitations on faculty staffing, trends in learner attrition, and increased enrollment of nontraditional students force medical dosimetry educational leadership to reevaluate current admission practices. Program officials wish to select medical dosimetry students with the best chances of successful graduation. The purpose of the quantitative ex post facto correlation study was to investigate the relationship between applicant characteristics (cumulative undergraduate grade point average (GPA), science grade point average (SGPA), prior experience as a radiation therapist, and previous academic degrees) and the successful completion of a medical dosimetry program, as measured by graduation. A key finding from the quantitative study was the statistically significant positive correlation between a student׳s previous degree and his or her successful graduation from the medical dosimetry program. Future research investigations could include a larger research sample, representative of more medical dosimetry student populations, and additional studies concerning the relationship of previous work as a radiation therapist and the effect on success as a medical dosimetry student. Based on the quantitative correlation analysis, medical dosimetry leadership on admissions committees could revise student selection rubrics to place less emphasis on an applicant׳s undergraduate cumulative GPA and increase the weight assigned to previous degrees. Copyright © 2016 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
Full Text Available This study aims to assess the prevalence of stress and burnout among preclinical medical students in a private university in Beirut, Lebanon, and evaluate the association between extracurricular involvement and stress and burnout relief in preclinical medical students. A cross-sectional survey was conducted on a random sample of 165 preclinical medical students. Distress level was measured using the 12-item General Health Questionnaire (GHQ-12 while that of burnout was measured through the Maslach Burnout Inventory-Student Survey (MBI-SS. The MBI-SS assesses three interrelated dimensions: emotional exhaustion, cynicism, and academic efficacy. Extracurricular activities were divided into four categories: physical exercise, music, reading, and social activities. All selected participants responded. A substantial proportion of preclinical medical students suffered from stress (62% and burnout (75%. Bivariate and multivariate regression analyses revealed that being a female or a 1st year medical student correlated with higher stress and burnout. Music-related activities were correlated with lower burnout. Social activities or living with parents were associated with lower academic efficacy. The high stress and burnout levels call for action. Addressing the studying conditions and attending to the psychological wellbeing of preclinical medical students are recommendations made in the study.
Fares, Jawad; Saadeddin, Zein; Al Tabosh, Hayat; Aridi, Hussam; El Mouhayyar, Christopher; Koleilat, Mohamad Karim; Chaaya, Monique; El Asmar, Khalil
This study aims to assess the prevalence of stress and burnout among preclinical medical students in a private university in Beirut, Lebanon, and evaluate the association between extracurricular involvement and stress and burnout relief in preclinical medical students. A cross-sectional survey was conducted on a random sample of 165 preclinical medical students. Distress level was measured using the 12-item General Health Questionnaire (GHQ-12) while that of burnout was measured through the Maslach Burnout Inventory-Student Survey (MBI-SS). The MBI-SS assesses three interrelated dimensions: emotional exhaustion, cynicism, and academic efficacy. Extracurricular activities were divided into four categories: physical exercise, music, reading, and social activities. All selected participants responded. A substantial proportion of preclinical medical students suffered from stress (62%) and burnout (75%). Bivariate and multivariate regression analyses revealed that being a female or a 1st year medical student correlated with higher stress and burnout. Music-related activities were correlated with lower burnout. Social activities or living with parents were associated with lower academic efficacy. The high stress and burnout levels call for action. Addressing the studying conditions and attending to the psychological wellbeing of preclinical medical students are recommendations made in the study. Copyright © 2015 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.
Full Text Available Jiannong Liu1, Haifeng Guo1, David Gilbertson1, Robert Foley1,2, Allan Collins1,21Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA; 2Department of Medicine, University of Minnesota, Minneapolis, MN, USAAbstract: Most end-stage renal disease (ESRD patients begin renal replacement therapy with hemoglobin levels below the recommended US National Kidney Foundation Dialysis Outcomes Quality Initiative Guidelines lower level of 110 g/L. Although most patients eventually reach this target, the time required varies substantially. This study aimed to determine whether length of time with below-target hemoglobin levels after dialysis initiation is associated with medical costs, and if so, whether intermediate factors underlie the associations. US patients initiating dialysis in 2002 were studied using the Centers for Medicare and Medicaid Services ESRD database. Anemia persistence (time in months with hemoglobin below 110 g/L was determined in a six-month entry period, and outcomes were assessed in the subsequent six-month follow-up period. The structural equation modeling technique was used to evaluate associations between persistent anemia and medical costs and to determine intermediate factors for these associations. The study included 28,985 patients. Mean per-patient-per-month medical cost was $6267 (standard deviation $5713 in the six-month follow-up period. Each additional month with hemoglobin below 110 g/L was associated with an 8.9% increment in medical cost. The increased cost was associated with increased erythropoietin use and blood transfusions, and increased rates of hospitalization and vascular access procedures in the follow-up period. Keywords: anemia persistency, end-stage renal disease, medical costs, structural equation modeling
Saeed Haji Aghajani
Full Text Available Background and purpose: Today with growth of information, information sources are also growing in number and diversity. The users should welcome these changes and learn the skills which help with optional use of information resources and prevents confusion. This study is an attempt to evaluate student use of information resources and library services in Semnan University of Medical Sciences and Health Services.Methods: In this survey a questionnaire was used to collect the date. The questionnaire included question on demographic data such as the degree program of study, sex, living place and 15 items on study habits and library use. The last year students of 13 disciplines leading to Associate degree, Bachelors degree, and Professional doctoral degree (medicine were included in this study. The association of variables was tested with chi-square and fisher exact tests and to examine the correlation of variables Spearman correlation coefficient was used. A P value of less than 0.05 was considered significantResults: In this study 215 last year students participated. Of all participants 70.3% were female; 43.3% study for an associate degree, 47.4% studies for Bachelor’s degree and 9.3% studied for doctoral degree; 92.6% lived in dormitories. There is a significant association between use of library sources and the study program degree (r=0.191, P=0.005 and living place (P=0.026 Original English books are used scarcely. Use of English sources are associated with the degree the students studied for (r=0.137, P=0.045 and sex; using specialty journal is associated with program degree (r=0.160, P=0.013.Most students of doctoral degree (40%, bachelors degree (42.2%, and associate degree (32.3% did not use library as an educational setting. Male students (28.2% and students living in dormitories (24.6% “always” used library as main study place.Conclusions: Most of our students always or often preferred transcripts of instructors’ lecture over
Shnier, Adrienne; Lexchin, Joel
Professional medical associations (PMAs) play a crucial role in providing accredited continuing medical education (CME) to physicians. Funding from the pharmaceutical industry may lead to biases in CME. This study examines publicly available policies on CME, adopted by Canadian PMAs as of December 2015. Policies were evaluated using an original scoring tool comprising 21 items, two questions about PMAs' general and CME funding from industry, and three enforcement measures. We assessed 236 policies adopted by Canadian PMAs (range, 0 to 32). Medical associations received summative scores that ranged from 0% to 49.2% of the total possible points (maximum score = 63). Twenty-seven associations received an overall score of 0%. The highest mean scores were achieved in the areas of industry involvement in planning CME activities (mean: 1.1/3), presence of a review process for topics of CME activities (mean: 1.1/3), content review for balanced information (mean: 1.1/3), and responsibility of distribution of funds (mean: 1.0/3). The lowest mean scores were achieved in the areas of awards (mean: 0.0/3), industry personnel, representatives, and employees (mean: 0.1/3), distribution of industry-funded educational materials at CME activities (mean: 0.1/3), and distinction between marketing and educational materials (mean: 0.1/3). These results suggest that Canadian PMAs' publicly available policies on industry involvement in CME are generally weak or non-existent; therefore, the accredited CME that is provided to Canadian physicians may be viewed as open to bias. We encourage all Canadian medical associations to strengthen their policies to avoid the potential for industry influence in CME.
Crane, Monique F; Brouwers, Sue; Forrest, Kirsty; Tan, Suyin; Loveday, Thomas; Wiggins, Mark W; Munday, Chris; David, Leila
This study extends previous research by exploring the association between mood states (i.e., positive and negative affect) and fixation in practicing anesthetists using a realistic medical simulation. The impact of practitioner emotional states on fixation is a neglected area of research. Emerging evidence is demonstrating the role of positive affect in facilitating problem solving and innovation, with demonstrated implications for practitioner fixation. Twelve practicing anesthetists (4 females; M age = 39 years; SD = 6.71) were involved in a medical simulation. Prior to the simulation, practitioners rated the frequency they had experienced various positive and negative emotions in the previous three days. During the simulation, the patient deteriorated rapidly, and anesthetists were observed for their degree of fixation. After the simulation, practitioners indicated the frequency of these same emotions during the simulation. Nonparametric correlations were used to explore the independent relationships between positive and negative affect and the behavioral measures. Only positive affect impacted the likelihood of fixation. Anesthetists who reported more frequent recent positive affect in the three days prior to the simulation and during the simulation tended to be less fixated as judged by independent raters, identified a decline in patient oxygen saturation more quickly, and more rapidly implemented the necessary intervention (surgical cricothyroidotomy). These findings have some real-world implications for positive affect in patient safety. This research has broad implications for professions where fixation may impair practice. This research suggests that professional training should teach practitioners to identify their emotions and understand the role of these emotions in fixation.
Hicks, Kristen K; Murano, Peter S
The purpose of this research study was to determine whether a 1-hour online continuing medical education (CME) course focused on nutrition for type 2 diabetes would result in a gain in nutrition knowledge by practicing physicians. A practicing physician and dietitian collaborated to develop an online CME course (both webinar and self-study versions) on type 2 diabetes. This 1-hour accredited course was launched through the state-level medical association's education library, available to all physicians. Physicians (n=43) registered for the course, and of those, 31 completed the course in its entirety. A gain in knowledge was found when comparing pre- versus post-test scores related to the online nutrition CME ( P Online CME courses launched via state-level medical associations offer convenient continuing education to assist practicing physicians in addressing patient nutrition and lifestyle concerns related to chronic disease. The present diabetes CME one-credit course allowed physicians to develop basic nutrition care concepts on this topic to assist patients in a better way.
Jember, Abebaw; Hailu, Mignote; Messele, Anteneh; Demeke, Tesfaye; Hassen, Mohammed
A medication error (ME) is any preventable event that may cause or lead to inappropriate medication use or patient harm. Voluntary reporting has a principal role in appreciating the extent and impact of medication errors. Thus, exploration of the proportion of medication error reporting and associated factors among nurses is important to inform service providers and program implementers so as to improve the quality of the healthcare services. Institution based quantitative cross-sectional study was conducted among 397 nurses from March 6 to May 10, 2015. Stratified sampling followed by simple random sampling technique was used to select the study participants. The data were collected using structured self-administered questionnaire which was adopted from studies conducted in Australia and Jordan. A pilot study was carried out to validate the questionnaire before data collection for this study. Bivariate and multivariate logistic regression models were fitted to identify factors associated with the proportion of medication error reporting among nurses. An adjusted odds ratio with 95% confidence interval was computed to determine the level of significance. The proportion of medication error reporting among nurses was found to be 57.4%. Regression analysis showed that sex, marital status, having made a medication error and medication error experience were significantly associated with medication error reporting. The proportion of medication error reporting among nurses in this study was found to be higher than other studies.
Domingues,Renan Barros; Domingues,Simone Aires
The aim of this study was to investigate the association between headache and alcohol consumption among medical students. 480 medical students were submitted to a questionnaire about headaches and drinking alcohol. Headache was assessed by ID-Migraine and functional disability was evaluated with MIDAS. The evaluation of alcohol consumption was assessed with Alcohol Use Disorders Identification Test (AUDIT). There was significantly lower proportion of students with drinking problem among stude...
Full Text Available Background Many studies indicate that one of the leading preventable causes of premature death, disease and disability around the world is Tobacco use. Unfortunately, adolescents and young adults of colleges are often targeted of marketing by the tobacco industry. The aim of this study was to assess the relative frequency of tobacco use and associated factors in medical students. Methods This cross-sectional study has done among medical students in 2014 - 2015. Totally, 284 students from 4 levels (basic, extern, intern and residents were selected by random sampling from each category. We used a checklist for collecting demographic information that was distributed among participants by a trained interviewer. SPSS-11.5 software was used for data analysis andsignificance level was considered < 0.05. Results Among 284 medical students, 17 (6% smoked cigarette and 3 (1.05% used illicit substance. All of the users were male, 15 (88% of which were single. 1 (1.4 % of the basic level students, 6 (6.9 % of the externs, 9 (14.8 % of the Interns and 1(1.6 % of the residents used cigarette but the differences among these groups were not significant (P = 0.36. Generally, 13 (76.5% of the users resided in dormitory and the others lived in parental home, which shows a significant difference among these groups (P = 0.01.The logistic regression indicated stage level was positively associated with cigarette use (P < 0.007. Conclusions In this study, we evaluated how several environmental factors may influence illicit substance and tobacco use. We found an association between living in a dormitory and smoking cigarette, so it is an important factor to be considered in program planning for new students who entered into this environment.
Teng, Sha; Zhang, Shuping; Zhang, Wenxin; Lin, Xiaohong; Shang, Yabin; Peng, Xiao; Liu, Hongxia
Kidney transplant recipients require lifelong treatment with immunosuppressive medications to avoid graft rejection and graft loss. Symptoms experienced may influence recipients' perceived quality of life and medication adherence. The purpose of this study was to evaluate the symptom experience associated with immunosuppressive medications in adult kidney transplant recipients and to explore the association between the symptom experience and adherence to immunosuppressive medications. A cross-sectional design was used. The study was conducted in a general hospital in China from October 2013 to September 2014. A total of 231 recipients with a follow-up of at least 1 year after kidney transplantation were included. Symptom experience associated with immunosuppressive medications was measured by the 13-item Symptom Experience of Immunosuppressive-related Side Effects Scale. Self-reported adherence to immunosuppressive medications was assessed using the Adherence with Immunosuppressive Medication Scale. Ridit analysis was used to rank symptom distress items. A proportion of 60.6% of recipients were male; the time after kidney transplantation was arbitrarily divided into a short-term cohort (1-4 years) and a long-term cohort (4-16 years) according to the median duration of follow-up (4 years). High blood pressure, hair loss, and tiredness were the three most distressing symptoms over all items of the whole sample. High blood pressure was the most distressing symptom for the 1- to 4-year cohort and the 4- to 16-year cohort. For men high blood pressure was the most distressing symptom, whereas for women hair loss was the most distressing symptom. Recipients in the 4- to 16-year cohort perceived a higher level of symptom distress compared with those in the 1- to 4-year cohort, especially in excess hair growth and difficulty sleeping. A negative relationship was found between symptom distress and adherence to immunosuppressive medications (r = -.541, p = .000). Recipients
Olapade-Olaopa, E O; Sewankambo, N; Iputo, J E; Rugarabamu, P; Amlak, A H; Mipando, M; Monekosso G L
BACKGROUND - Globally, human resources for health are being optimized to address the increasing health burden and concomitant increased demands on health professionals. These demands are even more exacting in Sub-SaharanAfrica considering the shortage of health care workers, especially physicians. The noteworthy efforts at deploying task-shifting to address this situation not-withstanding, the situation also signals the need to re-define the objectives of medical instruction to ensure effective and contemporary medical practice in a mostly physician-led health workforce across the sub-continent. In this regard, medical and dental graduates must be educated to perform certain minimum essential professional duties competently. Essential Professional Duties are locally relevant professional activities of international standard that represent identifiable outcomes against which the effectiveness of physicians in a specific community can be measured to ensure social accountability. PROCEDURE AND PRODUCT - The Association of Medical Schools of Africa has developed the 'Essential Professional Duties for sub-Saharan medical and dental graduates' to ensure these physicians provide safe and effective contemporary medical/dental practice on the sub-continent. The duties have been grouped into those required for basic patient care, basic administrative skills, basic emergency care, communication, inter-professional relationships, self-directed learning and social responsibilities. Their relevance and suitability have been evaluated prior to their adoption by the Association. CONCLUSION; These Essential Physician Duties have been developed to serve as targets for health professionals training instruments and thus give direction to health system strategies. It is hoped that they will be adopted by medical and dental schools across sub-,. Saharan Africa.
Connor, Jennifer J
Objective: Centralized exchanges of scientific materials existed by the late nineteenth century, but they did not include medical publications. North American medical leaders therefore formed an association of institutions to run their own exchange: the Medical Library Association (MLA). After providing background to the exchange concept and the importance of institutional members for MLA, this article examines archival MLA correspondence to consider the role of its Exchange in the association's professional development before the 1950s. Results: MLA's membership policy admitted only libraries open to the medical profession with a large number of volumes. But the correspondence of the MLA Executive Committee reveals that the committee constantly adjusted the definition of library membership: personal, public, sectarian, commercial, allied science, and the then-termed “colored” medical school libraries all were denied membership. Conclusion: Study of these decisions, using commercial and sectarian libraries as a focus, uncovers the primary justification for membership exclusions: a goal of operating a scientific exchange. Also, it shows that in this way, MLA shadowed policies and actions of the American Medical Association. Finally, the study suggests that the medical profession enforced its policies of exclusion through MLA, despite a proclaimed altruistic sharing of medical literature. PMID:21464849
Windsor Westbrook Sherrill, Ph.D., MBA
Full Text Available Background: An increasing number of medical schools are offering dual degree MD/MBA programs. Career choices and factors influencing students to enter these programs provide an indicator of the roles in which dual degree students will serve in health care as well as the future of dual degree programs. Purpose: Using career choice theory as a conceptual framework, career goals and factors influencing decisions to enter dual degree programs were assessed among dual degree medical students. Methods: Students enrolled at dual degree programs at six medical schools were surveyed and interviewed. A control group of traditional medical students was also surveyed. Results: Factors influencing students to seek both medical and business training are varied but are often related to a desire for leadership opportunities, concerns about change in medicine and job security and personal career goals. Most students expect to combine clinical and administrative roles. Conclusions: Students entering these programs do so for a variety of reasons and plan diverse careers. These findings can provide guidance for program development and recruitment for dual degree medical education programs
Windsor Westbrook Sherrill, Ph.D., MBA
Full Text Available Background: An increasing number of medical schools are offering dual degree MD/MBA programs. Career choices and factors influencing students to enter these programs provide an indicator of the roles in which dual degree students will serve in health care as well as the future of dual degree programs. Purpose: Using career choice theory as a conceptual framework, career goals and factors influencing decisions to enter dual degree programs were assessed among dual degree medical students. Methods: Students enrolled at dual degree programs at six medical schools were surveyed and interviewed. A control group of traditional medical students was also surveyed. Results: Factors influencing students to seek both medical and business training are varied but are often related to a desire for leadership opportunities, concerns about change in medicine and job security and personal career goals. Most students expect to combine clinical and administrative roles. Conclusions: Students entering these programs do so for a variety of reasons and plan diverse careers. These findings can provide guidance for program development and recruitment for dual degree medical education program
Sherrill, Windsor Westbrook
An increasing number of medical schools are offering dual degree MD/MBA programs. Career choices and factors influencing students to enter these programs provide an indicator of the roles in which dual degree students will serve in health care as well as the future of dual degree programs. Using career choice theory as a conceptual framework, career goals and factors influencing decisions to enter dual degree programs were assessed among dual degree medical students. Students enrolled at dual degree programs at six medical schools were surveyed and interviewed. A control group of traditional medical students was also surveyed. Factors influencing students to seek both medical and business training are varied but are often related to a desire for leadership opportunities, concerns about change in medicine and job security and personal career goals. Most students expect to combine clinical and administrative roles. Students entering these programs do so for a variety of reasons and plan diverse careers. These findings can provide guidance for program development and recruitment for dual degree medical education programs.
Pillinger, Michael; Plottel, Claudia S.; Galeano, Claudia; Maddalo, Scott; Hochman, Judith S.; Cronstein, Bruce N.; Gold‐von Simson, Gabrielle
Abstract To develop the next generation of translational investigators, New York University School of Medicine (NYUSOM) and the NYU‐NYC Health and Hospitals Corporation Clinical and Translational Science Institute (NYU‐HHC CTSI) developed the Master's of Science in Clinical Investigation dual‐degree (MD/MSCI) program. This 5‐year program dedicates 1 year to coursework and biomedical research, followed by a medical school/research overlap year, to prepare students for academic research careers. This paper details the MD/MSCI program's curriculum and approach to mentorship, describes the research/professional interests of students, and reports student productivity. In the first 4 years of the program (2010–2014) 20 students were matriculated; 7 (35%) were women, and 12 (60%) research projects were in surgical specialties. To date, 14 students have applied to residency, and half pursued surgical residency programs. Our students have produced 68 accepted abstracts, 15 abstracts in submission, 38 accepted papers, and 24 papers in submission. Despite the time‐limited nature of this program, additional training in research design and implementation has promoted a high level of productivity. We conclude that dual‐degree training in medicine and translational research is feasible for medical students and allows for meaningful participation in valuable projects. Follow‐up is warranted to evaluate the academic trajectory of these students. PMID:26365704
Gillman, Jennifer; Pillinger, Michael; Plottel, Claudia S; Galeano, Claudia; Maddalo, Scott; Hochman, Judith S; Cronstein, Bruce N; Gold-von Simson, Gabrielle
To develop the next generation of translational investigators, New York University School of Medicine (NYUSOM) and the NYU-NYC Health and Hospitals Corporation Clinical and Translational Science Institute (NYU-HHC CTSI) developed the Master's of Science in Clinical Investigation dual-degree (MD/MSCI) program. This 5-year program dedicates 1 year to coursework and biomedical research, followed by a medical school/research overlap year, to prepare students for academic research careers. This paper details the MD/MSCI program's curriculum and approach to mentorship, describes the research/professional interests of students, and reports student productivity. In the first 4 years of the program (2010-2014) 20 students were matriculated; 7 (35%) were women, and 12 (60%) research projects were in surgical specialties. To date, 14 students have applied to residency, and half pursued surgical residency programs. Our students have produced 68 accepted abstracts, 15 abstracts in submission, 38 accepted papers, and 24 papers in submission. Despite the time-limited nature of this program, additional training in research design and implementation has promoted a high level of productivity. We conclude that dual-degree training in medicine and translational research is feasible for medical students and allows for meaningful participation in valuable projects. Follow-up is warranted to evaluate the academic trajectory of these students. © 2015 Wiley Periodicals, Inc.
Unplanned readmissions of medical hospital patients have been increasing in recent years. We examined the frequency and associates of emergency medical readmissions to Galway University Hospitals (GUH).
Spuur, Kelly M.; Falconi, Caroline L.; Cowling, Cynthia M.; Bowman, Anita L.; Maroney, Maria A.
Aim: To report the student demographics of the inaugural intake into the Bachelor of Medical Imaging and Bachelor of Medical Sonography/Graduate Diploma of Medical Sonography at CQUniversity, Mackay, Australia. Method: Surveys were distributed to students enrolled in the course MEDI11001 Fundamentals of the Imaging Professions; this course is common to both cohorts in Term 1 of the programs. All students enrolled at the time of the survey were present to participate in the survey. Participation was voluntary. Descriptive statistics were developed from responses and thematic analysis applied to open-ended questions. Results: A total of 44 students were enrolled in the programs. The most common place of residence on enrolment was within 40 km of the Mackay campus (16/36.4%); mature age students (30/68.2%); live on campus in the purpose built residences (18/40.9%) and were influenced by the location of the programs in Mackay to enrol (27/61.2%), with the primary justification for this being that the programs were offered close to home. The university website was identified as the primary source of information regarding the programs (15/34.1%) followed by family and friends (11/25%). The programs were first preference for 31 students (70.5%). The majority (23/52.3%) undertakes some type of paid work. Conclusion: Both programs have attracted a diverse student cohort. The majority of students were mature age students from outside of the area local to the Mackay campus of CQUniversity.
Harvard Vanguard Medical Associates (Harvard Vanguard) decided to develop a Shared Medical Appointment (SMA) program in 2007 for a variety of reasons. The program has launched 86 SMAs in 17 specialties at 12 sites and has exceeded 13 000 patient visits. Currently, the practice offers 54 SMAs and is believed to be the largest program in the country. This article provides an overview regarding staffing, space and equipment, project planning, promotional materials, training programs, workflow development, and the use of quality improvement (ie, LEAN) tools used to monitor the work to be completed and the metrics to date.
Boehnke, Kevin F; Litinas, Evangelos; Clauw, Daniel J
Opioids are commonly used to treat patients with chronic pain (CP), though there is little evidence that they are effective for long term CP treatment. Previous studies reported strong associations between passage of medical cannabis laws and decrease in opioid overdose statewide. Our aim was to examine whether using medical cannabis for CP changed individual patterns of opioid use. Using an online questionnaire, we conducted a cross-sectional retrospective survey of 244 medical cannabis patients with CP who patronized a medical cannabis dispensary in Michigan between November 2013 and February 2015. Data collected included demographic information, changes in opioid use, quality of life, medication classes used, and medication side effects before and after initiation of cannabis usage. Among study participants, medical cannabis use was associated with a 64% decrease in opioid use (n = 118), decreased number and side effects of medications, and an improved quality of life (45%). This study suggests that many CP patients are essentially substituting medical cannabis for opioids and other medications for CP treatment, and finding the benefit and side effect profile of cannabis to be greater than these other classes of medications. More research is needed to validate this finding. This article suggests that using medical cannabis for CP treatment may benefit some CP patients. The reported improvement in quality of life, better side effect profile, and decreased opioid use should be confirmed by rigorous, longitudinal studies that also assess how CP patients use medical cannabis for pain management. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.
Mott, David A; Martin, Beth; Breslow, Robert; Michaels, Barb; Kirchner, Jeff; Mahoney, Jane; Margolis, Amanda
The use of fall risk-increasing drugs (FRIDs) by older adults is one factor associated with falling, and FRID use is common among older adults. A targeted medication therapy management intervention focused on FRID use that included prescription and over-the-counter (OTC) medications, along with follow-up telephone calls was designed. The purpose of this pilot study was to examine preliminary effects of a medication therapy management (MTM) intervention focused on FRIDs provided by a community pharmacist to older adults. Randomized, controlled trial. One community pharmacy. Eighty older adults who completed a fall prevention workshop. The main outcome measures were the rate of discontinuing FRIDs, the proportion of older adults falling, and the number of falls. A secondary outcome was the acceptance rate of medication recommendations by patients and prescribers. Thirty-eight older adults received the targeted MTM intervention. Of the 31 older adults using a FRID, a larger proportion in the intervention group had FRID use modified relative to controls (77% and 28%, respectively; P FRID use among older adults was effective in modifying FRID use. This result supports the preliminary conclusion that community pharmacists can play an important role in modifying FRID use among older adults. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
Godwin, Kyler M; Wasserman, Joan; Ostwald, Sharon K
This study aimed to capture direct costs of outpatient rehabilitative stroke care and medications for a 1-year period after discharge from inpatient rehabilitation. Outpatient rehabilitative services and medication costs for 1 year, during the time period of 2001 to 2005, were calculated for 54 first-time stroke survivors. Costs for services were based on Medicare reimbursement rates. Medicaid reimbursement rates and average wholesale price were used to estimate medication costs. Of the 54 stroke survivors, 40 (74.1%) were categorized as independent, 12 (22.2%) had modified dependence, and 2 (3.7%) were dependent at the time of discharge from inpatient rehabilitation. Average cost for outpatient stroke rehabilitation services and medications the first year post inpatient rehabilitation discharge was $17,081. The corresponding average yearly cost of medication was $5,392, while the average cost of yearly rehabilitation service utilization was $11,689. Cost attributed to medication remained relatively constant throughout the groups. Outpatient rehabilitation service utilization constituted a large portion of cost within each group: 69.7% (dependent), 72.5% (modified dependence), and 66.7% (independent). Stroke survivors continue to incur significant costs associated with their stroke for the first 12 months following discharge from an inpatient rehabilitation setting. Changing public policies affect the cost and availability of care. This study provides a snapshot of outpatient medication and therapy costs prior to the enactment of major changes in federal legislation and serves as a baseline for future studies.
Ayalon, Liat; Gross, Revital; Yaari, Aviv; Feldhamer, Elan; Balicer, Ran; Goldfracht, Margalit
This study analyzed the role of patient and physician characteristics associated with the purchase of antidepressant or antianxiety medications in Israel, a country that has a universal health care system. A national sample of 30,000 primary care patients over the age of 22 was randomly drawn from the registry of the largest health care fund in Israel. Data concerning medication purchase between January and December 2006 were extracted. Physician and patient characteristics were merged with Israel's unique identification number. Multilevel analysis was conducted to identify patient- and physician-level predictors of medication purchase. Overall, 19% (N = 4,762) of the sample purchased antidepressant or antianxiety medications. Individuals with greater general medical and psychiatric comorbidity were more likely to purchase antidepressant or antianxiety medications. Older adults, women, those of higher socioeconomic status, and immigrants (with the exception of Jews born in Asia or Africa) were also more likely to purchase medications. Arabs and Jews born in Asia and Africa were less likely to purchase medications even after all other variables were accounted for. Physician characteristics were minimally associated with the purchase of medications. The findings demonstrate that despite universal health care access, there were variations by population groups. Educational efforts should target patients as well as physicians.
Craig, Christopher K; Holmes, James H; Carter, Jeffery E
As the United States faces a predicted physician shortage over the next 2 decades, physician assistants (PAs) and NPs are expected to fill the void. At the same time, because education is expensive, student loan and tuition increases have many potential applicants assessing differences in reimbursement and wondering about their return on investment (ROI). An analysis compared PA and NP salaries by incorporating national salary data, federal income tax, and student loans for a comparative analysis of each career pathway. Salaries were abstracted from the 2012 Bureau of Labor Statistics database. The net present value (NPV) of PA and NP salaries was calculated with a 5% discount rate. Principal and interest for student loans was calculated at a 6% interest fixed-rate loan over 30 years. NPVs were then compared with projected ROI at retirement age. Relative career values were also given to each career choice, based on a retirement age of 65 years, which translates to about 41 years of employment for both PAs and NPs. PAs' and NPs' educational loans both equalled $129,484 on total repayment. The median annual salary of a PA was $90,930 and $89,960 for an NP. PA data yielded a 5% NPV of $781,323 compared with $764,348 for NPs. Of note, the 5% NPV of a 4-year nursing degree is $728,436. PAs have a slightly higher ROI compared with NPs. These findings may change due to adjustments in nursing training models. Many PA programs allow matriculation immediately after obtaining a bachelor's degree. NP schools often require nursing experience before entering their program. Some schools are considering an accelerated NP program, allowing immediate matriculation after obtaining a bachelor's degree. Because many NP programs have become doctoral degrees, the increased duration of training, higher tuition, and fewer years worked before retirement lower the overall NP ROI. A similar reduction in ROI was considered marginal in PAs who attend residency programs-though these programs are
Freeland, Kathryn N; Thompson, Amy N; Zhao, Yumin; Leal, Julie E; Mauldin, Patrick D; Moran, William P
Studies have shown that approximately one third of community-dwelling people aged 65 years and older will experience a fall each year. Many studies indicate that use of multiple medications may put patients at an increased risk of falling, but few studies have been conducted to correlate the number of medications with the risk of falls. To determine the medications most frequently used in patients aged 65 years or older who have experienced a fall within the past year, with particular attention to type or number of medications most commonly associated with multiple falls or a fall with injury. We conducted a chart review in an outpatient internal medicine clinic over a 13-month period. A total of 118 patients 65 years of age or older who were taking 4 or more medications and had experienced at least 1 fall in the previous 12 months were included. Data relating to sex, age, race, diagnoses, medications, and number and type of falls were obtained during the chart review. The primary end point of the study was number and type of medications most commonly used in patients experiencing a fall. A total of 116 patients were examined for trends in fall risk. A logistic regression model and receiver operating characteristic curve demonstrated significant fall risk with the addition of medications, with patients experiencing a 14% increase in fall risk with the addition of each medication beyond a 4-medication regimen (OR 1.14; 95% CI 1.02 to 1.27; p = 0.027). The addition of medications is associated with a significant increase in risk of falls in elderly patients, regardless of drug class. Further studies are needed to assess the possible increased risk of falls with increasing number of medications.
Jang, Sou Hyun
Applying Andersen's health care utilization model, this paper shows the prevalence of immigrants' medical and dental tourism and associated factors. An analysis of the 2003 New Immigrant Survey data shows that about 17% of immigrants received medical care in a foreign country, whereas about one-third obtained dental care outside the United States. Latino immigrants have a higher prevalence of both types of tourism than their Asian counterparts. Race, level of education, and health insured status are commonly associated with medical and dental tourism. The findings contribute to the scarce literature on immigrants' health care utilization and medical and dental tourism.
Mogaka, John J. O.; Mupara, Lucia; Tsoka-Gwegweni, Joyce M
ABSTRACT Global disparities in medical technologies, laws, economic inequities, and social–cultural differences drive medical tourism (MT), the practice of travelling to consume healthcare that is either too delayed, unavailable, unaffordable or legally proscribed at home. Africa is simultaneously a source and destination for MT. MT however, presents a new and challenging health ethics frontier, being largely unregulated and characterized by policy contradictions, minority discrimination and conflict of interest among role-players. This article assesses the level of knowledge of MT and its associated ethical issues in Africa; it also identifies critical research gaps on the subject in the region. Exploratory design guided by Arksey and O’Malley’s (2005) framework was used. Key search terms and prior determined exclusion/inclusion criteria were used to identify relevant literature sources. Fifty-seven articles met the inclusion criteria. Distributive justice, healthcare resource allocation, experimental treatments and organ transplant were the most common ethical issues of medical tourism in Africa. The dearth of robust engagement of MT and healthcare ethics, as identified through this review, calls for more rigorous research on this subject. Although the bulk of the medical tourism industry is driven by global legal disparities based on ethical considerations, little attention has been given to this subject. PMID:28740618
Mogaka, John J O; Mupara, Lucia; Tsoka-Gwegweni, Joyce M
Global disparities in medical technologies, laws, economic inequities, and social-cultural differences drive medical tourism (MT), the practice of travelling to consume healthcare that is either too delayed, unavailable, unaffordable or legally proscribed at home. Africa is simultaneously a source and destination for MT. MT however, presents a new and challenging health ethics frontier, being largely unregulated and characterized by policy contradictions, minority discrimination and conflict of interest among role-players. This article assesses the level of knowledge of MT and its associated ethical issues in Africa; it also identifies critical research gaps on the subject in the region. Exploratory design guided by Arksey and O'Malley's (2005) framework was used. Key search terms and prior determined exclusion/inclusion criteria were used to identify relevant literature sources. Fifty-seven articles met the inclusion criteria. Distributive justice, healthcare resource allocation, experimental treatments and organ transplant were the most common ethical issues of medical tourism in Africa. The dearth of robust engagement of MT and healthcare ethics, as identified through this review, calls for more rigorous research on this subject. Although the bulk of the medical tourism industry is driven by global legal disparities based on ethical considerations, little attention has been given to this subject.
Sapra, Mamta; Vahia, Ipsit V; Reyes, Pia N; Ramirez, Paul; Cohen, Carl I
There are limited data examining subjective influences on medication adherence among older persons with schizophrenia. The subjective reasons for adherence to antipsychotic medication and associated clinical and psychosocial factors in this population are examined. The sample consisted of 198 community dwelling persons aged >or=55 who developed schizophrenia before age 45. Using the Rating of Medication Influences Scale (ROMI), a principal component factor analysis with varimax rotation yielded three subscales: Medication Affinity and Prevention, Influence of Others, and Impact of Authority. These subscales were dichotomized into high and low based on a median split. We also created an ordinal High Adherence measure based on the summed scores of each person's three dichotomized ROMI subscales. A modified Health Belief Model was used to examine the association between 18 predictor variables and the ROMI subscales and the adherence scale. The mean subscale rankings were Medication Affinity and Prevention > Impact of Authority > Influence of Others. In logistic regression, lower education, more side effects, higher depression scores, and more mental health services were associated with higher scores on Influence of Others subscale. More side effects and more entitlements were associated with higher scores on the Medication Affinity and Prevention subscale. The Impact of Authority subscale had no significant associations. More side effects and higher depression scores were associated with higher scores on High Adherence measure. We identified a three-dimensional model for explaining the subjective reasons for medication adherence in older persons with schizophrenia. Our findings suggest that cognitive approaches and use of authority figures may be useful for promoting adherence in older adults. Independent variables associated with these subscales may provide guidance for improving adherence in this population.
Hofstad, van der R.W.; Litvak, N.
Mixing patterns in large self-organizing networks, such as the Internet, the World Wide Web, social, and biological networks are often characterized by degree-degree dependencies between neighboring nodes. In assortative networks, the degree-degree dependencies are positive (nodes with similar
van der Hofstad, Remco; Litvak, Nelly
Mixing patterns in large self-organizing networks, such as the Internet, the World Wide Web, social, and biological networks are often characterized by degree-degree dependencies between neighboring nodes. In assortative networks, the degree-degree dependencies are positive (nodes with similar
Mosconi, P; Colombo, C; Guella, F; Pierotti, B; Vimercati, F
In the framework of PartecipaSalute--an Italian research project aimed to involve lay people, patients' associations and scientific-medical representatives on the health debate --we carried out a survey with the Italian Federation of Medical Societies. The aims of the survey were to know medical societies attitude vs. patients involvement in research activities and healthcare setting and to find out possible projects conducted in partnership with patients associations. A web-questionnaire with 17 closed questions, and three open questions has been prepared on the basis of some experiences published on the literature and through the collaboration of members of the Italian Federation of Medical Societies. A total of 205 medical societies has been contacted by e-mail with a cover letter explaining the aims of the survey. At the end 74 medical societies completed the survey. Medical societies participating to the survey varied widely in terms of years of activity, number of members, and geographical distribution. Remarkably, 36 medical societies respondent organized collaborative initiatives with patients/consumers associations during the last three years. Among these, the most frequent were the preparation of written material for patients, organization of conferences or workshops, and health awareness campaigns. Moreover, 6 medical societies published documents on patients' rights but patients or their associations were involved in only 2 of these initiatives. Advantages and disadvantages reported by medical societies answering are also presented and discussed. In conclusion, to our knowledge this is the first survey on the value of patients' involvement conducted together with medical societies in Italy, and the results point the way to stronger collaboration in future between patients' associations and medical societies.
Sachin C. Deorukhkar
Full Text Available Health care associated infections (HCAIs add incrementally to the morbidity, mortality, and cost expected of the patient’s underlying diseases alone. Approximately, about half all cases of HCAIs are associated with medical devices. As Candida medical device-associated infection is highly drug resistant and can lead to serious life-threatening complications, there is a need of continuous surveillance of these infections to initiate preventive and corrective measures. The present study was conducted at a rural tertiary care hospital of India with an aim to evaluate the rate of medical device-associated Candida infections. Three commonly encountered medical device-associated infections (MDAI, catheter-associated urinary tract infection (CA-UTI, intravascular catheter-related blood stream infections (CR-BSI, and ventilator-associated pneumonia (VAP, were targeted. The overall rate of MDAI in our hospital was 2.1 per 1000 device days. The rate of Candida related CA-UTI and CR-BSI was noted as 1.0 and 0.3, respectively. Untiring efforts taken by team members of Hospital Acquired Infection Control Committee along with maintenance of meticulous hygiene of the hospital and wards may explain the low MDAI rates in our institute. The present surveillance helped us for systematic generation of institutional data regarding MDAI with special reference to role of Candida spp.
Full Text Available Although the left and right human cerebral hemispheres differ both functionally and anatomically, the mechanisms that underlie the establishment of these hemispheric specializations, as well as their physiological and behavioral implications, remain largely unknown. Since cerebral asymmetry is strongly correlated with handedness, and handedness is assumed to be influenced by a number of genetic and environmental factors, we performed an association study of LRRTM1 rs6733871 and a number of polymorphisms in PCSK6 and different aspects of handedness assessed with the Edinburgh handedness inventory in a sample of unrelated healthy adults (n = 1113. An intronic 33bp variable-number tandem repeat (VNTR polymorphism in PCSK6 (rs10523972 shows a significant association (significance threshold: p<0.0025, adjusted for multiple comparisons with a handedness category comparison (P = 0.0005 and degree of handedness (P = 0.001. These results provide further evidence for the role of PCSK6 as candidate for involvement in the biological mechanisms that underlie the establishment of normal brain lateralization and thus handedness and support the assumption that the degree of handedness, instead the direction, may be the more appropriate indicator of cerebral organization.
... the Payment Process Physician Payment Resource Center Reinventing Medical Practice Managing Your Practice CPT® (Current Procedural Terminology) Medicare & Medicaid Private Payer Reform Claims Processing & Practice ...
Full Text Available Background. Blood pressure (BP control is poor among hypertensives in many parts of sub-Saharan Africa. A potentially modifiable factor for control of BP is medication nonadherence (MNA; our study therefore aimed to determine factors associated with MNA among hypertensives in Ghana and Nigeria. Methodology. We conducted a multicenter cross-sectional study. Patients were recruited from Korle-Bu Hospital (n=120, Ghana; and University of Port Harcourt Teaching Hospital, (n=73 Apapa General Hospital Lagos (n=79 and University College Hospital Ibadan (n=85, Nigeria. Results. 357 hypertensive patients (42.6% males participated. MNA was found in 66.7%. Adherence showed correlation with depression (r=-0.208, P<0.001, concern about medications (r=-0.0347, P=0.002, and knowledge of hypertension (r=0.14, P=0.006. MNA was associated with formal education (P=0.001 and use of herbal preparation (P=0.014. MNA was found in 61.7% of uninsured participants versus 73.1% of insured participants (P=0.032. Poor BP control was observed in 69.7% and there was significant association between MNA and poor BP control (P=0.006. Conclusion. MNA is high among hypertensives in Ghana and Nigeria and is associated with depression, concern about hypertensive medications, formal education, and use of herbal preparations. The negative association between health insurance and MNA suggests interplay of other factors and needs further investigation.
Børsting, Tove E; Tvedt, Christine R; Skogestad, Ingrid J; Granheim, Tove I; Gay, Caryl L; Lerdal, Anners
To describe the prevalence of pressure ulcers among middle- and older-aged patients in a general medical hospital in Norway and to describe the associations between pressure ulcers and potential risk factors additional to the Braden risk score. Degrees of mobility, activity, perfusion and skin status are risk factors for development of pressure ulcer. Nurses' clinical judgements combined with risk assessment tools are effective to detect pressure ulcer risk. Cross-sectional study. The study was performed as part of a research project conducted between September 2012-May 2014 in a general hospital in the capital of Norway. Registered nurses and nursing students collected data from all eligible patients on 10 days during the students' clinical practice studies. The Braden scale was used to measure pressure ulcer risk, and skin examinations were performed to classify the skin area as normal or as indicative of pressure ulcer according to the definitions by the National Pressure Ulcer Advisory Panel. Comorbidities were collected by patient's self-report. This analysis focused on the 255 inpatients at the medical wards ≥52 years of age, most of whom had more than one comorbidity. The prevalence of pressure ulcers was 14.9% in this sample. Higher age, underweight, diabetes and worse Braden scores were factors associated with pressure ulcer, and pressure ulcer was most frequently sited at the sacrum or heel. Adding age, weight and diabetes status to pressure ulcer risk assessment scales may improve identification of patients at risk for pressure ulcers. Knowledge about strengths and limitations of risk assessment tools is important for clinical practice. Age, weight and diabetes status should be considered for inclusion in risk assessment tools for pressure ulcers in medical wards. © 2017 John Wiley & Sons Ltd.
Brandstetter, Susanne; Finger, Tamara; Fischer, Wiebke; Brandl, Magdalena; Böhmer, Merle; Pfeifer, Michael; Apfelbacher, Christian
Adherence to medication is crucial for achieving treatment control in chronic obstructive lung diseases. This study refers to the "necessity-concerns framework" and examines the associations between beliefs about medicines and self-reported medication adherence in people with chronic obstructive lung disease. 402 patients (196 with asthma, 206 with COPD) participated in the study and completed a questionnaire comprising the "Beliefs about Medicines-Questionnaire" (BMQ) and the "Medication Adherence Report Scale" (MARS). Multivariable logistic regression analyses with the BMQ-subscales as explanatory and the dichotomized MARS-score as dependent variable were computed for the asthma and the COPD sample, respectively, and adjusted for potentially confounding variables. 19% of asthma patients and 34% of COPD patients were completely adherent to their prescribed medication. While specific beliefs about the necessity of medicines were positively associated with medication adherence both in patients with asthma and with COPD, general beliefs about harm and overuse of medicines by doctors were negatively associated with medication adherence only among patients with asthma. The findings of this study suggest that patients' specific beliefs about the necessity of medicines represent an important modifiable target for improving patient-doctor consultations when prescribing medicines.
Chaudry, Imtiaz; Brown, Gary C; Brown, Melissa M
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.
Saraf, Avantika A.; Peterson, Alec W.; Simmons, Sandra F.; Schnelle, John F.; Bell, Susan P.; Kripalani, Sunil; Myers, Amy P.; Mixon, Amanda S.; Long, Emily A.; Jacobsen, J. Mary Lou; Vasilevskis, Eduard E.
Background More than half of the hospitalized older adults discharged to skilled nursing facilities (SNFs) have more than three geriatric syndromes. Pharmacotherapy may be contributing to geriatric syndromes in this population. Objectives Develop a list of medications associated with geriatric syndromes and describe their prevalence in patients discharged from acute care to skilled nursing facilities (SNFs) Design Literature review and multidisciplinary expert panel discussion, followed by cross-sectional analysis. Setting Academic Medical Center in the United States Participants 154 hospitalized Medicare beneficiaries discharged to SNFs Measurements Development of a list of medications that are associated with six geriatric syndromes. Prevalence of the medications associated with geriatric syndromes was examined in the hospital discharge sample. Results A list of 513 medications was developed as potentially contributing to 6 geriatric syndromes: cognitive impairment, delirium, falls, reduced appetite or weight loss, urinary incontinence, and depression. Medications included 18 categories. Antiepileptics were associated with all syndromes while antipsychotics, antidepressants, antiparkinsonism and opioid agonists were associated with 5 geriatric syndromes. In the prevalence sample, patients were discharged to SNFs with an overall average of 14.0 (±4.7) medications, including an average of 5.9 (±2.2) medications that could contribute to geriatric syndromes, with falls having the most associated medications at discharge, 5.5 (±2.2). Conclusions Many commonly prescribed medications are associated with geriatric syndromes. Over 40% of all medications ordered upon discharge to SNFs were associated with geriatric syndromes and could be contributing to the high prevalence of geriatric syndromes experienced by this population. PMID:27255830
Beistle, Kimberly S.
This study explores dental hygiene faculty's perceptions regarding the issues surrounding the concept of critical thinking skills integration within Michigan accredited associate degree dental hygiene programs. The primary research goals are to determine faculty understanding of the concept of critical thinking, identify personal and departmental…
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Request for Comments on Ethical Issues Associated with the... ethical issues associated with the development of medical countermeasures for children, including ethical... issues associated with the development of medical countermeasures for children, including ethical...
Cardarelli, Roberto; Licciardone, John C
There has been an increase in research evaluating factors associated with disciplinary action of physicians by state medical boards. However, factors related to the severity of disciplinary action are lacking. By investigating these factors while controlling for the type of violation, the authors sought to determine whether physician characteristics influenced the process of disciplinary action by state medical boards. Physicians disciplined by the Texas Medical Board between January 1, 1989, and December 31, 1998, were included in this case-controlled study (N=1129). Multivariate logistic regression analysis was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with license revocation, the most severe disciplinary action, compared with all other forms of disciplinary action combined. Anesthesiologists (OR, 2.45; 95% CI, 1.05-5.74), general practitioners (OR, 1.80; 95% CI, 1.01-3.19), and psychiatrists (OR, 2.68; 95% CI, 1.41-5.13), as well as those with multiple disciplinary actions (OR, 1.91; 95% CI, 1.29-2.83) were most susceptible to license revocation. The more years a disciplined physician was in practice, the greater risk he or she had of license revocation (OR, 1.05; 95% CI, 1.04-1.07). Factors associated with a greater likelihood of license revocation for physicians are: primary medical specialty, number of years in practice, and a history of multiple disciplinary actions.
Agahi, Farshad; Speicher, Mark R; Cisek, Grace
Medical schools use a variety of preadmission indices to select potential students. These indices generally include undergraduate grade point average (GPA), Medical College Admission Test (MCAT) scores, and preadmission interviews. To investigate whether the admission indices used by Midwestern University Arizona College of Osteopathic Medicine are associated with the academic and clinical performance of their students. Associations between the prematriculation variables of undergraduate science GPA, undergraduate total GPA, MCAT component scores, and interview scores and the academic and clinical variables of the first- and second-year medical school GPA, Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 and Level 2-Cognitive Evaluation (CE) total and discipline scores, scores in clinical rotations for osteopathic competencies, COMLEX-USA Level 2-Performance Evaluation passage, and match status were evaluated. Two-tailed Pearson product-moment correlations with a Bonferroni adjustment were used to examine these relationships. The traditional predictors of science and total undergraduate GPA as well as total and component MCAT scores had small to moderate associations with first- and second-year GPA, as well as COMLEX-USA Level 1 and Level 2-CE total scores. Of all predictors, only the MCAT biological sciences score had a statistically significant correlation with failure of the COMLEX-USA Level 2-Performance Evaluation examination (P=.009). Average interview scores were associated only with the osteopathic competency of medical knowledge (r=0.233; n=209; P=.001), as assessed by clerkship preceptors. No predictors were associated with scores in objective structured clinical encounters or with failing to match to a residency position. The data indicate that traditional predictors of academic performance (undergraduate GPA, undergraduate science GPA, and MCAT scores) have small to moderate association with medical school grades and
Maisha Kelly Freeman
those studies were included in this review. Several studies were located that evaluated the safety of medical marijuana; however, much of the review focused on inhaled, recreational marijuana use due to the paucity of information on inhaled medical marijuana. Since marijuana is a Schedule1 product, few clinical studies have been conducted to determine the adverse event profile of the product. As a result, several articles that characterized recreational inhaled marijuana were included. Recreational inhaled marijuana use may be associated with an increase in cardiovascular (CV/ cerebrovascular effects (CVA; however, conflicting information exists in the literature. Recreational marijuana use may also increase risky behaviors that increase the transmission of infectious diseases and respiratory diseases. Many of the studies were retrospective in nature; therefore, it was difficult to determine a cause and effect relationship between inhaled marijuana use and the development of adverse reactions or drug-drug interactions. Conclusions: There is a paucity of information related to the use of inhaled medical marijuana. Recreational marijuana use is associated with several adverse events including CV/CVA, respiratory, and transmission of infectious diseases. Theoretical literature indicates that medical marijuana may be associated with significant drug-drug interactions and adverse drug reactions. Legalization of medical marijuana may be associated with an increase in abuse/dependence and accidental exposures in children. Pharmacists need to be educated regarding the appropriate use of medical marijuana to avoid adverse reactions and potential drug-drug interactions between medical marijuana and other products. Type: Original Research
Ministry of Advanced Education and Labour Market Development, 2009
The BC Diploma, Associate Degree, and Certificate Student Outcomes (DACSO) Survey (formerly the BC College and Institute Student Outcomes Survey) collects and disseminates information about former students' post-secondary experiences and their subsequent labour market and further education experiences. The survey is administered annually to former…
Page, Kathleen Raquel; Castillo-Page, Laura; Wright, Scott M
To describe diversity programs for racial and ethnic minority faculty in U.S. medical schools and identify characteristics associated with higher faculty diversity. The authors conducted a cross-sectional survey study of leaders of diversity programs at 106 U.S. MD-granting medical schools in 2010. Main outcome measures included African American and Latino faculty representation, with correlations to diversity program characteristics, minority medical student representation, and state demographics. Responses were obtained from 82 of the 106 institutions (77.4%). The majority of the respondents were deans, associate and assistant deans (68.3%), members of minority ethnic/racial background (65.9% African American, 14.7% Latino), and women (63.4%). The average time in the current position was 6.7 years, with approximately 50% effort devoted to the diversity program. Most programs targeted medical trainees and faculty (63.4%). A majority of programs received monetary support from their institutions (82.9%). In bivariate analysis, none of the program characteristics measured were associated with higher than the mean minority faculty representation in 2008 (3% African American and 4.2% Latino faculty). However, minority state demographics in 2008, and proportion of minority medical students a decade earlier, were significantly associated with minority faculty representation. Medical student diversity 10 years earlier was the strongest modifiable factor associated with faculty diversity. Our results support intervening early to strengthen the minority medical student pipeline to improve faculty diversity. Schools located in states with low minority representation may need to commit additional effort to realize institutional diversity.
Leng, Yu-xin; Song, Ya-han; Yao, Zhi-yuan; Zhu, Xi
To systemically analyze the effect of 45 degree angle semirecumbent position on the incidence of ventilator-associated pneumonia (VAP) and other outcomes in mechanical ventilated patients, and to evaluate whether 45 degree angle semirecumbent position is superior to 25 degree angle-30 degree angle head of bed (HOB). The randomized controlled trials (RCTs) comparing the effect of different HOB on the outcomes of mechanical ventilated patients were searched (from 1st January 1990 to 20th July 2012) from five databases including the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, China Knowledge Resource Integrated Database (CNKI), and Wanfang Database. Meta analysis was conducted using RevMan 5.0 software. Data extracted from five RCTs with a total of 427 patients were analyzed. The risks of developing clinically diagnosed VAP were significantly lower among the patients in semirecumbent 45 degree angle position compared to the patients in lower position [15.96% (34/213) vs. 26.64% (57/214), relative risk (RR)=0.57, 95% confidence interval (95%CI) 0.39 to 0.83, P=0.003], while no significant differences were detected between the two groups regarding the mortality rate [27.04% (53/196) vs. 28.22% (57/202), RR=0.93, 95%CI 0.68 to 1.27, P=0.66], the length of intensive care unit (ICU) stay [weighted mean difference (WMD)=-0.45, 95%CI -1.08 to 0.18, P=0.16] and the percentage of antibiotics treatment [71.11% (32/45) vs. 60.87% (28/46), RR=1.14, 95%CI 0.85 to 1.53, P=0.37]. Two of the five trials (91 patients) were included in the sub-analysis between 45 degree angle group (45 patients) and 25 degree angle-30 degree angle group (46 patients). The results showed that comparing with 25 degree angle-30 degree angle, 45 degree angle semirecumbent position had no significance in improving patients' clinical outcomes. This study proved that the clinically preferred semirecumbent 45 degree angle position did have effect in reducing the incidence of VAP
Grimes, Tamasine C
AIMS: Movement into or out of hospital is a vulnerable period for medication safety. Reconciling the medication a patient is using before admission with the medication prescribed on discharge, and documenting any changes (medication reconciliation) is recommended to improve safety. The aims of the study were to investigate the factors contributing to medication reconciliation on discharge, and identify the prevalence of non-reconciliation. METHODS: The study was a cross-sectional, observational survey using consecutive discharges from purposively selected services in two acute public hospitals in Ireland. Medication reconciliation, potential for harm and unplanned re-admission were investigated. RESULTS: Medication non-reconciliation was identified in 50% of 1245 inpatient episodes, involving 16% of 9569 medications. The majority of non-reconciled episodes had potential to result in moderate (63%) or severe (2%) harm. Handwritten rather than computerized discharges (adjusted odds ratio (adjusted OR) 1.60, 95% CI 1.11, 2.99), increasing number of medications (adjusted OR 1.26, 95% CI 1.21, 1.31) or chronic illness (adjusted OR 2.08, 95% CI 1.33, 3.24) were associated with non-reconciliation. Omission of endocrine, central nervous system and nutrition and blood drugs was more likely on discharge, whilst omission on admission and throughout inpatient care, without documentation, was more likely for obstetric, gynaecology and urinary tract (OGU) or respiratory drugs. Documentation in the discharge communication that medication was intentionally stopped during inpatient care was less likely for cardiovascular, musculoskeletal and OGU drugs. Errors involving the dose were most likely for respiratory drugs. CONCLUSIONS: The findings inform strategies to facilitate medication reconciliation on discharge from acute hospital care.
Koos, Ralf; Mahnken, Andreas Horst; Dohmen, Guido; Brehmer, Kathrin; Günther, Rolf W; Autschbach, Rüdiger; Marx, Nikolaus; Hoffmann, Rainer
This study sought to examine a possible relationship between the severity of aortic valve calcification (AVC), the distribution of AVC and the degree of aortic valve regurgitation (AR) after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS). 57 patients (22 men, 81 ± 5 years) with symptomatic AS and with a logistic EuroSCORE of 24 ± 12 were included. 38 patients (67%) received a third (18F)-generation CoreValve® aortic valve prosthesis, in 19 patients (33%) an Edwards SAPIEN™ prosthesis was implanted. Prior to TAVI dual-source computed tomography for assessment of AVC was performed. To determine the distribution of AVC the percentage of the calcium load of the most severely calcified cusp was calculated. After TAVI the degree of AR was determined by angiography and echocardiography. The severity of AR after TAVI was related to the severity and distribution of AVC. There was no association between the distribution of AVC and the degree of paravalvular AR after TAVI as assessed by angiography (r = -0.02, p = 0.88). Agatston AVC scores were significantly higher in patients with AR grade ≥ 3 (5055 ± 1753, n = 3) than in patients with AR grade AVC scores > 3000 were associated with a relevant paravalvular AR and showed a trend for increased need for second manoeuvres. There was a significant correlation between the severity of AVC and the degree of AR after AVR (r = 0.50, p AVC have an increased risk for a relevant AR after TAVI as well as a trend for increased need for additional procedures. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Jay R. Hoffman
Full Text Available For the past 50 years anabolic steroids have been at the forefront of the controversy surrounding performance enhancing drugs. For almost half of this time no attempt was made by sports governing bodies to control its use, and only recently have all of the major sports governing bodies in North America agreed to ban from competition and punish athletes who test positive for anabolic steroids. These punitive measures were developed with the primary concern for promotion of fair play and eliminating potential health risks associated with androgenic-anabolic steroids. Yet, controversy exists whether these testing programs deter anabolic steroid use. Although the scope of this paper does not focus on the effectiveness of testing, or the issue of fair play, it is of interest to understand why many athletes underestimate the health risks associated from these drugs. What creates further curiosity is the seemingly well-publicized health hazards that the medical community has depicted concerning anabolic steroidabuse. Is there something that the athletes know, or are they simply naïve regarding the dangers? The focus of this review is to provide a brief history of anabolic steroid use in North America, the prevalence of its use in both athletic and recreational populations and its efficacy. Primary discussion will focus on health issues associated with anabolic steroid use with an examination of the contrasting views held between the medical community and the athletes that are using these ergogenic drugs. Existing data suggest that in certain circumstances the medical risk associated with anabolic steroid use may have been somewhat exaggerated, possibly to dissuade use in athletes
Fleischer, Jesper; Cichosz, Simon Lebech; Jakobsen, Poul Erik
OBJECTIVE: The objective of this study was to elucidate whether the degree of autonomic modulation is associated with the degree of microvascular complications in patients with type 1 diabetes. METHODS: A total of 290 type 1 individuals with diabetes were randomly recruited during normal visits t......, nephropathy, and peripheral neuropathy in individuals with type 1 diabetes patients. CONCLUSIONS: Autonomic dysfunction is present in early stages of retinopathy, nephropathy, and peripheral neuropathy in patients with type 1 diabetes....
Opondo, Dedan; Visscher, Stefan; Eslami, Saeid; Verheij, Robert A.; Korevaar, Joke C.; Abu-Hanna, Ameen
To assess guideline adherence of co-prescribing NSAID and gastroprotective medications for elders in general practice over time, and investigate its potential association with the electronic medical record (EMR) system brand used. We included patients 65 years and older who received NSAIDs between
Opondo, D.; Visscher, S.; Eslami, S.; Verheij, R.A.; Korevaar, J.C.; Abu-Hanna, A.
Objective: To assess guideline adherence of co-prescribing NSAID and gastroprotective medications for elders in general practice over time, and investigate its potential association with the electronic medical record (EMR) system brand used. Methods: We included patients 65 years and older who
Full Text Available Background: This study aims to examine the prevalence and predictors associated with self-medication, and related consequences in Wuhan, China. Methods: Two-hundred-sixty residents were interviewed from randomly selected four districts of Wuhan, China. A modified version of Anderson’s health behavioral model was used in the survey to collect information of self-medication behavior. Multivariable logistic regression analyses were used to measure correlates of the prevalence of self-medication. Results: Nearly half of the respondents would select self-medication, and 39.1% would see a doctor if they felt sick. The most common self-medicated illnesses were cold and cough, cardiovascular disease and gastrointestinal disease. The main reasons for self-medication were that the illness was not severe (enough to see the doctor (45%; the patient did not think that the trouble of seeing a doctor was worth the effort (23%; the patient had no time to see the doctor (12%, and the patient did not want to pay high medical costs (15%. Logistic regression results suggested that respondents tended to select self-medication if the illness was minor or short-term (less than seven days. Conclusions: Our findings suggest that more strict regulation on over-the-counter medicines may be required to reduce health risks related to self-medication. Targeted health education on the risks of self-medication should be considered.
Abdelaziz, Ammar M Y; Alotaibi, Khalid T; Alhurayyis, Jarah H; Alqahtani, Turky A; Alghamlas, Aamer M; Algahtani, Haifa M; Jahrami, Haitham A
To examine the association between depression and physical symptoms among medical students in Bahrain. The present study employed a cross-sectional design. A total of 160 students were recruited, 41.3% were male and 58.8% female, using a convenience sampling approach. Participants completed the validated Patients Health Questionnaires (PHQs) in which they provided information about demographics, physical symptoms, and depression. Results were considered significant if p medical students in Bahrain. Medical educators should take such symptoms seriously among medical students as it may have serious consequences on the mental health of medical students. In practice, adequate awareness initiatives should be organized and provided for medical students to help them overcome their challenges they face. Additionally, incorporating screening self-screening strategies in the medical curriculum can be beneficial for early detections of mental health problems. The Implications and limitations of the study are discussed.
Tung, Joyce Y; Do, Chuong B; Hinds, David A; Kiefer, Amy K; Macpherson, J Michael; Chowdry, Arnab B; Francke, Uta; Naughton, Brian T; Mountain, Joanna L; Wojcicki, Anne; Eriksson, Nicholas
While the cost and speed of generating genomic data have come down dramatically in recent years, the slow pace of collecting medical data for large cohorts continues to hamper genetic research. Here we evaluate a novel online framework for obtaining large amounts of medical information from a recontactable cohort by assessing our ability to replicate genetic associations using these data. Using web-based questionnaires, we gathered self-reported data on 50 medical phenotypes from a generally unselected cohort of over 20,000 genotyped individuals. Of a list of genetic associations curated by NHGRI, we successfully replicated about 75% of the associations that we expected to (based on the number of cases in our cohort and reported odds ratios, and excluding a set of associations with contradictory published evidence). Altogether we replicated over 180 previously reported associations, including many for type 2 diabetes, prostate cancer, cholesterol levels, and multiple sclerosis. We found significant variation across categories of conditions in the percentage of expected associations that we were able to replicate, which may reflect systematic inflation of the effects in some initial reports, or differences across diseases in the likelihood of misdiagnosis or misreport. We also demonstrated that we could improve replication success by taking advantage of our recontactable cohort, offering more in-depth questions to refine self-reported diagnoses. Our data suggest that online collection of self-reported data from a recontactable cohort may be a viable method for both broad and deep phenotyping in large populations.
Fernanda Brenneisen Mayer
Full Text Available Abstract Background To evaluate personal and institutional factors related to depression and anxiety prevalence of students from 22 Brazilian medical schools. Methods The authors performed a multicenter study (August 2011 to August 2012, examining personal factors (age, sex, housing, tuition scholarship and institutional factors (year of the medical training, school legal status, location and support service in association with scores of Beck Depression Inventory (BDI and State Trait Anxiety Inventory (STAI. Results Of 1,650 randomly selected students, 1,350 (81.8 % completed the study. The depressive symptoms prevalence was 41 % (BDI > 9, state-anxiety 81.7 % and trait-anxiety in 85.6 % (STAI > 33. There was a positive relationship between levels of state (r = 0,591, p < 0.001 and trait (r = 0,718, p < 0.001 anxiety and depression scores. All three symptoms were positively associated with female sex and students from medical schools located in capital cities of both sexes. Tuition scholarship students had higher state-anxiety but not trait-anxiety or depression scores. Medical students with higher levels of depression and anxiety symptoms disagree more than their peers with the statements “I have adequate access to psychological support” and “There is a good support system for students who get stressed”. Conclusions The factors associated with the increase of medical students’ depression and anxiety symptoms were female sex, school location and tuition scholarship. It is interesting that tuition scholarship students showed state-anxiety, but not depression and trait-anxiety symptoms.
Tanaka, Masaaki; Fukuda, Sanae; Mizuno, Kei; Kuratsune, Hirohiko; Watanabe, Yasuyoshi
Fatigue is a common complaint among medical students and researchers consider it to be related to poor academic outcomes. The authors' goal in the present study was to determine whether stress and coping strategies were associated with fatigue in medical students. The study group consisted of 73 second-year healthy students attending the Osaka…
Waggener, R.G.; Kereiakes, J.G.; Shalek, R.J.
In this work, the care and testing of measurement and diagnostic instruments are described in detail. Difficulties encountered with therapeutic and diagnostic calibrations are explored and solutions are suggested. VOLUME III Physics Teaching for Radiologic Technologists, Physics Teaching for Diagnostic Radiology Residents, Physics Teaching for Nuclear Medicine Residents, Physics Teaching for Radiotherapy Residents, Degree Programs in Medical Physics, Radiobiology Teaching, Non-Degree Medical Physics Training and American Board of Radiology Certifications, Radioactivity and Production of Medical Isotopes, Practical Medical Physics Consulting, Radiologic Terminology, Nuclear Medicine Imaging Techniques, Description of Radiotherapy Procedures, Medical Applications of Ultrasonography and Thermography, Glossary of Medical and Anatomical Terms Used in Medical Physics, Equipment List for Medical Physics and Acquisition Priority. Bibliography of Reference Materials. Index
Full Text Available Visual acuity is a major parameter for quality of vision and quality of life. Information on visual acuity and its associated factors in rural societies almost untouched by any industrialization is mostly non-available. It was, therefore, the purpose of our study to determine the distribution of visual acuity and its associated factors in a rural population not marked influenced by modern lifestyle. The population-based Central India Eye and Medical Study included 4711 subjects (aged 30+ years, who underwent a detailed ophthalmologic examination including visual acuity measurement. Visual acuity measurements were available for 4706 subjects with a mean age of 49.5±13.4 years (range: 30-100 years. BCVA decreased significantly (P<0.001 from the moderately hyperopic group (0.08±0.15 logMAR to the emmetropic group (0.16±0.52 logMAR, the moderately myopic group (0.28±0.33 logMAR, the highly hyperopic group (0.66±0.62 logMAR and finally the highly myopic group (1.32±0.92 logMAR. In multivariate analysis, BCVA was significantly associated with the systemic parameters of lower age (P<0.001, higher level of education (P<0.001, higher body stature (P<0.001 and higher body mass index (P<0.001, and with the ophthalmic parameters of more hyperopic refractive error (spherical equivalent (P<0.001, shorter axial length (P<0.001, lower degree of nuclear cataract (P<0.001, and lower intraocular pressure (P = 0.006. The results suggest that in the rural population of Central India, major determinants of visual acuity were socioeconomic background, body stature and body mass index, age, refractive error, cataract and intraocular pressure.
McKenzie, D; Pifalo, V
The Medical Library Association Oral History Program uses accepted oral history techniques to collect and preserve interviews with members. The original taped interviews and transcripts are kept in the Medical Library Association archives and made available for research purposes; edited copies of the interviews are distributed through the National Network of Libraries of Medicine, and members are encouraged to borrow and read the histories. Summaries of forty-three interviews provide personal views on health sciences librarianship and the Medical Library Association.
Gastroenterology is one of the most competitive internal medicine fellowship. However, factors that associated with program competitiveness have not been documented. The objective of this study was to evaluate associations between characteristics of gastroenterology fellowship programs and their competitiveness through the proportion of US medical graduates for the academic year 2016/17. This study used a retrospective, cross-sectional design with data obtained from the American Medical Association. The proportion of US medical graduates in gastroenterology fellowships was used as an indicator of program competitiveness. Using both univariate and multivariate linear regression analyses, we analyzed the association between the proportion of medical graduates in each program and 27 program characteristics based on a significance level of 0.05. In total, 153 out of 171 gastroenterology fellowship programs satisfied the inclusion criteria. A multivariate analysis revealed that a higher proportion of US medical graduates was significantly associated with five program characteristics: that it was a university-based program (p < 0.001), the ratio of full-time paid faculty to fellow positions (p < 0.001), the proportion of females in the program (p = 0.002), location in the Pacific region (p = 0.039), and a non-smoker hiring policy (p = 0.042). Among the five significant factors, being university based, located in the Pacific, and having a non-smoker hiring policy were likely to remain unchanged over a long period. However, program directors and candidates should pay attention to equivalence between full-time paid faculty and fellowship positions, and the proportion of women in the program. The former indicates the level of supervision while the latter has become increasingly important owing to the higher proportion of women in medicine.
The purpose of the Salish Koontenai College (SKC) Project for Recruitment and Retention of Native Americans in Associate Degree Nursing was to increase the numbers of Native American registered nurses providing health care to the Native American population of Montana and the northwest mountain states. Recruitment and retention efforts targeted…
Lynch, C; Grant, T; McLoughlin, P; Last, J
Evolving and changing undergraduate medical curricula raise concerns that there will no longer be a place for basic sciences. National and international trends show that 5-year programmes with a pre-requisite for school chemistry are growing more prevalent. National reports in Ireland show a decline in the availability of school chemistry and physics. This observational cohort study considers if the basic sciences of physics, chemistry and biology should be a prerequisite to entering medical school, be part of the core medical curriculum or if they have a place in the practice of medicine. Comparisons of means, correlation and linear regression analysis assessed the degree of association between predictors (school and university basic sciences) and outcomes (year and degree GPA) for entrants to a 6-year Irish medical programme between 2006 and 2009 (n = 352). We found no statistically significant difference in medical programme performance between students with/without prior basic science knowledge. The Irish school exit exam and its components were mainly weak predictors of performance (-0.043 ≥ r ≤ 0.396). Success in year one of medicine, which includes a basic science curriculum, was indicative of later success (0.194 ≥ r (2) ≤ 0.534). University basic sciences were found to be more predictive than school sciences in undergraduate medical performance in our institution. The increasing emphasis of basic sciences in medical practice and the declining availability of school sciences should mandate medical schools in Ireland to consider how removing basic sciences from the curriculum might impact on future applicants.
Funk, Mark E
This lecture explores changes in the medical library profession over the last fifty years, as revealed by individual word usage in a body of literature. I downloaded articles published in the Bulletin of the Medical Library Association and Journal of the Medical Library Association between 1961 and 2000 to create an electronic corpus and tracked annual frequency of individual word usage. I used frequency sparklines of words, matching one of four archetypal shapes (level, rise, fall, and rise-and-fall) to identify significant words. Most significant words fell into the categories of environment, management, technology, and research. Based on word usage changes, the following trends are revealed: Compared to 1961, today's medical librarians are more concerned with digital information, not physical packages. We prefer information to be evidence-based. We focus more on health than medicine. We are reaching out to new constituents, sometimes leaving our building to do so. Teaching has become important for us. We run our libraries more like businesses, using constantly changing technology. We are publishing more research articles. Although these words were chosen by individual authors to tell their particular stories, in the aggregate, our words reveal our story of change in our profession.
Braczko, M.; Tederko, A.; Grzybowski, J.
Collagen membranes were crosslinked by using three agents: glutaraldehyde, hexametylenediisocyanate, and UV irradiation. The increasing concentrations of above chemical agents or longer time of UV exposition resulted in the higher cross-links degree and in the decrease of collagen membranes swelling (measured as water absorption), their elasticity and mechanical resistance. According to American standards, the degree of collagen biomaterial cross-links is determined by measuring of the digestion time by pepsin. However, that method is very time-consuming. In our study, we have that a simple, linear regression between logarithm of digestion time by pepsin exists and it was identical for all three cross-linking agents used. We have concluded that determination of water absorption can be an alternative, simple and fast method for examination of collagen membrane cross-links degree. (author). 16 refs, 7 figs, 1 tab
Full Text Available Background. Nonadherence to medication is a common problem after kidney transplantation. The aim of this study was to explore attitudes towards medication, adherence, and the relationship with clinical outcomes. Method. Kidney recipients participated in a Q-methodological study 6 weeks after transplantation. As a measure of medication adherence, respondents completed the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS©-interview. Moreover, the intrapatient variability in the pharmacokinetics of tacrolimus was calculated, which measures stability of drug intake. Data on graft survival was retrieved from patient records up to 2 years after transplantation. Results. 113 renal transplant recipients (19–75 years old participated in the study. Results revealed three attitudes towards medication adherence—attitude 1: “confident and accurate,” attitude 2: “concerned and vigilant,” and attitude 3: “appearance oriented and assertive.” We found association of attitudes with intrapatient variability in pharmacokinetics of tacrolimus, but not with self-reported nonadherence or graft survival. However, self-reported nonadherence immediately after transplantation was associated with lower two-year graft survival. Conclusion. These preliminary findings suggest that nonadherence shortly after kidney transplantation may be a risk factor for lower graft survival in the years to follow. The attitudes to medication were not a risk factor.
Full Text Available OBJECTIVES: The aim of this study was to demonstrate the existence of systematic associations in drug prescription that lead to the establishment of patterns of polypharmacy, and the clinical interpretation of the associations found in each pattern. METHODS: A cross-sectional study was conducted based on information obtained from electronic medical records and the primary care pharmacy database in 2008. An exploratory factor analysis of drug dispensing information regarding 79,089 adult patients was performed to identify the patterns of polypharmacy. The analysis was stratified by age and sex. RESULTS: Seven patterns of polypharmacy were identified, which may be classified depending on the type of disease they are intended to treat: cardiovascular, depression-anxiety, acute respiratory infection (ARI, chronic obstructive pulmonary disease (COPD, rhinitis-asthma, pain, and menopause. Some of these patterns revealed a clear clinical consistency and included drugs that are prescribed together for the same clinical indication (i.e., ARI and COPD patterns. Other patterns were more complex but also clinically consistent: in the cardiovascular pattern, drugs for the treatment of known risk factors-such as hypertension or dyslipidemia-were combined with other medications for the treatment of diabetes or established cardiovascular pathology (e.g., antiplatelet agents. Almost all of the patterns included drugs for preventing or treating potential side effects of other drugs in the same pattern. CONCLUSIONS: The present study demonstrated the existence of non-random associations in drug prescription, resulting in patterns of polypharmacy that are sound from the pharmacological and clinical viewpoints and that exist in a significant proportion of the population. This finding necessitates future longitudinal studies to confirm some of the proposed causal associations. The information discovered would further the development and/or adaptation of clinical
Song, Sunmi; Lee, Seung-Mi; Jang, Sunmee; Lee, Yoon Jin; Kim, Na-Hyun; Sohn, Hye-Ryoung; Suh, Dong-Churl
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.
Elabras Filho, José; Mello, Fernanda Carvalho de Queiroz; Lupi, Omar; Bica, Blanca Elena Rios Gomes; Papi, José Angelo de Souza; França, Alfeu Tavares
ABSTRACT Objective: To determine the presence of staphylococcal superantigen-specific IgE antibodies and degree of IgE-mediated sensitization, as well as whether or not those are associated with the severity of asthma in adult patients. Methods: This was a cross-sectional study involving outpatients with asthma under treatment at a tertiary care university hospital in the city of Rio de Janeiro, Brazil. Consecutive patients were divided into two groups according to the severity of asthma ba...
Norman, Daniel; Haberman, Paul B; Valladares, Edwin M
Sleep-related breathing disorders are a broad group of disorders that include obstructive sleep apnea, central sleep apnea, and periodic breathing disorders. This article reviews the scientific literature that links SRBD to various medical conditions including hypertension, coronary artery disease, cardiac arrhythmias, stroke, diabetes mellitus, obesity, and depression. Pathophysiologic mechanisms by which SRBD may contribute to these disorders will be discussed, as will data on the degree to which treatment of SRBD may improve these conditions.
Arrais, Paulo Sérgio Dourado; Fernandes, Maria Eneida Porto; Pizzol, Tatiane da Silva Dal; Ramos, Luiz Roberto; Mengue, Sotero Serrate; Luiza, Vera Lucia; Tavares, Noemia Urruth Leão; Farias, Mareni Rocha; Oliveira, Maria Auxiliadora; Bertoldi, Andréa Dâmaso
To analyze the prevalence and associated factors regarding the use of medicines by self-medication in Brazil. This cross-sectional population-based study was conducted using data from the PNAUM (National Survey on Access, Use and Promotion of Rational Use of Medicines), collected between September 2013 and February 2014 by interviews at the homes of the respondents. All people who reported using any medicines not prescribed by a doctor or dentist were classified as self-medication practitioners. Crude and adjusted prevalence ratios (Poisson regression) and their respective 95% confidence intervals were calculated in order to investigate the factors associated with the use of self-medication by medicines. The independent variables were: sociodemographic characteristics, health conditions and access to and use of health services. In addition, the most commonly consumed medicines by self-medication were individually identified. The self-medication prevalence in Brazil was 16.1% (95%CI 15.0-17.5), with it being highest in the Northeast region (23.8%; 95%CI 21.6-26.2). Following the adjusted analysis, self-medication was observed to be associated with females, inhabitants from the North, Northeast and Midwest regions and individuals that have had one, or two or more chronic diseases. Analgesics and muscle relaxants were the therapeutic groups most used for self-medication, with dipyrone being the most consumed medicines. In general, most of the medicines used for self-medication were classified as non-prescriptive (65.5%). Self-medication is common practice in Brazil and mainly involves the use of non-prescription medicines; therefore, the users of such should be made aware of the possible risks. Analisar a prevalência e os fatores associados à utilização de medicamentos por automedicação no Brasil. Este estudo transversal de base populacional foi realizado com dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de medicamentos (PNAUM
Halonen, Jaana I; Lanki, Timo; Yli-Tuomi, Tarja; Turunen, Anu W; Pentti, Jaana; Kivimäki, Mika; Vahtera, Jussi
Road traffic noise is a common environmental nuisance, which has been thought to increase the risk of many types of health problems. However, population-level evidence often remains scarce. This study examined whether road traffic noise is associated with self-rated health and use of psychotropic medication in a cohort of public sector employees. Data are from the Finnish Public Sector Study cohort. Geographical information system (GIS) was used to link modeled outdoor road traffic noise levels (L den) to residential addresses of 15 611 men and women with cross-sectional survey responses on self-rated health and register-based information on the use of antidepressants, anxiolytics, and hypnotics. High trait anxiety scores were used to identify potentially vulnerable individuals. The analyses were run with logistic regression models adjusting for individual and area-level variables. All participants were blind to the aim of the study. Mean level of road traffic noise at participants' home addresses was 52 decibels (dB) (standard deviation 8.1). Noise level >60 dB versus ≤45 dB was associated with poor self-rated health in men [odds ratio (OR) 1.58, 95% confidence interval (95% CI) 1.14-2.21]. Further stratification revealed that the association was evident only among men with high trait anxiety scores (OR 2.23, 95% CI 1.28-3.89). No association was found with psychotropic medication use or among women. Exposure to road traffic noise was not associated with increased use of psychotropic medication, although it was associated with weakened self-rated health among men.
Joyce Y Tung
Full Text Available While the cost and speed of generating genomic data have come down dramatically in recent years, the slow pace of collecting medical data for large cohorts continues to hamper genetic research. Here we evaluate a novel online framework for obtaining large amounts of medical information from a recontactable cohort by assessing our ability to replicate genetic associations using these data. Using web-based questionnaires, we gathered self-reported data on 50 medical phenotypes from a generally unselected cohort of over 20,000 genotyped individuals. Of a list of genetic associations curated by NHGRI, we successfully replicated about 75% of the associations that we expected to (based on the number of cases in our cohort and reported odds ratios, and excluding a set of associations with contradictory published evidence. Altogether we replicated over 180 previously reported associations, including many for type 2 diabetes, prostate cancer, cholesterol levels, and multiple sclerosis. We found significant variation across categories of conditions in the percentage of expected associations that we were able to replicate, which may reflect systematic inflation of the effects in some initial reports, or differences across diseases in the likelihood of misdiagnosis or misreport. We also demonstrated that we could improve replication success by taking advantage of our recontactable cohort, offering more in-depth questions to refine self-reported diagnoses. Our data suggest that online collection of self-reported data from a recontactable cohort may be a viable method for both broad and deep phenotyping in large populations.
Lucca, J M; Ramesh, M; Parthasarathi, G; Ram, D
In spite of the progress made in the treatment of psychiatric disorders during the last few decades, nonadherence continues to be a frequent phenomenon, often associated with potentially severe clinical consequences and increased health-care costs. There are numerous factors associated with medication nonadherence in patients with mental illness. The aim of the study was to determine the incidence and factors associated with medication nonadherence among psychiatric outpatients. A cross-sectional study was carried out in the outpatient psychiatric department of an Indian tertiary care private hospital over a period of 1 year. Patients aged 18 years and above who presented with mental illness as diagnosed by the International Classification of Diseases (ICD)-10 and who were receiving at least one psychotropic medication for at least 1 month were included in the study. Medication adherence was assessed using the Medication Adherence Rating Scale (MARS). Of the 400 patients, 172 (43%) were nonadherent to their prescribed medications. There is a statistically significant association between the education (P = 0.001), number of drugs (P = 0.002), family income (P = 0.013), and nonadherence. Among the 172 patients, 33.5 % were nonadherent to their therapy due to patient-related factors followed by drug-related factors (32%) and disease-related factors (31%). The overall incidence of medication nonadherence in patients with mental illness was 43%. Numerous factors contributed to medication nonadherence. Strategies need to be developed and implemented to enhance medication adherence, and thereby achieve a better therapeutic outcome in patients with mental illness.
J M Lucca
Full Text Available Background: In spite of the progress made in the treatment of psychiatric disorders during the last few decades, nonadherence continues to be a frequent phenomenon, often associated with potentially severe clinical consequences and increased health-care costs. There are numerous factors associated with medication nonadherence in patients with mental illness. The aim of the study was to determine the incidence and factors associated with medication nonadherence among psychiatric outpatients. Materials and Methods: A cross-sectional study was carried out in the outpatient psychiatric department of an Indian tertiary care private hospital over a period of 1 year. Patients aged 18 years and above who presented with mental illness as diagnosed by the International Classification of Diseases (ICD-10 and who were receiving at least one psychotropic medication for at least 1 month were included in the study. Medication adherence was assessed using the Medication Adherence Rating Scale (MARS. Results: Of the 400 patients, 172 (43% were nonadherent to their prescribed medications. There is a statistically significant association between the education (P = 0.001, number of drugs (P = 0.002, family income (P = 0.013, and nonadherence. Among the 172 patients, 33.5 % were nonadherent to their therapy due to patient-related factors followed by drug-related factors (32% and disease-related factors (31%. Conclusion: The overall incidence of medication nonadherence in patients with mental illness was 43%. Numerous factors contributed to medication nonadherence. Strategies need to be developed and implemented to enhance medication adherence, and thereby achieve a better therapeutic outcome in patients with mental illness.
Brummelman, Pauline; Koerts, Janneke; Dullaart, Robin P. F.; van den Berg, Gerrit; Tucha, Oliver; Wolffenbuttel, Bruce H. R.; van Beek, Andre P.
Background In untreated acromegaly patients, decreased cognitive functioning is reported to be associated with the degree of growth hormone (GH) and IGF-1 excess. Whether previous GH excess or current medical treatment for acromegaly specifically affects cognition remains unclear. The aim of this
Viana, Michele; Bottiroli, Sara; Sances, Grazia; Ghiotto, Natascia; Allena, Marta; Guaschino, Elena; Nappi, Giuseppe; Tassorelli, Cristina
Background and aim Factors implicated in the evolution of episodic migraine into chronic migraine are largely elusive. Medication overuse is considered to be one of the main determinants, but other possible clinical and psychological factors can play a role. The aim of this study is to identify factors that are associated with chronic migraine with medication overuse. Method We enrolled consecutive migraine patients, subdividing them in two groups: Subjects with a long history of episodic migraine and subjects with chronic migraine and medication overuse. We then compared their clinical and psychological variables in a cross-sectional study. Results Three hundred and eighteen patients were enrolled, of which 156 were episodic migraine and 162 were chronic migraine and medication overuse patients. The mean age was 42.1 ± 10.3, 80.8% were female. The duration of migraine was 24.6 years in episodic migraine and 24.0 years in chronic migraine and medication overuse ( p = 0.57). After the multivariate analysis, the factors associated to chronic migraine and medication overuse were: Marital status (married vs. unmarried, OR 3.65, 95% CI 1.63-8.19, p = 0.002; separated/divorced/widowed vs. unmarried, OR 4.19, 95% CI 1.13-15.47, p = 0.031), physical activity (OR 0.42, 95% CI 0.19-0.91, p = 0.029), age at onset of migraine (OR 0.94, 95% CI 0.89-0.98, p = 0.016), use of at least one migraine preventive medication (OR 2.36, 95% CI 1.18-4.71, p = 0.014), history of depression (OR 2.91, 95% CI 1.25-6.73, p = 0.012), insomnia associated with the use of hypnotics (OR 5.59, 95% CI 1.65-18.93, p = 0.006), traumatic head injuries (OR 3.54, 95% CI 1.57-7.99, p = 0.002), snoring (OR 2.24, 95% CI 1.05-4.79, p = 0.036), previous and/or actual use of combined oral contraceptives (OR 3.38, 95% CI 1.10-10.3, p = 0.031) and higher scores in the Childhood Trauma questionnaire (OR 1.48, 95% CI 1.09-2.02, p = 0.012). Conclusion We considered
Payne, Rupert A; Abel, Gary A; Simpson, Colin R; Maxwell, Simon R J
Falls are a major cause of morbidity and mortality in the elderly. This study examined the frequency of hospital admission for falls or fractures, and the association with a recent change in the use of cardiovascular and psychotropic medications. We conducted a retrospective case-cohort study of 39,813 patients aged >65 years from 40 Scottish general practices. Data on current prescriptions, dates of drug changes (defined as increases in dose or starting new drugs), diagnoses and clinical measurements were extracted from primary care electronic records, linked to national hospital admissions data. Multivariable logistic regression was used to model the association of change in prescribing of cardiovascular or psychotropic medication with admission to hospital for falls or fractures in the following 60 days. A total of 838 patients (2.1 %) were admitted in the 1-year study period. Following adjustment for factors including age, sex, socioeconomic deprivation, co-morbidity and current prescribing, changes in both cardiovascular and psychotropic medications were associated with subsequent admission for falls or fractures (odds ratio [OR] 1.54 [95 % confidence interval (CI) 1.17-2.03] and 1.68 [95 % CI 1.28-2.22], respectively). There was no evidence for a difference in the effect of change in medication for different cardiovascular drug types (p = 0.86), but there was evidence (p = 0.003) for variation in the association between change in different psychotropic medications and admission; the strongest associations were observed for changes in selective serotonin reuptake inhibitor (SSRI) antidepressants (OR 1.99 [95 % CI 1.29-3.08]), non-SSRI/tricyclic antidepressants (OR 4.39 [95 % CI 2.21-8.71]) and combination psychotropic medication (OR 3.05 [95 % CI 1.66-5.63]). Recent changes in psychotropic and cardiovascular medications are associated with a substantial increase in risk of hospital admission for falls and fractures. Caution should thus be taken when
Haynes, Douglas M
In May 1870 the American Medical Association (AMA) voted to deny the admission of black delegates and their white colleagues to the national meeting in Washington, D.C. Historians of race and medicine have customarily viewed this decision as marking a crucial milestone in the formation of the nexus between racism and the development of the American medical profession in the era after the Civil War (1861-64). This study recasts this narrative by locating the 1870 decision in relation to the antebellum practices of the association and their social consequences for American medicine. It argues that the viability of the AMA as the national voice of the profession was critically dependent on rejecting racial equality. Indeed, at a moment when the question of the abolition of slavery polarized the nation, the AMA was founded in 1847 to create a voluntary professional organization, national in scope, dedicated to raising the standards of medical training and practice. To this end, the AMA elected presidents and selected host cities for annual meetings in the North, South, and West. Seven out of the fourteen meetings and six out of fourteen presidents were from slave and/or border states. These institutional practices together with the representation of blacks as different and enjoying an appropriate status as slaves grounded the national identity of the profession in black subordination. Similarly, the gendered discourses about healing and practices of female exclusion privileged medical authority as male by drawing on and reinforcing patriarchy. In the wake of the war, leaders hoped to restore the national character of the organization by resuming antebellum practices. In response to the new possibilities for blacks in medicine--as represented by the biracial National Medical Society--the AMA took steps to vigorously police the racial boundaries of the national profession. As this study will show, the 1870 decision reflected the logic of the racial politics at the heart
Full Text Available BACKGROUND: Few data are available evaluating the associations of formal public health education with long-term career choice and professional outcomes among medical school graduates. The objective of this study was to determine if formal public health education via completion of a masters of public health (MPH degree among US medical school graduates was associated with early and long-term career choice, professional satisfaction, or research productivity. METHODS: We conducted a retrospective cohort study in 1108 physicians (17.1% completed a MPH degree who had 10-20 years of follow-up post medical school graduation. Multivariable logistic regression analyses were conducted. RESULTS: Compared to their counterparts with no MPH, medical school graduates with a MPH were more likely to have completed a generalist primary care residency only [relative risk (RR 1.79, 95% confidence interval (CI 1.35-2.29], obtain employment in an academic institution (RR 1.81; 95% CI 1.33-2.37 or government agency (RR 3.26; 95% CI 1.89-5.38, and practice public health (RR 39.84; 95% CI 12.13-107.38 or primary care (RR 1.59; 95% CI 1.18-2.05. Furthermore, medical school graduates with a MPH were more likely to conduct public health research (RR 8.79; 95% CI: 5.20-13.82, receive NIH or other federal funding (RR 3.11, 95% CI 1.74-5.33, have four or more peer-reviewed publications (RR 2.07; 95% CI 1.56-2.60, and have five or more scientific presentations (RR 2.31, 95% CI 1.70-2.98. CONCLUSION: Formal public health education via a MPH was associated with career choice and professional outcomes among physicians.
Gu, Linni; Wu, Shaomin; Zhao, Shuliang; Zhou, Huixuan; Zhang, Shengfa; Gao, Min; Qu, Zhiyong; Zhang, Weijun; Tian, Donghua
The prevalence of diabetes is steadily increasing in China. When diabetes is uncontrolled, it generates dire consequences for health and well-being. Numerous studies have shown that health outcomes were associated with social support and medication adherence. Previous study confirmed that social support was associated with medication adherence in patients with heart failure, HIV diseases, and first-episode psychosis. However, the relationship between social support and medication adherence in patients with type 2 diabetes mellitus (T2DM) is remains unclear. This study aims to examine whether social support is associated with medication adherence in patients with T2DM. This study was conducted in the First Affiliated Hospital of the General Hospital of the People's Liberation Army (PLA). In Beijing, a systematic random sample of 412 patients with T2DM over 18 years was recruited at baseline, and demographic characteristics, clinical data and their assessment of social support were collected from medical records and self-reported questionnaires. 330 of these patients completed a self-report measure of medication adherence at the sixth month after baseline data collection. Regression analysis showed that social support presented a positive effect on medication adherence, additionally, support utilization and the subscale of social support exhibited a significantly strong influence on medication adherence in patients with T2DM. Although medication adherence was influenced by multiple factors, this finding confirmed that social support must be recognized as a core element in interventions aimed at improving in the management of patients with T2DM.
Stepansky, Mona A; Roache, Caitlin R; Holmbeck, Grayson N; Schultz, Karen
The purpose of this study was 2-fold: (1) to explore the transfer of responsibility of medical tasks from parent to child during the transition to adolescence, and (2) to examine the associations between family functioning and medical adherence in youth with spina bifida. Seventy families of children with spina bifida participated in this study. Data were collected during family interaction sessions by using questionnaires completed by mothers, fathers, youth, teachers and health professionals. Findings suggest that responsibility for medical regimens transfers gradually from parent to child over time. Additionally, family conflict and cohesion were correlated with medical adherence. Finally, family conflict over medical issues was related to a decrease in medical adherence over time. Results suggest that as youth take more responsibility over their medical regimens, family conflict regarding medical issues becomes a contributor to their adherence behaviors. Interventions that target family conflict may facilitate adherence behaviors.
Phelan, Sean M; Burke, Sara E; Hardeman, Rachel R; White, Richard O; Przedworski, Julia; Dovidio, John F; Perry, Sylvia P; Plankey, Michael; A Cunningham, Brooke; Finstad, Deborah; W Yeazel, Mark; van Ryn, Michelle
Implicit and explicit bias among providers can influence the quality of healthcare. Efforts to address sexual orientation bias in new physicians are hampered by a lack of knowledge of school factors that influence bias among students. To determine whether medical school curriculum, role modeling, diversity climate, and contact with sexual minorities predict bias among graduating students against gay and lesbian people. Prospective cohort study. A sample of 4732 first-year medical students was recruited from a stratified random sample of 49 US medical schools in the fall of 2010 (81% response; 55% of eligible), of which 94.5% (4473) identified as heterosexual. Seventy-eight percent of baseline respondents (3492) completed a follow-up survey in their final semester (spring 2014). Medical school predictors included formal curriculum, role modeling, diversity climate, and contact with sexual minorities. Outcomes were year 4 implicit and explicit bias against gay men and lesbian women, adjusted for bias at year 1. In multivariate models, lower explicit bias against gay men and lesbian women was associated with more favorable contact with LGBT faculty, residents, students, and patients, and perceived skill and preparedness for providing care to LGBT patients. Greater explicit bias against lesbian women was associated with discrimination reported by sexual minority students (b = 1.43 [0.16, 2.71]; p = 0.03). Lower implicit sexual orientation bias was associated with more frequent contact with LGBT faculty, residents, students, and patients (b = -0.04 [-0.07, -0.01); p = 0.008). Greater implicit bias was associated with more faculty role modeling of discriminatory behavior (b = 0.34 [0.11, 0.57); p = 0.004). Medical schools may reduce bias against sexual minority patients by reducing negative role modeling, improving the diversity climate, and improving student preparedness to care for this population.
To conduct a bibliometric analysis of the Original articles published in the Journal of Pakistan Medical Association. The study was conducted in Peshawar and comprised all Original articles published in the Journal of Pakistan Medical Association between 2009 and2013. The articles were downloaded from the Journal website and bibliometric parameters were analysed. A total number of 913 Original articles were found in regular issues of the Journal, while leaving out six special supplements that were published during the period under study. The number of Original articles increased steadily from 148(16.2%) in 2009 to 214(23.4%) in 2013, In yearly terms, Original articles published each year ranged between 148 and 214; 510(55.9%) had 21-30 citations; 3-author contributions ranked the highest with 206(22.6%); 481(52.7%) authors were geographically affiliated to Sindh, Pakistan; Community Medicine was the most popular medical specialty with was 140(15.3%) articles; 17340(90.5%) citations were from journals; and the most productive institution was Aga Khan University, Karachi. The number of papers published in Journal of Pakistan Medical Association per issue increased from 2009 to 2013 and the main region in terms of contribution was Sindh.
The Association of Canadian Medical Colleges has evolved over the 50 years of its existence in ways that could not have been anticipated by its founders who, none the less, would approve of the mature adult their infant has become. Both undergraduate and postgraduate medical education in Canada are now on a firmer and more rational base than would have been possible without the guidance and direction provided by a national body capable of resisting regional and sectarian pressures. Credit for this achievement must go to those who were responsible for the creation of the secretariat in the early 1960s. The vision of Wendell Macleod, the first chief executive officer, led to the development of the association's strong research arm, and his charm and wisdom created a smoothly operating and loyal staff. The record of the organization is a tribute to its staff and to the wisdom and foresight of its Council of Deans and Board of Directors. PMID:8477373
Lally, John; McDonald, Colm
The authors report the case of a 44-year-old man with a long history of chronic enduring schizophrenia who experienced dramatic weight loss after commencing treatment with clozapine, an antipsychotic medication characteristically associated with the greatest degree of weight gain among medical treatments for schizophrenia. He was obese with a body mass index (BMI) of 41.5 kg/m2, but after commencing clozapine therapy he experienced an improvement in psychotic symptoms and 40% loss of his body...
Thomas, Cynthia M; McIntosh, Constance E; Mensik, Jennifer S
Health care has become very complex and is in a constant state of change. As a result of the evolving change and increasing complexity, a more educated nursing workforce is needed (Dracup K. Master's nursing programs. American Association of Colleges of Nursing. 2015; Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. 2010). It is now becoming necessary for registered nurses to earn an advanced degree to work at the highest level of their practice authority (Dracup K. Master's nursing programs. American Association of Colleges of Nursing. 2015; Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. 2010.). Preparing to reenter college may be an overwhelming prospect for some registered nurses seeking an advanced degree. However, there are some simple strategies that may help sort out the many degree options, financial obligations, decisions about brick and mortar versus online learning, commitment to degree completion, and changing career paths. This article will provide the registered nurse valuable information that will assist in the exciting process of returning to college.
Antony B Holmes
Full Text Available Electronic health record (EHR systems offer an exceptional opportunity for studying many diseases and their associated medical conditions within a population. The increasing number of clinical record entries that have become available electronically provides access to rich, large sets of patients' longitudinal medical information. By integrating and comparing relations found in the EHRs with those already reported in the literature, we are able to verify existing and to identify rare or novel associations. Of particular interest is the identification of rare disease co-morbidities, where the small numbers of diagnosed patients make robust statistical analysis difficult. Here, we introduce ADAMS, an Application for Discovering Disease Associations using Multiple Sources, which contains various statistical and language processing operations. We apply ADAMS to the New York-Presbyterian Hospital's EHR to combine the information from the relational diagnosis tables and textual discharge summaries with those from PubMed and Wikipedia in order to investigate the co-morbidities of the rare diseases Kaposi sarcoma, toxoplasmosis, and Kawasaki disease. In addition to finding well-known characteristics of diseases, ADAMS can identify rare or previously unreported associations. In particular, we report a statistically significant association between Kawasaki disease and diagnosis of autistic disorder.
Loayza H.,Maria Paz; Ponte,Talles S.; Carvalho,Clarissa G.; Pedrotti,Michell R.; Nunes,Paula V.; Souza,Camila M.; Zanette,Camila B.; Voltolini,Sara; Chaves,Marcia L. F.
Epidemiological research points to the high prevalence of psychiatric disorders among insomniacs. We carried out a cross-sectional study with medical students with the aim of evaluating the association between insomnia and suspicion of psychiatric disorder; 302 medical students were included (184 males and 118 females; mean age = 20.47±1.89 years). The main association was tested by logistic regression analysis. The overall prevalence of positivity in a screening test for psychiatric disorder...
Kassie, Aster Desalew; Bifftu, Berhanu Boru; Mekonnen, Habtamu Sewunet
Self-medication practice (SMP) is the use of medication without the prescription of health care professionals. The major problems associated with self-medication practice have been drug resistance, drug side effects, wastage of resources, and serious health hazards including death. Thus, the main purpose of this study was to assess the prevalence of self-medication practice and its associated factors among adult household members in Meket District, Northeast Ethiopia. A community based cross-sectional study was conducted among 722 adult household members in Meket District, from April 5 to May 5, 2017. The systematic random sampling method was used to select study participants. A pre-tested, structured questionnaire was used for data collection using an interviewer-administered technique. Epi-info version and SPSS version 22 were utilized for data entry and analysis, respectively. Univariate and multivariate logistic regression was used to identify association factors. The overall prevalence of self-medication was found to be 35.9%. Unmarried status (AOR = 2.17, 95% CI = 1.18, 4.01), previous experience of self-medication (AOR = 1.78, 95% CI = 1.22, 2.61), accessibility of pharmacies (AOR = 3.71, 95% CI = 1.31, 10.51), peer/family pressure (AOR = 2.88, 95% CI = 1.98, 4.18) and presence of medication at home (AOR = 1.80, 95% CI = 1.11, 2.92) were factors associated with self-medication practices. More than one-third of the study participants practiced self-medication. Thus, strengthening communities awareness on drug side effects and integrated efforts of individuals, communities, health facilities, and regulatory bodies are highly necessary.
Lourinho, Isabel; Moreira, André; Mota-Cardoso, Rui; Severo, Milton; Ferreira, Maria Amélia
Personality has became popular in medical student's selection. However, few research exists about the association between the big five personality traits and the existent medical school selection tools. Our aim was to study which personality traits were selected by a medical school admission interview. One hundred ninety four graduate applicants that had applied to the Faculty of Medicine of the University of Porto through the graduate entry approach, after ranked on previous achievement, were interviewed between the academic years of 2011 and 2013. From these, 181 (93.3%) answered to the NEO Five-Factor Inventory that assesses high order personality traits of openness to experience, conscientiousness, extraversion, agreeableness and neuroticism. Admission interview corresponded to the second phase of the seriation process. Every applicant was interviewed and scored by three interviewers on seven dimensions asesssed by Lickert scale (1-10). Interview score was the sum of the dimensions. Linear mixed effects model and respective regression coefficients were used to estimate the association between personality traits from each interviewer's score. Final models were adjusted for gender, interviewers and previous achievement. Openness to experience (Beta = 0.18: CI 95%: 0.05; 0.30) had the strongest association with interview score followed by the interaction effect between the extraversion and conscientiousness traits (Beta = 0.14; CI 95%: 0.02; 0.25). Also, applicants scored higher when their gender was opposite to the interviewers. Previous achievement and interview score had no association. Our admission interview selected different personality traits when compared to other selection tools. Medical schools should be aware of the implications of the adopted selection tools on the admitted medical student's personality because it can help providing beneficial interventions.
Williams, Ishmael; Valderrama, Amy L; Bolton, Patricia; Greek, April; Greer, Sophia; Patterson, Davis G; Zhang, Zefeng
To examine prehospital emergency medical services (EMS) scope of practice for acute cardiovascular events and characteristics that may affect scope of practice; and to describe variations in EMS scope of practice for these events and the characteristics associated with that variability. In 2008, we conducted a telephone survey of 1,939 eligible EMS providers in nine states to measure EMS agency characteristics, medical director involvement, and 18 interventions authorized for prehospital care of acute cardiovascular events by three levels of emergency medical technician (EMT) personnel. A total of 1,292 providers responded to the survey, for a response rate of 67%. EMS scope of practice interventions varied by EMT personnel level, with the proportion of authorized interventions increasing as expected from EMT-Basic to EMT-Paramedic. Seven of eight statistically significant associations indicated that EMS agencies in urban settings were less likely to authorize interventions (odds ratios department-based EMS agencies were two to three times more likely to authorize interventions for EMT-Intermediate personnel. Volunteer EMS agencies were more than twice as likely as nonvolunteer agencies to authorize interventions for EMT-Basic and EMT-Intermediate personnel but were less likely to authorize any one of the 11 interventions for EMT-Paramedics. Greater medical director involvement was associated with greater likelihood of authorization of seven of the 18 interventions for EMT-Basic and EMT-Paramedic personnel but had no association with EMT-Intermediate personnel. We noted statistically significant variations in scope of practice by rural vs. urban setting, medical director involvement, and type of EMS service (fire department-based/non-fire department-based; volunteer/paid). These variations highlight local differences in the composition and capacity of EMS providers and offer important information for the transition towards the implementation of a national scope of
Pisani, Margaret A; Araujo, Katy L B; Murphy, Terrence E
To evaluate the association between cumulative dose of haloperidol and next-day diagnosis of delirium in a cohort of older medical ICU patients, with adjustment for its time-dependent confounding with fentanyl and intubation. Prospective, observational study. Medical ICU at an urban, academic medical center. Age 60 years and older admitted to the medical ICU who received at least one dose of haloperidol (n = 93). Of these, 72 patients were intubated at some point in their medical ICU stay, whereas 21 were never intubated. None. Detailed data were collected concerning time, dosage, route of administration of all medications, as well as for important clinical covariates, and daily status of intubation and delirium using the confusion assessment method for the ICU and a chart-based algorithm. Among nonintubated patients, and after adjustment for time-dependent confounding and important covariates, each additional cumulative milligram of haloperidol was associated with 5% higher odds of next-day delirium with odds ratio of 1.05 (credible interval [CI], 1.02-1.09). After adjustment for time-dependent confounding and covariates, intubation was associated with a five-fold increase in odds of next-day delirium with odds ratio of 5.66 (CI, 2.70-12.02). Cumulative dose of haloperidol among intubated patients did not change their already high likelihood of next-day delirium. After adjustment for time-dependent confounding, the positive associations between indicators of intubation and of cognitive impairment and next-day delirium became stronger. These results emphasize the need for more studies regarding the efficacy of haloperidol for treatment of delirium among older medical ICU patients and demonstrate the value of assessing nonintubated patients.
Chen, Hsiu-Chin; Bennett, Sean
Little evidence shows the use of decision-tree algorithms in identifying predictors and analyzing their associations with pass rates for the NCLEX-RN(®) in associate degree nursing students. This longitudinal and retrospective cohort study investigated whether a decision-tree algorithm could be used to develop an accurate prediction model for the students' passing or failing the NCLEX-RN. This study used archived data from 453 associate degree nursing students in a selected program. The chi-squared automatic interaction detection analysis of the decision trees module was used to examine the effect of the collected predictors on passing/failing the NCLEX-RN. The actual percentage scores of Assessment Technologies Institute®'s RN Comprehensive Predictor(®) accurately identified students at risk of failing. The classification model correctly classified 92.7% of the students for passing. This study applied the decision-tree model to analyze a sequence database for developing a prediction model for early remediation in preparation for the NCLEXRN. [J Nurs Educ. 2016;55(8):454-457.]. Copyright 2016, SLACK Incorporated.
Schifano, Fabrizio; Orsolini, Laura; Papanti, Duccio; Corkery, John
Over the last decade, the 'traditional' drug scene has been supplemented - but not replaced - by the emergence of a range of novel psychoactive substances (NPS), which are either newly created or existing drugs, including medications, now being used in novel ways. By the end of 2014, in excess of 500 NPS had been reported by a large number of countries in the world. Most recent data show, however, that synthetic cathinones, synthetic cannabinoids, and psychedelics/phenethylamines account for the largest number of NPS.The present chapter aims at providing an overview of the clinical and pharmacological issues relating to these most popular NPS categories. Given the vast range of medical and psychopathological issues associated with the molecules here described, it is crucial for health professionals to be aware of the effects and toxicity of NPS. A general overview of the acute management of NPS adverse events is provided as well, although further studies are required to identify a range of evidence-based, index molecule-focused, treatment strategies. The rapid pace of change in the NPS online market constitutes a major challenge to the provision of current and reliable scientific knowledge on these substances.
Yusoff, Muhamad S B
The demanding and intense environment of medical training can create excessive pressures on medical students that eventually lead to unfavorable consequences, either at a personal or professional level. These consequences can include poor academic performance and impaired cognitive ability. This study was designed to explore associations between pass-fail outcome and psychological health parameters (i.e. stress, anxiety, and depression symptoms). A cross-sectional study was conducted on a cohort of first-year medical students in a Malaysian medical school. The depression anxiety stress scale 21-item assessment (DASS-21) was administered to them right after the final paper of the first-year final examination. Their final examination outcomes (i.e. pass or fail) were traced by using their student identity code (ID) through the Universiti Sains Malaysia academic office. A total of 194 (98.0%) of medical students responded to the DASS-21. An independent t-test showed that students who passed had significantly lower stress, anxiety, and depression symptoms than those who failed the first-year final examination (P passed the examination. Those who experienced high stress levels were more likely to fail than those who did not. Reducing the psychological distress of medical students prior to examination may help them to perform better in the examination.
Psihogios, Alexandra M; Holmbeck, Grayson N
This study investigated mother-child discrepancies over perceptions of who is responsible for spina bifida (SB) medical tasks in relation to family conflict and medical adherence. 140 youth with SB and their mothers completed questionnaires regarding who is responsible for specific SB medical tasks, family conflict, and medical adherence. An observational measure was also used to assess family conflict. Although children viewed themselves as more responsible for medical management than mothers did, mother-child discrepancies were not associated with family conflict or medical adherence. Interaction effects revealed that adherence was better when family conflict was low and when parents were responsible for medical tasks. Parental involvement in SB medical care is essential for optimal medical adherence during adolescence. The presence of family conflict also plays an influential role on SB medical adherence. Future research should evaluate the relations between discrepancies, family conflict, and medical adherence across time.
Fowler-Brown, Angela G; Ngo, Long H; Phillips, Russell S; Wee, Christina C
The current impact of adolescent obesity on educational attainment is not clear. The objectives of our study were to determine whether adolescent obesity is associated with college degree attainment and how this association may have changed over time. We used data from a contemporary national cohort of over 4,000 persons who were adolescents (aged 14-18) in 1997 to assess the relationship between adolescent obesity and education. To assess for changes in this relationship over time, we also analyzed an older, similarly structured cohort of over 3,000 persons who were adolescents (aged 16-18) in 1981. Our primary outcome was college degree completion. We found that in the older cohort (adolescents in 1979), there were no differences in college degree attainment by adolescent weight status before and after adjustment. However, unadjusted analysis of the contemporary cohort (adolescents in 1997) demonstrated that those who were normal weight as adolescents had a higher prevalence of college degree attainment at follow-up compared to obese adolescents (24% vs. 10%). After adjustment for socio-demographic variables (age, sex, race, height, parental income-to-poverty ratio, parental education, aptitude test scores), obese adolescents were less likely to have attained a college degree compared to normal weight peers (adjusted risk ratio 0.61 95% confidence interval 0.38-0.83). Expectations for a future college degree did not vary by weight status and did not explain this observation. In conclusion, adolescent obesity is associated with lower likelihood of college completion. This relationship was not observed in an older cohort of adolescents.
Full Text Available Background. Chronic stress among medical students affects academic performance of students and leads to depression, substance use, and suicide. There is, however, a shortage of such research evidence in Ethiopia. Objective. We aimed to estimate the prevalence and severity of stress and its association with substance use and academic performance among medical students. Methods. A cross-sectional survey was conducted on a sample of 329 medical students at Jimma University. Data were collected using the General Health Questionnaire (GHQ-12, Medical Students Stress Questionnaire (MSSQ-20, and Drug Abuse Surveillance Test (DAST. Data were analyzed using SPSS version 20.0. Logistic regression analysis and Student’s t-test were applied. Results. The mean age of the respondents was 23.02 (SD = 2.074 years. The current prevalence of stress was 52.4%. Academic related stressor domain was the main source of stress among 281 (88.6% students. Stress was significantly associated with khat chewing [AOR = 3.03, 95% CI (1.17, 7.85], smoking [AOR = 4.55, 95% CI (1.05, 19.77], and alcohol intake [AOR = 1.93, 95% CI (1.03, 3.60]. The prevalence of stress was high during the initial three years of study. Stress was significantly (p=0.001 but negatively (r=-0.273 correlated with academic achievement. Conclusion. Stress was a significant problem among medical students and had a negative impact on their academic performance. Year of study, income, and substance use were associated with stress. Counseling and awareness creation are recommended.
Darnell, Doyanne; Peterson, Roselyn; Berliner, Lucy; Stewart, Terri; Russo, Joan; Whiteside, Lauren; Zatzick, Douglas
Rape is associated with posttraumatic stress disorder (PTSD) and related comorbidities. Most victims do not obtain treatment for these conditions. Acute care medical settings are well positioned to link patients to services; however, difficulty engaging victims and low attendance at provided follow-up appointments is well documented. Identifying factors associated with follow-up can inform engagement and linkage strategies. Administrative, patient self-report, and provider observational data from Harborview Medical Center were combined for the analysis. Using logistic regression, we examined factors associated with follow-up health service utilization after seeking services for rape in the emergency department. Of the 521 diverse female (n = 476) and male (n = 45) rape victims, 28% attended the recommended medical/counseling follow-up appointment. In the final (adjusted) logistic regression model, having a developmental or other disability (OR = 0.40, 95% CI = 0.21-0.77), having a current mental illness (OR = 0.25, 95% CI = 0.13-0.49), and being assaulted in public (OR = 0.50, 95% CI = 0.28-0.87) were uniquely associated with reduced odds of attending the follow-up. Having a prior mental health condition (OR = 3.02, 95% CI = 1.86-4.91), a completed Sexual Assault Nurse Examiner's (SANE) examination (OR = 2.97, 95% CI = 1.84-4.81), and social support available to help cope with the assault (OR = 3.54, 95% CI = 1.76-7.11) were associated with an increased odds of attending the follow-up. Findings point to relevant characteristics ascertained at the acute care medical visit for rape that may be used to identify victims less likely to obtain posttraumatic medical and mental health services. Efforts to improve service linkage for these patients is warranted and may require alternative service delivery models that engage rape survivors and support posttraumatic recovery.
Vijay, Aishwarya; Earnshaw, Valerie A.; Tee, Ying Chew; Pillai, Veena; White Hughto, Jaclyn M.; Clark, Kirsty; Kamarulzaman, Adeeba; Altice, Frederick L.
Abstract Purpose: Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. Methods: A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. Results: Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. Conclusions: Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings. PMID:29227183
Vijay, Aishwarya; Earnshaw, Valerie A; Tee, Ying Chew; Pillai, Veena; White Hughto, Jaclyn M; Clark, Kirsty; Kamarulzaman, Adeeba; Altice, Frederick L; Wickersham, Jeffrey A
Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings.
Thiemann, Pia; Quince, Thelma; Benson, John; Wood, Diana; Barclay, Stephen
Death anxiety (DA) is related to awareness of the reality of dying and death and can be negatively related to a person's psychological health. Physicians' DA also may influence their care for patients approaching death. Doctors face death in a professional context for the first time at medical school, but knowledge about DA among medical students is limited. This study examined medical students' DA in relation to: 1) its severity, gender differences, and trajectory during medical education and 2) its associations with students' attitudes toward palliative care and their psychological health. Four cohorts of core science and four cohorts of clinical students at the University of Cambridge Medical School took part in a questionnaire survey with longitudinal follow-up. Students who provided data on the revised Collett-Lester Fear of Death Scale were included in the analysis (n = 790). Medical students' DA was moderate, with no gender differences and remained very stable over time. High DA was associated with higher depression and anxiety levels and greater concerns about the personal impact of providing palliative care. The associations between high DA and lower psychological health and negative attitudes toward palliative care are concerning. It is important to address DA during medical education to enhance student's psychological health and the quality of their future palliative care provision. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Wolf, Megan R; Rosenstock, Jason B
The authors studied whether low levels of exercise or inadequate sleep correlated with higher levels of burnout and depression in medical students. Medical students of all years at the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, were invited to participate in an anonymous online survey in Fall 2012 and Winter 2013. Validated measures were used to assess exercise, sleep, burnout, and depression. Response rates were 28.7 % at the beginning of the school year and 22.6 % at the middle of the school year. Burnout rates overall were 22.4 % at the beginning of the year and 19.2 % in the middle of the year. Eight percent of students screened positive for depression at the beginning of the year and 9.3 % in the middle of the year. Decreased exercise frequency was significantly correlated with lower professional efficacy. Pathological sleepiness was significantly associated with a higher prevalence of burnout. Inadequate sleep correlated with significantly lower professional efficacy and higher exhaustion scores. Burnout was associated with a positive depression screen. Positive depression screening, pathological sleepiness, and sleeping less than 7 h a night were independent predictors of burnout. Sleep habits, exercise, and a positive depression screen were associated with burnout risk within the medical student population.
Zheng, Bang; Wang, Kailu; Pan, Ziqi; Li, Man; Pan, Yuting; Liu, Ting; Xu, Dan; Lyu, Jun
To investigate the sleep quality and related factors among medical students in China, understand the association between dormitory environment and sleep quality, and provide evidence and recommendations for sleep hygiene intervention. A total of 555 undergraduate students were selected from a medical school of an university in Beijing through stratified-cluster random-sampling to conduct a questionnaire survey by using Chinese version of Pittsburgh Sleep Quality Index (PSQI) and self-designed questionnaire. Analyses were performed by using multiple logistic regression model as well as multilevel linear regression model. The prevalence of sleep disorder was 29.1%(149/512), and 39.1%(200/512) of the students reported that the sleep quality was influenced by dormitory environment. PSQI score was negatively correlated with self-reported rating of dormitory environment (γs=-0.310, Psleep disorder included grade, sleep regularity, self-rated health status, pressures of school work and employment, as well as dormitory environment. RESULTS of multilevel regression analysis also indicated that perception on dormitory environment (individual level) was associated with sleep quality with the dormitory level random effects under control (b=-0.619, Psleep disorder was high in medical students, which was associated with multiple factors. Dormitory environment should be taken into consideration when the interventions are taken to improve the sleep quality of students.
Cheung, Ka-Chun; van der Veen, Willem; Bouvy, Marcel L; Wensing, Michel; van den Bemt, Patricia M L A; de Smet, Peter A G M
Information technology (IT) plays a pivotal role in improving patient safety, but can also cause new problems for patient safety. This study analyzed the nature and consequences of a large sample of IT-related medication incidents, as reported by healthcare professionals in community pharmacies and hospitals. The medication incidents submitted to the Dutch central medication incidents registration (CMR) reporting system were analyzed from the perspective of the healthcare professional with the Magrabi classification. During classification new terms were added, if necessary. The principal source of the IT-related problem, nature of error. Additional measures: consequences of incidents, IT systems, phases of the medication process. From March 2010 to February 2011 the CMR received 4161 incidents: 1643 (39.5%) from community pharmacies and 2518 (60.5%) from hospitals. Eventually one of six incidents (16.1%, n=668) were related to IT; in community pharmacies more incidents (21.5%, n=351) were related to IT than in hospitals (12.6%, n=317). In community pharmacies 41.0% (n=150) of the incidents were about choosing the wrong medicine. Most of the erroneous exchanges were associated with confusion of medicine names and poor design of screens. In hospitals 55.3% (n=187) of incidents concerned human-machine interaction-related input during the use of computerized prescriber order entry. These use problems were also a major problem in pharmacy information systems outside the hospital. A large sample of incidents shows that many of the incidents are related to IT, both in community pharmacies and hospitals. The interaction between human and machine plays a pivotal role in IT incidents in both settings.
Haukka, Jari; Kriikku, Pirkko; Mariottini, Claudia; Partonen, Timo; Ojanperä, Ilkka
The aims of this study were to estimate the prevalence and predictors of non-medical substance use, and to assess the association between non-medical substance use and fatal poisoning or history of drug abuse in Finland. Retrospective cohort study of all medico-legally investigated death cases in Finland. The postmortem toxicology database was linked together with the register on reimbursed prescription medicines. All postmortem cases between 2011 and 2013 positive for one or more of the following drugs: oxycodone, fentanyl, tramadol, clonazepam, gabapentin, pregabalin, tizanidine, olanzapine, quetiapine, risperidone, alprazolam, zolpidem, mirtazapine and bupropion, n = 2974. Non-medical use of substance was the outcome variable. Predictors were the following: gender, residence at the time of death, place of death, blood alcohol concentration, age, drug abuse, number of prescriptions of any psychoactive drugs in last year and proportion of prescriptions issued by psychiatrist in last year. In 50.4% of the studied cases, at least one drug was detected without a prescription. Clonazepam, alprazolam and tramadol were the most prevalent non-medical findings in these cases (6.6, 6.1 and 5.6%, respectively). The risk of non-medical use of prescription drugs was especially high in cases with history of drug abuse (88.5%) and in fatal poisonings (71.0%). The proportion of non-medical use of the studied substances varied between 5.9% [95% confidence interval (CI) = 3.1-10.1%)] for risperidone and 55.7% for fentanyl (95% CI = 44.1-66.9%). Valid prescription for one or more of any psychoactive drug was associated with lower odds for non-medical use of the studied substances. Additionally, the higher the proportion of psychoactive drugs prescribed by a psychiatrist, the lower the probability of non-medical use. Non-prescribed psychoactive drugs are found commonly at postmortem in drug poisoning deaths in Finland, with history of drug abuse being a major contributing
Riley, Lydia; Litsch, Tyler; Cook, Michelle L
The purpose of this study was twofold: to describe the average cost of nurse practitioner (NP) tuition based on degree program, program type, and geography; and to compare the cost of NP tuition to medical school tuition. A listing of all NP degree granting universities was obtained from the American Association of Colleges of Nursing during the fall of 2014, and tuition data were obtained from university websites. Medical school tuition data were obtained online during the fall of 2014 from the American Association of Medical Colleges. Average 1-year tuition rates were calculated for NP programs and medical schools and compared across private and public institutions. Average 1-year resident tuition for public university NP programs ranges between $8671 and $11,077 based on type of program. The cost of 1-year NP program tuition at the master's and the doctoral level is much lower than the cost of 1-year medical school tuition at both private and public universities. NPs can perform many of the same services as physicians in the primary care setting with comparable outcomes, yet the cost of educating NPs is much lower. NPs are a cost-effective solution to the healthcare workforce shortage. ©2015 American Association of Nurse Practitioners.
Lalić, Jelena; Veličković-Radovanović, Radmila; Mitić, Branka; Paunović, Goran; Cvetković, Tatjana
To assess the degree of immunosuppressive medication adherence in kidney transplant patients (KTPs) and to determine if there is a difference in the rate of adherence to tacrolimus (Tac), cyclosporine (CsA) and sirolimus (Sir). From a total of 63 KTPs treated at the Clinic of Nephrology, Clinical Centre Niš, Serbia, 60 participated in the study by responding to questionnaires. They were divided into the adherence group (n = 43) and the nonadherence group (n = 17) according to their degree of adherence which was measured using a validated survey form, the simplified medication adherence questionnaire. The KTP adherence to the different immunosuppressive regimens (Tac, CsA and Sir) was compared. Statistical analysis was performed using the Student t test. Adherence was observed in 43 (71.7%) patients, and only 17 (28.3%) did not follow the prescribed therapy. The estimated glomerular filtration rate was significantly lower in the nonadherence group (38.52 ± 18.22 ml/min) than in the adherence group (52.43 ± 16.91 ml/min, p adherers and the nonadherers (6.30 ± 2.06 vs. 5.0 ± 1.52 ng/ml, p adherence. Nonadherence was associated with worse graft function and a lower Tac level. Knowledge about the degree of adherence could help the early identification of nonadherent patients and the development of strategies to improve this. © 2014 S. Karger AG, Basel
Liu, Jinlin; Zhu, Bin; Mao, Ying
A large number of programs have been implemented in many countries to increase the healthcare workforce recruitment in rural and remote areas. Rural early exposure programs for medical students have been shown to be effective strategies. However, no related studies have been reported before in China. This study was carried out to determine the association between medical students' participation in rural clinical clerkships and their intentions to choose rural medical work after graduation from western medical schools in China. Based on a two-stage random sampling method, the cross-sectional survey was carried out in ten western provinces in China. A brief questionnaire filled in by medical students was used for data collection. A total of 4278 medical students participated in the study. The response rate was approximately 90.34%. Pearson's chi-squared tests and binary logistic regression analyses were performed for data analyses. Approximately 52.0% of medical students disclosed intentions to work in rural medical institutions after graduation. Only one in five participants had experience with a rural clinical clerkship. Rural clinical clerkships were significantly associated with medical students' intentions to work in rural medical institutions (OR: 1.24, 95%CI: 1.05-1.46); further analyses indicated that such clerkships only had a significant impact among the medical students with an urban background (OR: 2.10, 95%CI: 1.48-2.97). In terms of the sociodemographic characteristics, younger age, low level of parental education, majoring in general practice, and studying in low-level medical schools increased the odds of having intentions to engage in rural medical work among medical students; however, rural origins was the only positive univariate predictor. In addition, the predictors of intentions to choose rural medical work were different between medical students with a rural background and those with an urban background. Rural clinical clerkship is likely to
Mintz-Binder, Ronda D; Fitzpatrick, Joyce J
A troubling trend noted in California has been an increase in the number of open positions for program directors of associate degree registered nursing (ADRN) programs. Positions remain open for extended periods of time, and the number of qualified applicants for such positions is insufficient. The loss of and ensuing slow replacement of ADRN program directors can put these programs in jeopardy of student admission suspension, or, worse yet, closure by the state nursing board. In this exploratory study, variables of social support and job satisfaction were studied. Variables were found to be limited opportunities for peer interaction, expressed discontent, and retention concerns. A significant positive relationship between job satisfaction and social support was noted. Recommendations for future research are offered.
The purpose of this study was to examine the impact of moderate- and high-fidelity patient simulator use on the critical thinking skills of associate degree nursing students. This quantitative study used a quasi-experimental design and the Health Sciences Reasoning Test (HSRT) to evaluate the critical thinking skills of third semester nursing…
Andritsou, Fotini; Benetou, Vassiliki; Michail, Koralia A.; Pantazis, Nikolaos; Pavlopoulou, Ioanna D.
The increasing trend of administering nonprescribed medicines in children is a significant public health issue. The aim of the present study was to assess the use of medication without a prescription (MWP), including both nonprescribed medication (NPM) and prescription-only medication (POM), and identify associated factors, among preschoolers in Athens, Greece. A predesigned questionnaire was distributed to parents from May through June 2011. Multivariable binary logistic regression analysis ...
Chaubey, Santosh K; Sangla, Kunwarjit S; Suthaharan, Emershia N; Tan, Yong M
Cross-border importation of traditional and prescription medications is common, and many of these drugs are not approved by the Australian Therapeutic Goods Administration. Furthermore, counterfeit versions of prescription medications are also available (eg, weight-loss medications, anabolic steroids, and medications to enhance sexual performance). We describe a 54-year-old man with the first Australian case of severe hypoglycaemia induced by imported, laboratory-confirmed counterfeit Cialis. This serves to remind medical practitioners that counterfeit medication may be the cause of severe hypoglycaemia (or other unexplained illness).
Jafrani, Sana; Zehra, Nosheen; Zehra, Muneeza; Abuzar Ali, Syed Muhmmad; Abubakar Mohsin, Saiyed Abdullah; Azhar, Rasheed
To assess personality type of medical students and associate it with their choice of medical specialty. This cross-sectional study was conducted in February 2014 at one public and one private medical university of Karachi, and comprised medical students. A self- administered questionnaire based on Myers-Briggs type indicator was used to collect data which was analysed using SPSS 20. Of the 400 participants, there were 200(50%) each from public and private universities. Of all, 201(50.3%) students were found to be extroverted and 199(49.8%) were introverted personality types. Clinical fields were the main preference of students after their medical degree as selected by 317(79.2%) students; of the, Extroverted-Sensing-Feeling-Perceptive was the most common type identified in39(7.2%) students. Extroverted-Sensing-Feeling-Perceptive 11(2.8%), Extroverted-Sensing-Thinking-Judging 12(3%), Extroverted-Sensing-Feeling-Judging 5(1.3%), Introverted-Sensing-Feeling-Judging 6(1.5%), Introverted-Sensing-Thinking-Perceptive 7(1.8%) had preference for surgery, medicine, gynaecology, paediatrics and cardiology, respectively. Personality had significant impact on specialty and career choice.
The purpose of this study was to analyze the effectiveness of an online medical laboratory technician program in the academic preparation and development of laboratory professionals. A semi-quantitative comparative research design was used. Several factors were considered in this evaluation. Academic outcomes between online and campus medical laboratory technician (MLT) students was determined by comparing overall and categorical scores on certification exams as well as first time pass rate. Certification exam scores and first time pass rates were also compared to national norms when possible to do so. Demographic data, including age and experience were compared. Additionally, learning styles were assessed to determine if there was a correlation to overall GPA and MLT GPA and if learning styles could be used to predict successful completion of an online Associates of Applied Science. The research was conducted at an academic university located in the mountain west United States. Participants consisted of online and campus students enrolled in a Medical Laboratory Technician program that graduated with their Associate of Applied Science degree between the years 2007-2009. Results of these years were also compared to graduates from 2004-2006 in the same program. Certification performance and first time pass rates were the major outcomes measured. Age and experience were correlated. Online learning styles and GPA were also compared to successful degree completion. The researcher found no significant difference in certification performance with regard to total and categorical scores, and first time pass rates between campus and online MLT students. Online students were slightly older and had more experience working in a laboratory in some capacity. Correlation studies showed significant positive correlation between learning styles, GPA, and successful completion of an Associate of Applied Science degree. When registry scores were compared to the prior cohort of online
Costa, Edméa Fontes de Oliva; Santos, Shirley Andrade; Santos, Ana Teresa Rodrigues de Abreu; Melo, Enaldo Vieira de; Andrade, Tarcísio Matos de
To assess the prevalence and levels of burnout syndrome among medical students at the Universidade Federal de Sergipe-Brazil and to identify associated factors. A cross-sectional study was performed with randomly selected students in 2009. The Maslach Burnout Inventory/Student Survey (MBI-SS) and a structured questionnaire on socio-demographic characteristics, the educational process, and individual aspects were used. Statistical evaluation of multiple variables was performed through backward stepwise logistic regression analysis. The prevalence of burnout was 10.3% (n = 369). The prevalence was higher among those who did not have confidence in their clinical skills (Odds Ratio-OR = 6.47), those who felt uncomfortable with course activities (OR = 5.76), and those who did not see the coursework as a source of pleasure (OR = 4.68). There was a significant prevalence of burnout among the medical students studied. Three variables, in particular, were associated with burnout and were directly related to the medical education process. Preventive and intervention measures must be adopted, and longitudinal studies should be conducted.
Edméa Fontes de Oliva Costa
Full Text Available OBJECTIVES: To assess the prevalence and levels of burnout syndrome among medical students at the Universidade Federal de Sergipe-Brazil and to identify associated factors. METHODS: A cross-sectional study was performed with randomly selected students in 2009. The Maslach Burnout Inventory/Student Survey (MBI-SS and a structured questionnaire on socio-demographic characteristics, the educational process, and individual aspects were used. Statistical evaluation of multiple variables was performed through backward stepwise logistic regression analysis. RESULTS: The prevalence of burnout was 10.3% (n = 369. The prevalence was higher among those who did not have confidence in their clinical skills (Odds Ratio-OR = 6.47, those who felt uncomfortable with course activities (OR = 5.76, and those who did not see the coursework as a source of pleasure (OR = 4.68. CONCLUSION: There was a significant prevalence of burnout among the medical students studied. Three variables, in particular, were associated with burnout and were directly related to the medical education process. Preventive and intervention measures must be adopted, and longitudinal studies should be conducted.
de Oliva Costa, Edméa Fontes; Santos, Shirley Andrade; de Abreu Santos, Ana Teresa Rodrigues; de Melo, Enaldo Vieira; de Andrade, Tarcísio Matos
OBJECTIVES: To assess the prevalence and levels of burnout syndrome among medical students at the Universidade Federal de Sergipe-Brazil and to identify associated factors. METHODS: A cross-sectional study was performed with randomly selected students in 2009. The Maslach Burnout Inventory/Student Survey (MBI-SS) and a structured questionnaire on socio-demographic characteristics, the educational process, and individual aspects were used. Statistical evaluation of multiple variables was performed through backward stepwise logistic regression analysis. RESULTS: The prevalence of burnout was 10.3% (n = 369). The prevalence was higher among those who did not have confidence in their clinical skills (Odds Ratio–OR = 6.47), those who felt uncomfortable with course activities (OR = 5.76), and those who did not see the coursework as a source of pleasure (OR = 4.68). CONCLUSION: There was a significant prevalence of burnout among the medical students studied. Three variables, in particular, were associated with burnout and were directly related to the medical education process. Preventive and intervention measures must be adopted, and longitudinal studies should be conducted. PMID:22760894
Neugebauer, Martin; Weiss, Felix
Academic education is generally rewarded by employers, but what happens to graduates if they are trained for two years less and have to compete with vocationally trained labor market entrants in a similar field of study? Focusing on Germany, we analyze labor market entries of individuals eligible...... for higher education, who either opted for newly introduced short bachelor’s degrees, or for well-established vocational degrees. Based on Microcensus data, we find that bachelor’s degrees from classical universities are associated with higher earnings and more prestigious jobs than initial vocational...... training degrees, and with higher prestige (but similar earnings) than further vocational degrees. However, bachelor’s degrees from universities are also related to higher risks of unemployment or fixed-term employment. Universities of applied sciences, which combine academic and practical training, offer...
Keeshin, Brooks R; Cronholm, Peter F; Strawn, Jeffrey R
Although the extant evidence is replete with data supporting linkages between exposure to violence or abuse and the subsequent development of medical illnesses, the underlying mechanisms of these relationships are poorly defined and understood. Physiologic changes occurring in violence- or abuse-exposed individuals point to potentially common biological pathways connecting traumatic exposures with medical outcomes. Herein, the evidence describing the long-term physiologic changes in abuse- and violence-exposed populations and associated medical illnesses are reviewed. Current data support that (a) specific neurobiochemical changes are associated with exposure to violence and abuse; (b) several biological pathways have the potential to lead to the development of future illness; and (c) common physiologic mechanisms may moderate the severity, phenomenology, or clinical course of medical illnesses in individuals with histories of exposure to violence or abuse. Importantly, additional work is needed to advance our emerging understanding of the biological mechanisms connecting exposure to violence and abuse and negative health outcomes.
Cho, Chung Che; Lee, Chang Jun; Kim, Kun Sang; Park, Soo Soung
The medical collateral ligament rupture is the most common injury involving the knee joint ligaments. The ruptured medical collateral ligaments of 73 cases with clinical and surgical confirmations were radiologically analyzed. The results were obtained as follows: 1. The most risky age for tearing of the medical collateral ligament was third to fifth decades (50 cases of male and 23 of females). 2. The most common cause of the medical collateral ligament rupture was traffic accident (82.2%). 3. The mean distance of medial knee joint space was 7.9 ± 2.0 mm on the normal side and 13.7 ± 4.2 mm on the affected side. 4. The mean degree of knee joint space was 10.1 ± 2.5 on the normal side and 14.7 ± 3.8 on the affected side. 5. The fibula was the bone fractured most frequently in association with the medial collateral ligament rupture (30.6%).
Leslie A Reperant
Full Text Available Wild bird movements and aggregations following spells of cold weather may have resulted in the spread of highly pathogenic avian influenza virus (HPAIV H5N1 in Europe during the winter of 2005-2006. Waterbirds are constrained in winter to areas where bodies of water remain unfrozen in order to feed. On the one hand, waterbirds may choose to winter as close as possible to their breeding grounds in order to conserve energy for subsequent reproduction, and may be displaced by cold fronts. On the other hand, waterbirds may choose to winter in regions where adverse weather conditions are rare, and may be slowed by cold fronts upon their journey back to the breeding grounds, which typically starts before the end of winter. Waterbirds will thus tend to aggregate along cold fronts close to the 0 degrees C isotherm during winter, creating conditions that favour HPAIV H5N1 transmission and spread. We determined that the occurrence of outbreaks of HPAIV H5N1 infection in waterbirds in Europe during the winter of 2005-2006 was associated with temperatures close to 0 degrees C. The analysis suggests a significant spatial and temporal association of outbreaks caused by HPAIV H5N1 in wild birds with maximum surface air temperatures of 0 degrees C-2 degrees C on the day of the outbreaks and the two preceding days. At locations where waterbird census data have been collected since 1990, maximum mallard counts occurred when average and maximum surface air temperatures were 0 degrees C and 3 degrees C, respectively. Overall, the abundance of mallards (Anas platyrhynchos and common pochards (Aythya ferina was highest when surface air temperatures were lower than the mean temperatures of the region investigated. The analysis implies that waterbird movements associated with cold weather, and congregation of waterbirds along the 0 degrees C isotherm likely contributed to the spread and geographical distribution of outbreaks of HPAIV H5N1 infection in wild birds in
Drent, Gerda; Moons, P.; De Geest, S.; Kleibeuker, J. H.; Haagsma, E. B.
Symptom experience (occurrence and perceived distress) associated with side effects of immunosuppressive medications in organ transplant patients may well be associated with poorer quality of life and medication non-compliance. The aims of this study were: first, to assess symptom experience in
Ghada A. Bin Saif
Full Text Available Objectives: To evaluate the association between psychological stress and skin symptoms among medical students. Methods: A cross-sectional study was carried out between January and June 2015. Electronic survey consists of Perceived Stress Questionnaire (PSQ and Self-Reported Skin Complaints Questionnaire were distributed to all 1435 undergraduate students at College of Medicine, King Saud University (KSU, Riyadh, Saudi Arabia. Results: Final analysis was performed on data from 529 (36.9% students. Students were divided into three groups: least stressed students, n=135, PSQ index less than 0.39; highly stressed students, n=136, PSQ index greater than 0.61; and moderately stressed students, n=258. Older age, female gender, during exam weeks, and fourth and fifth years of medical school (all p less than 0.01 were associated with the highest perceived stress levels. When compared to least stressed students, highly stressed students suffered from more oily, waxy patches or flakes on scalp (p≤0.0001, dry/sore rash (p≤0.0001, warts (p≤0.0001, pimples (p≤0.0001, itchy skin (p≤0.0001, hands itchy rash (p≤0.0001, hair loss (p≤0.0001, pull-out own hair (p=0.008, scaly skin (p=0.012, troublesome sweating (p=0.016, nails biting (p=0.028, and other rashes on face (p= 0.028. Conclusion: Various common skin conditions could appear in context of psychological stress among medical students.
Bonilla-Escobar, Francisco Javier; Bonilla-Velez, Juliana; Tobón-García, Daniel; Ángel-Isaza, Ana María
Gaps between evidence-based research and clinical-public health practice have been evident for decades. One of the aims of medical student research is to close this gap. Accordingly, evaluating individual and environmental factors that influence participation of medical students in research are needed to understand and identify potential targets for action. This study aims to identify characteristics of medical student researchers in Colombia and the associated factors with scientific publications. A cross-sectional study of Colombian medical students involved in research using a validated, self-administered, online survey. The survey was distributed through the Colombian Association of Medical Students' Associations (ASCEMCOL). Data sets were analyzed using descriptive and summary statistics. Bivariate analysis and a multiple logistic regression model were conducted to identify predictors of scientific publications. A total of 133 responses were analyzed from students at 12 Colombian cities and 20 higher-education institutions. Although 94% of responders had at least one research proposal, only 57% had completed a project, and 17% had published their findings. Barriers for undertaking research included time restrictions and a lack of mentorship. Motivational factors included opportunity to publish findings and good mentorship. Students planning to do a specialization (OR = 3.25; 95% Confidence interval [CI] = 1.27-8.30), innovators (OR = 3.52; 95%CI = 1.30-9.52) and committed (OR = 3.39; 95%CI = 1.02-11.29), those who had previously published their findings (OR 9.13 IC95% 2.57-32.48), and were further in their medical education (OR 2.26 IC95% 1.01-5.07), were more likely to publish scientific papers. Our findings describe medical students understanding of the process of conducting research in Colombia. Although there appears to be motivation to participate in research, very few students achieve publication. Barriers such as time constraints
Brandstetter, Susanne; Finger, Tamara; Fischer, Wiebke; Brandl, Magdalena; Böhmer, Merle; Pfeifer, Michael; Apfelbacher, Christian
Adherence to medication is crucial for achieving treatment control in chronic obstructive lung diseases. This study refers to the “necessity-concerns framework” and examines the associations between beliefs about medicines and self-reported medication adherence in people with chronic obstructive lung disease. 402 patients (196 with asthma, 206 with COPD) participated in the study and completed a questionnaire comprising the “Beliefs about Medicines-Questionnaire” (BMQ) and the “Medication Adh...
Wisniewski, A E
In this exploratory analysis, I use a Burkean dramatist approach to investigate the relatively under-examined dynamics of how medical knowledge on obesity has changed outside of the American context. I examine how, over the past forty years, Canadian medical professionals have used the Canadian Medical Association Journal to generate a field of knowledge which organizes the ways in which obesity can be described, studied and treated. I argue that since the 1970s medical professionals have been increasingly interested in the relationship between obesity and a broadly defined social environment, and that this merger is rhetorically realized in the concept of the "obesogenic environment." I suggest that the process of engaging obesity has generated rhetoric that has often been resonant with the political ideologies expressed in health policy, but that can also create opportunities for the expression of alternative social goals.
Suppli, Nis P; Deltour, Isabelle; Damkjaer, Lars H
We evaluated factors associated with use of antidepressant medication subsequent to a diagnosis of breast cancer. We also evaluated the effect of participation in a cancer rehabilitation program on use of antidepressants....
Kovic, Ivor; Lulic, Ileana; Brumini, Gordana
Blogs are the major contributors to the large increase of new websites created each year. Most blogs allow readers to leave comments and, in this way, generate both conversation and encourage collaboration. Despite their popularity, however, little is known about blogs or their creators. To contribute to a better understanding of the medical blogosphere by investigating the characteristics of medical bloggers and their blogs, including bloggers' Internet and blogging habits, their motivations for blogging, and whether or not they follow practices associated with journalism. We approached 197 medical bloggers of English-language medical blogs which provided direct contact information, with posts published within the past month. The survey included 37 items designed to evaluate data about Internet and blogging habits, blog characteristics, blogging motivations, and, finally, the demographic data of bloggers. Pearson's Chi-Square test was used to assess the significance of an association between 2 categorical variables. Spearman's rank correlation coefficient was utilized to reveal the relationship between participants' ages, as well as the number of maintained blogs, and their motivation for blogging. The Mann-Whitney U test was employed to reveal relationships between practices associated with journalism and participants' characteristics like gender and pseudonym use. A total of 80 (42%) of 197 eligible participants responded. The majority of responding bloggers were white (75%), highly educated (71% with a Masters degree or doctorate), male (59%), residents of the United States (72%), between the ages of 30 and 49 (58%), and working in the healthcare industry (67%). Most of them were experienced bloggers, with 23% (18/80) blogging for 4 or more years, 38% (30/80) for 2 or 3 years, 32% (26/80) for about a year, and only 7% (6/80) for 6 months or less. Those who received attention from the news media numbered 66% (53/80). When it comes to best practices associated
van Eyk, Huub J.; Hooiveld, Michiel H. W.; Van Leeuwen, Thed N.; Van der Wurff, Bert L. J.; De Craen, Anton J. M.; Dekker, Friedo W.
Aim: To assess the number of students who published at least one scientific paper during the course of their medical studies. Methods: Names and initials of all students who received their medical degree in 2006 or 2007 in one of the six participating university medical centers in the Netherlands
Muhamad S. B. Yusoff
Full Text Available Objectives: The demanding and intense environment of medical training can create excessive pressures on medical students that eventually lead to unfavorable consequences, either at a personal or professional level. These consequences can include poor academic performance and impaired cognitive ability. This study was designed to explore associations between pass-fail outcome and psychological health parameters (i.e. stress, anxiety, and depression symptoms. Methods: A cross-sectional study was conducted on a cohort of first-year medical students in a Malaysian medical school. The depression anxiety stress scale 21-item assessment (DASS-21 was administered to them right after the final paper of the first-year final examination. Their final examination outcomes (i.e. pass or fail were traced by using their student identity code (ID through the Universiti Sains Malaysia academic office. Results: A total of 194 (98.0% of medical students responded to the DASS-21. An independent t-test showed that students who passed had significantly lower stress, anxiety, and depression symptoms than those who failed the first-year final examination (P <0.05. Those who experienced moderate to high stress were at 2.43 times higher risk for failing the examination than those who experienced normal to mild stress. Conclusion: Medical students whofailed in the final examination had higher psychological distress than those who passed the examination. Those who experienced high stress levels were more likely to fail than those who did not. Reducing the psychological distress of medical students prior to examination may help them to perform better in the examination.
Full Text Available Hyekyung Jin,1 Yeonhee Kim,2 Sandy Jeong Rhie1,3 1College of Pharmacy, 2Center for Excellence in Teaching & Learning, 3Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea Background: Little is known about the functional health literacy (FHL associated with medication adherence in elderly patients. The aim of this study was to examine the FHL among older adults and identify influencing factors that can predict medication adherence. Methods: This was a cross-sectional survey. Participants (n=160 aged 65 years and older were selected from outpatient clinics of 3 tertiary care hospitals, 6 community pharmacies, and 2 senior centers between November 1 and 30, 2014. The participants’ FHL was measured using the Korean Functional Health Literacy Test, which consists of 15 items including 8 numeracy and 7 reading comprehension items. Medication adherence was measured by the Adherence to Refills and Medication Scale. Descriptive statistics, chi-square or Fisher’s exact test, and multiple regression analyses were used to analyze the data. Results: The mean score of the total FHL was 7.72±3.51 (range 0–15. The percentage of the total number of correct answers for the reading comprehension subtest and numeracy subtest were 48.1% and 54.4%, respectively. Among 160 participants, 52.5% showed low adherence to medication. The factors affecting medication adherence included the patient’s degree of satisfaction with the service (β=-0.215, P=0.022, sufficient explanation of medication counseling (β=-0.335, P=0.000, education level (β=-0.153, P=0.045, health-related problems (β=-0.239, P=0.004, and dosing frequency (β=0.189, P=0.018. Conclusion: In this study, we found medication adherence of elderly patients was associated with education level, health-related problems, dosing frequency, satisfaction with patient counseling, and explanation of medication, but no association was found with FHL. Pharmacists
Piyathilake, Chandrika J; Badiga, Suguna; Alvarez, Ronald D; Partridge, Edward E; Johanning, Gary L
Identification of associations between global DNA methylation and excess body weight (EBW) and related diseases and their modifying factors are an unmet research need that may lead to decreasing DNA methylation-associated disease risks in humans. The purpose of the current study was to evaluate the following; 1) Association between the degree of peripheral blood mononuclear cell (PBMC) L1 methylation and folate, and indicators of EBW, 2) Association between the degree of PBMC L1 methylation and folate, and insulin resistance (IR) as indicated by a higher homeostasis model assessment (HOMA-IR). The study population consisted of 470 child-bearing age women diagnosed with abnormal pap. The degree of PBMC L1 methylation was assessed by pyrosequencing. Logistic regression models specified indicators of EBW (body mass index-BMI, body fat-BF and waist circumference-WC) or HOMA-IR as dependent variables and the degree of PBMC L1 methylation and circulating concentrations of folate as the independent predictor of primary interest. Women with a lower degree of PBMC L1 methylation and lower plasma folate concentrations were significantly more likely to have higher BMI, % BF or WC (OR = 2.49, 95% CI:1.41-4.47, P = 0.002; OR = 2.49, 95% CI:1.40-4.51, P = 0.002 and OR = 1.98, 95% = 1.14-3.48 P = 0.0145, respectively) and higher HOMA-IR (OR = 1.78, 95% CI:1.02-3.13, P = 0.041). Our results demonstrated that a lower degree of PBMC L1 methylation is associated with excess body weight and higher HOMA-IR, especially in the presence of lower concentrations of plasma folate.
Carr, Mark F; Bergman, Brett A
: Numerous medical schools currently offer a master of arts (MA) in bioethics dual degree for physicians. A degree in bioethics enhances the care physicians provide to patients and prepares physicians to serve on ethics committees and consult services. Additionally, they may work on institutional and public policy issues related to ethics. Several physician assistant (PA) programs currently offer a master of public health (MPH) dual degree for PAs. A degree in public health prepares PAs for leadership roles in meeting community health needs. With the success of PA/MPH dual degree programs, we argue here that a PA/bioethics dual degree would be another opportunity to advance the PA profession and consider how such a program might be implemented. The article includes the individual perspectives of the authors, one of whom completed a graduate-level certificate in bioethics concurrently with his 2-year PA program, while the other served as a bioethics program director.
van der Hoorn, W.L.F.; Litvak, Nelli
In network theory, Pearson's correlation coefficients are most commonly used to measure the degree assortativity of a network. We investigate the behavior of these coefficients in the setting of directed networks with heavy-tailed degree sequences. We prove that for graphs where the in- and
Full Text Available Rajesh Subhash Joshi, Sonal Jayant Muley Department of Ophthalmology, Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India Purpose: To evaluate the effective phaco time (EPT, cumulative dissipated energy (CDE and nucleus emulsification time (NET as phaco parameters with 0- and 30-degree phaco tip. Patients and methods: This prospective, interventional and observational case series included 294 patients scheduled for cataract removal by phacoemulsification technique. Patients with nuclear cataracts of grade 4 and 5 nuclear opalescence of Lens Opacities Classification System III were included in the study. Patients were consecutively allocated to phaco chop technique with 0-degree (0-degree group, n=147 and combined bevel up and down position using 30-degree phaco tip (combined bevel up/down group, n=147. The 0-degree group had phacoemulsification with 0-degree phaco tip, while the 30-degree group had chopping of the nucleus with bevel down phaco tip and emulsification of nuclear fragments was accomplished with bevel up tip. EPT, CDE, NET and intraoperative complications were noted and compared between the groups using analysis of variance. Results: Average EPT, CDE and NET were lower in the 30-degree group than in the 0-degree group. However, no statistically significant difference was found in EPT (P=0.0733, CDE (P=0.0663 and NET (P=0.0633 between the two groups. No serious intraoperative complications were noted. The anterior chamber was maintained throughout the procedure in both groups. No patients had wound burn and miosis during the procedure. None of the patients developed bullous keratopathy, uveitis and cystoid macular edema during the follow-up period. Conclusion: Combined bevel up and down 30-degree tip can yield effective hard nucleus phacoemulsification. Bevel down tip of 30-degree helps in effective chopping and bevel up tip assists in emulsification of the nuclear fragments. Although combined bevel up and down 30
Steinkellner, Amy; Chen, William; Denison, Shannon E
Over 6% of women become pregnant when taking teratogenic medications, and contraceptive counseling appears to occur at suboptimal rates. Adherence to contraception is an important component in preventing unwanted pregnancy and has not been evaluated in this population. We undertook a pharmacy claims-based analysis to evaluate the degree to which women of childbearing age who receive Category X medications adhere to their oral contraception. We evaluated the prescription medication claims for over 6 million women, age 18-44 years, with prescription benefits administered by a pharmacy benefits manager. Women with 2 or more claims for a Category X medication and 2 or more claims for oral contraception were evaluated in further detail. Adherence to oral contraception was measured by analyzing pharmacy claims. Multivariable logistic regression was performed to identify factors associated with adherence. There were 146,758 women of childbearing age who received Category X medications, of which 26,136 also took oral contraceptive medication. Women who received Category X medications were prescribed oral contraception (18%) at rates similar to others of childbearing age (17%). Women prescribed both Category X and oral contraception demonstrated adherence similar to the overall population. Age, class of Category X medication, number of medications, prescriber's specialty, and ethnicity correlated with lower adherence rates. Despite added risk associated with unintended pregnancy, many women who receive Category X medications have refill patterns suggesting nonadherence to oral contraception. Compared with all women age 18-44 years, women receiving teratogenic medications do not have better adherence to oral contraception. Copyright © 2010 Elsevier Inc. All rights reserved.
van der Hoorn, W.L.F.; Litvak, Nelly
In network theory, Pearson’s correlation coefficients are most commonly used to measure the degree assortativity of a network. We investigate the behavior of these coefficients in the setting of directed networks with heavy-tailed degree sequences. We prove that for graphs where the in- and
Haugh, C; Doyle, B; O'Flynn, S
Internationally medical student debt is a cause of concern. A survey of medical students in UCC (response rate of 191 representing 35% of the EU student cohort) reveals that 34 (26%) of direct entry medicine (DEM) students and 36 (61%) graduate entrants (GEM) have a loan with an anticipated average debt of Euro17,300 and Euro80,000 on graduation respectively. Fifty-three (90%) graduate entrants and 75 (57%) direct entrants revealed that they often worry about their current financial situation. Fifty-three (28%) of students have a part-time job and many were concerned about the degree to which this conflicted with their academic workload. 118 (89%) of school leavers and 48 (81%) graduates received financial assistance from their families to fund their college expenses. Student responses recommended the introduction of a government supported low interest rate loan and other incentives to help service high levels of debt associated with medical education.
Jain, Mamta K
Antiretroviral therapy (ART) for HIV infection frequently has been associated with elevated liver enzyme levels. Determining the cause of elevated liver enzyme levels in patients who have HIV is difficult because ART usually consists of three different drugs, patients may be taking additional hepatotoxic medications and patients who have HIV often suffer from other liver diseases. Several agents, however, are recognized as having noteworthy and specific patterns of toxicity. This article reviews the different HIV drug classes, incidence of elevated liver enzyme values by class and by individual drug, risk factors, specific toxicities, and possible mechanisms of injury.
Mirghani, Hyder Osman; Mohammed, Osama Salih; Almurtadha, Yahia Mohamed; Ahmed, Moneir Siddig
Background There is increasing awareness about the association of sleep quality and academic achievement among university students. However, the relationship between sleep quality and academic performance has not been examined in Sudan; this study assessed the relationship between sleep quality and academic performance among Sudanese medical students. Methods A case?control study was conducted among 165 male and female medical students at two Sudanese universities. Excellent (A) and pass (C) ...
Phatak, Hemant M; Thomas, Joseph
Medication beliefs of patients with a specific medical condition have been associated with nonadherence to drugs used to treat that condition. However, associations between medication beliefs and nonadherence of individuals on chronic, multiple medications have not been studied. To investigate associations between patients' medication beliefs and nonadherence to chronic drug therapy. A cross-sectional, self-administered survey of patients waiting to see pharmacists at an outpatient pharmacy in a primary care clinic was conducted. Participants' medication beliefs were assessed using the Beliefs about Medicines Questionnaire, and nonadherence was assessed using the Morisky Medication Adherence Scale. Pearson correlation analysis was used to assess bivariate associations between medication beliefs and nonadherence. Regression was used to assess relative strength of associations between various medication beliefs and nonadherence and also to assess the significance of the interactions between those beliefs and nonadherence. There were positive bivariate associations between specific concerns about medications (p harmful effects of medications (p belief and nonadherence was assessed, while controlling for other medication beliefs, specific-necessity (p = 0.02) and specific-concerns (p = 0.01) exhibited significant negative and positive associations with nonadherence, respectively. All two-way interactions between variables in the model were insignificant. A model consisting of age, total number of drugs used, and medication beliefs, that is, specific-necessity, specific-concerns, general-overuse, and general-harm, accounted for 26.5% of variance. Medication beliefs alone explained 22.4% of variation in nonadherence to chronic drug therapy. Patients' medication beliefs explained a significant portion of variation in medication nonadherence.
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
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.
Shortliffe, Edward H.; Bates, David W.; Bloomrosen, Meryl; Greenwood, Karen; Safran, Charles; Steen, Elaine B.; Tang, Paul C.; Williamson, Jeffrey J.
Don E. Detmer has served as President and Chief Executive Officer of the American Medical Informatics Association (AMIA) for the past five years, helping to set a course for the organization and demonstrating remarkable leadership as AMIA has evolved into a vibrant and influential professional association. On the occasion of Dr. Detmer's retirement, we fondly reflect on his professional life and his many contributions to biomedical informatics and, more generally, to health care in the U.S. and globally. PMID:19574463
Wijnen-Meijer, Marjo; Burdick, William; Alofs, Lonneke; Burgers, Chantalle; ten Cate, Olle
In a world that increasingly serves the international exchange of information on medical training, many students, physicians and educators encounter numerous variations in curricula, degrees, point of licensing and terminology. The aim of this study was to shed some light for those trying to compare medical training formats across countries. We surveyed a sample of key informants from 40 countries. Survey questions included: structure of medical education, moment that unrestricted practice is allowed, various options after general medical licensing, nomenclature of degrees granted and relevant terminology related to the medical education system. In addition, we searched the literature for description of country-specific information. Based on the results, we described the six models of current medical training around the world, supplemented with a list of degrees granted after medical school and an explanation of frequently used terminology. The results of this questionnaire study lead to the conclusion that while there are many differences between countries, there appear to be six dominant models. The models vary in structure and length of medical training, point of full registration and degrees that are granted.
Sobowale, Kunmi; Ham, Sandra A; Curlin, Farr A; Yoon, John D
This nationally representative study sought to identify personality traits that are associated with academic achievement in medical school. Third-year medical students, who completed an initial questionnaire in January 2011, were mailed a second questionnaire several months later during their fourth year. Controlling for sociodemographic characteristics and burnout, the authors used multivariate logistic regressions to determine whether Big Five personality traits were associated with receiving honors/highest grade in clinical clerkships, failing a course or rotation, and being selected for the Alpha Omega Alpha or Gold Humanism Honor Society. The adjusted response rates for the two surveys were 61 (n = 564/919) and 84% (n = 474/564). The personality trait conscientiousness predicted obtaining honors/highest grade in all clinical clerkships. In contrast, students high in neuroticism were less likely to do well in most specialties. Students with higher conscientiousness were more likely to be inducted into the Alpha Omega Alpha Honor Society, while students high in openness or agreeableness traits were more likely to be inducted into the Gold Humanism Honor Society. Burnout was not associated with any clinical performance measures. This study suggests the importance of personality traits, particularly conscientiousness, in predicting success during the clinical years of medical school. Medical educators should consider a nuanced examination of personality traits and other non-cognitive factors, particularly for psychiatry.
Wallace, Marc; McMullen, Thomas D.; Corcoran, Kate
Objective: The objective is to provide information on basic issues in library management identified by the Medical Library Association's (MLA's) seventh triennial salary survey. Methods: The survey was a Web-based questionnaire. A nonrandom sample of persons was obtained by posting messages to MLA's membership and to the MEDLIB-L email discussion list. Employed MLA members and nonmembers employed in medical library settings filled out a Web-based form designed using common gateway interface (CGI) programming. Results: Six hundred forty-five usable responses were analyzed by the Hay Group and presented in the MLA publication, Hay Group/MLA 2001 Compensation and Benefits Survey. Results from the 2001 survey in this article focus on pay and job satisfaction. Salary survey results since 1983 were analyzed to review trends in seniority, diversity, and pay equity. Conclusions: Given the age progression of respondents from 1983 to 2001, it is clear that succession planning is a core issue for medical libraries. Although efforts to create more diversity in medical libraries in member organizations have started to yield results, pay for white respondents has increased at a higher rate than for other racial categories. The authors found that the pay-for-performance system in the organizations of approximately two-thirds of the respondents is suboptimized and that most of the reasons medical librarians cite for leaving their organization can be addressed and potentially changed by management. Results from the eighth salary survey, slated to be conducted in the fall of 2004, will further track these trends and issues. PMID:15494762
Full Text Available Background Sociodemographic characteristics and health behaviours are associated with medication use in pregnancy, but it is unclear if they are independent predictors because women´s health status has hardly been accounted for. We aimed to identify predictors of use of medications and of iron/folic acid. Methods This cohort included pregnant women recruited in a prenatal clinic in Trieste, Italy, from 2007 to 2009. Dispensations were obtained from the regional outpatient dispensation database through record linkage. We calculated the Odds Ratio (OR, with 95% confidence interval (95%CI, of ≥ 1 dispensation of (a any medication and (b iron/folic acid, using unconditional logistic regression. The final model adjusted for age, partner education, housing size, comorbidities. Findings Of 767 women, 70.5% had ≥ 1 dispensation of any medication and 46.1% of iron/folic acid. Use of any medication was predicted by immigrant status of the woman (OR 1.21; 95%CI 0.57–2.53 or of her partner (1.51; 0.67–3.40, ≤ high school degree of the woman (1.11; 0.61–2.03 or of her partner (1.21; 0.75–1.95, unemployment (1.47; 0.72–2.98, smoking (1.25; 0.65–2.40, alcohol consumption (≥5 drinks/week: 2.78; 1.78–4.34, and obesity (1.33; 0.59–2.99. Use of iron and/or folic acid was predicted by ≤ high school degree (0.65; 0.40–1.08, smoking (0.80: 0.47–1.37, and obesity (0.62; 0.31–1.25. Discussion In this cohort, characteristics including education, immigrant and employment status, smoking, alcohol consumption, and obesity independently predicted medication use. Interventions to promote safe use of medications should carefully consider women´s characteristics.
Rosenman Marc B
Full Text Available Abstract Background Residential address is a common element in patient electronic medical records. Guidelines from the U.S. Centers for Disease Control and Prevention specify that residence in a nursing home, skilled nursing facility, or hospice within a year prior to a positive culture date is among the criteria for differentiating healthcare-acquired from community-acquired methicillin-resistant Staphylococcus aureus (MRSA infections. Residential addresses may be useful for identifying patients residing in healthcare-associated settings, but methods for categorizing residence type based on electronic medical records have not been widely documented. The aim of this study was to develop a process to assist in differentiating healthcare-associated from community-associated MRSA infections by analyzing patient addresses to determine if residence reported at the time of positive culture was associated with a healthcare facility or other institutional location. Results We identified 1,232 of the patients (8.24% of the sample with positive cultures as probable cases of healthcare-associated MRSA based on residential addresses contained in electronic medical records. Combining manual review with linking to institutional address databases improved geocoding rates from 11,870 records (79.37% to 12,549 records (83.91%. Standardization of patient home address through geocoding increased the number of matches to institutional facilities from 545 (3.64% to 1,379 (9.22%. Conclusions Linking patient home address data from electronic medical records to institutional residential databases provides useful information for epidemiologic researchers, infection control practitioners, and clinicians. This information, coupled with other clinical and laboratory data, can be used to inform differentiation of healthcare-acquired from community-acquired infections. The process presented should be extensible with little or no added data costs.
Laurell, C; Mercer, H
The authors report on research as part of the master's degree in social medicine at the Metropolitan Autonomous University, Xochimilco campus, Mexico. They discuss research within the curriculum design, instructional research, teaching staff and research, and research as a source of knowledge. They explain that in order to establish guidelines for research it is necessary to consider the health-disease process and medical practice within the economic and social framework and therefore subject to analysis by the social sciences. Finally, they summarize ongoing research in the fields of social epidemiology, medical practice and planning, and human resources.
Michelle Nigri Levitan
Full Text Available Objective: To present the most relevant findings regarding the Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. Methods: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes Project. The MEDLINE (PubMed, Scopus, Web of Science, and LILACS online databases were queried for articles published from 1980 to 2012. Searchable questions were structured using the PICO format (acronym for “patient” [or population], “intervention” [or exposure], “comparison” [or control], and “outcome”. Results: We present data on clinical manifestations and implications of panic disorder and its association with depression, drug abuse, dependence and anxiety disorders. In addition, discussions were held on the main psychiatric and clinical differential diagnoses. Conclusions: The guidelines are proposed to serve as a reference for the general practitioner and specialist to assist in and facilitate the diagnosis of panic disorder.
Sinclair Alan J
Full Text Available Abstract Aim To assess the factors associated with antihyperglycaemic medication initiation in UK patients with newly diagnosed type 2 diabetes. Methods In a retrospective cohort study, patients with newly diagnosed type 2 diabetes were identified during the index period of 2003-2005. Eligible patients were ≥ 30 years old at the date of the first observed diabetes diagnosis (referred to as index date and had at least 2 years of follow-up medical history (N = 9,158. Initiation of antihyperglycaemic medication (i.e., treatment was assessed in the 2-year period following the index date. Adjusted Cox regression models were used to examine the association between time to medication initiation and patient age and other factors. Results Mean (SD HbA1c at diagnosis was 8.1% (2.3. Overall, 51% of patients initiated antihyperglycaemic medication within 2 years (65%, 55%, 46% and 40% for patients in the 30- th, 75th percentile time to treatment initiation was 63 (8, 257 days. Of the patients with HbA1c ≥ 7.5% at diagnosis, 87% initiated treatment within 2 years. These patients with a higher HbA1c also had shorter time to treatment initiation (adjusted hazard ratio (HR = 2.44 [95% confidence interval (CI: 1.61, 3.70]; p Conclusions In this UK cohort of patients with newly diagnosed type 2 diabetes, only 51% had antihyperglycaemic medication initiated over a 2-year period following diagnosis. Older patients were significantly less likely to have been prescribed antihyperglycaemic medications. Elevated HbA1c was the strongest factor associated with initiating antihyperglycaemic medication in these patients.
Kunanitthaworn, Natchaya; Wongpakaran, Tinakon; Wongpakaran, Nahathai; Paiboonsithiwong, Salilthip; Songtrijuck, Natchaphon; Kuntawong, Pimolpun; Wedding, Danny
This study identified and investigated the relationship between demographics, mental health problems, positive personality traits and perceived social support and motivation in medical education (MME) among first year medical students. One hundred-thirty eight first year medical students completed the Academic Motivation Scale, Outcome Inventory, Strength Based Inventory, and Multidimensional Scale for Perceived Social Support. Path analysis was conducted to identify relationships between the variables of interest and each type of motivation, including intrinsic and extrinsic motivation and amotivation. The mean age of the sample was 18.86 ± 0.74 and 60% of the subjects were female. Path analysis showed that extrinsic motivation was positively associated with being female, personal choice for studying medicine, and grade point average at high school. Intrinsic motivation was correlated with perceived family support, personal choice for studying medicine and the positive attribute of determination. Amotivation was related to being male, personal choice, and depression. While both extrinsic and intrinsic motivation were correlated, they were uncorrelated with amotivation. All variables accounted for 18, 13, and 45% of variance of intrinsic motivation, extrinsic motivation and amotivation, respectively. Each type of motivation has different but related predictors. Extrinsic and intrinsic motivation can be promoted, whereas amotivation represents an exclusive issue, one related more to depression, that needs to be reduced to not interfere with academic achievement and quality of life of medical students.
Stroupe, K T; Murray, M D; Stump, T E; Callahan, C M
The amount of medication dispensed to older adults for the treatment of chronic disease must be balanced carefully. Insufficient medication supplies lead to inadequate treatment of chronic disease, whereas excessive supplies represent wasted resources and the potential for toxicity. We used an electronic medical record system to determine the distribution of medications supplied to older urban adults and to examine the correlations of these distributions with healthcare costs and use. A cross-sectional study using data acquired over 3 years (1994-1996). A tax-supported urban public healthcare system consisting of a 300-bed hospital, an emergency department, and a network of community-based ambulatory care centers. Patients were >60 years of age and had at least one prescription refill and at least two ambulatory visits or one hospitalization during the 3-year period. Focusing on 12 major categories of drugs used to treat chronic diseases, we determined the amounts and direct costs of these medications dispensed to older adult patients. Amounts of medications that were needed by patients to medicate themselves adequately were compared with the medication supply actually dispensed considering all sources of care (primary, emergency, and inpatient). We calculated the excess drug costs attributable to oversupply of medication (>120% of the amount needed) and the drug cost reduction caused by undersupply of medication (120% of the supply needed. The total direct cost of targeted medications for 3 years was $1.96 million or, on average, $654,000 annually. During the 3-year period, patients receiving >120% of their needed medications had excess direct medication costs of $279,084 or $144 per patient, whereas patients receiving <80% of drugs needed had reduced medication costs of $423,438 or $634 per patient. Multivariable analyses revealed that both under- and over-supplies of medication were associated with a greater likelihood of emergency department visits and hospital
Goodman, Craig; Knoll, Gabriella; Isakov, Victoria; Silver, Henry
A lack of insight into illness and negative attitudes towards medication are common among individuals with schizophrenia and impact clinical outcomes. This study aimed to examine the relationships between attitudes towards medication and cognitive function in schizophrenia patients. Thirty-five male forensic inpatients who were suffering from chronic schizophrenia participated in the study. A drug attitude inventory was used to evaluate the attitudes of the patients towards medication. Neuropsychological function was assessed with a comprehensive battery of tests. Patients with positive attitudes towards medication performed significantly better than those with negative attitudes on tests of verbal working memory (digit span forwards and backwards), inhibition and set shifting (Penn Inhibition test), delayed object memory and overall mental status (Mini Mental State Examination). There were no differences in age, education, hospitalizations or clinical symptoms between the groups. Our findings support an association between negative attitudes towards medication and poor cognitive performance, particularly of working memory.
Full Text Available Introduction: Few studies have documented the value of mentoring for medical students, and research has been limited to more subjective (e.g., job satisfaction, perceived career preparation rather than objective outcomes. This study examined whether having a mentor is associated with match outcome (where a student matched based on their rank order list [ROL]. Methods: We sent a survey link to all emergency medicine (EM program coordinators to distribute to their residents. EM residents were surveyed about whether they had a mentor during medical school. Match outcome was assessed by asking residents where they matched on their ROL (e.g., first choice, fifth choice. They were also asked about rank in medical school, type of degree (MD vs. DO, and performance on standardized tests. Residents who indicated having a mentor completed the Mentorship Effectiveness Scale (MES, which evaluates behavioral characteristics of the mentor and yields a total score. We assessed correlations among these variables using Pearson’s correlation coefficient. Post-hoc analysis using independent sample t-test was conducted to compare differences in the MES score between those who matched to their first or second choice vs. third or higher choice. Results: Participants were a convenience sample of 297 EM residents. Of those, 199 (67% reported having a mentor during medical school. Contrary to our hypothesis, there was no significant correlation between having a mentor and match outcome (r=0.06, p=0.29. Match outcome was associated with class rank (r=0.13, p=0.03, satisfaction with match outcome (r= -0.37, p<0.001, and type of degree (r=0.12, p=0.04. Among those with mentors, a t-test revealed that the MES score was significantly higher among those who matched to their first or second choice (M=51.31, SD=10.13 compared to those who matched to their third or higher choice (M=43.59, SD=17.12, t(194=3.65, p<0.001, d=0.55. Conclusion: Simply having a mentor during medical
Eric L. Anderson
Full Text Available Introduction: In the United States, the number of patients presenting to the emergency department (ED for a mental health concern is significant and expected to grow. The breadth of the medical evaluation of these patients is controversial. Attempts have been made to establish a standard evaluation for these patients, but to date no nationally accepted standards exist. A task force of the American Association of Emergency Psychiatry, consisting of physicians from emergency medicine and psychiatry, and a psychologist was convened to form consensus recommendations on the medical evaluation of psychiatric patients presenting to EDs. Methods: The task force reviewed existing literature on the topic of medical evaluation of psychiatric patients in the ED (Part I and then combined this with expert consensus (Part II. Results: In Part I, we discuss terminological issues and existing evidence on medical exams and laboratory studies of psychiatric patients in the ED. Conclusion: Emergency physicians should work cooperatively with psychiatric receiving facilities to decrease unnecessary testing while increasing the quality of medical screening exams for psychiatric patients who present to EDs. [West J Emerg Med. 2017;18(2235-242.
Baranov, A.E.; Bad'in, V.I.; Gasteva, G.N.
Basing on the accident at the Chernobyl Nuclear Power Plant, the paper studied practical questions of organization of medical aid and treatment in specialized medical establishments prepared well in advance, and in temporary arranged specialized medical institutions. The requirements to such medical treatment establishments are studied herein: the aims and structure of the admission department; the measures of decontamination and emergency medical aid in case of acute intake of certain radionuclides; control of radioactive contamination of human organism of the injured persons and dosimetry of medical personnel; minimum degree of clinical examinations; schemes of therapy of various forms of acute radiation disease with combined effects. The authors indicated a list of the necessary drug preparations for treatment of patients with acute radiation disease of 3-4 degree of severity and the regulations of autopsy and taking samples for biophysical investigations of persons who died from radiation disease. 5 tabs
Hullmann, Stephanie E; Brumley, Lauren D; Schwartz, Lisa A
The current study examined adherence to medication regimens among adolescents with cancer by applying the Pediatric Self-Management Model. Adolescents and their parents reported on adherence to medication, reasons for nonadherence, and patient-, family-, and community-level psychosocial variables. Adolescent- and parent-reported adherence were significantly correlated, with about half of the sample reporting perfect adherence. The majority reported "just forgot" as the most common reason for missed medication. Patient-, family-, and community-level variables were examined as predictors of adherence. With regard to individual factors, adolescents who endorsed perfect adherence reported a greater proportion of future-orientated goals and spent fewer days in outpatient clinic visits. For family factors, adolescents who endorsed perfect adherence reported greater social support from their family and were more likely to have a second caregiver who they perceived as overprotective. The community-level variable (social support from friends) tested did not emerge as a predictor of adherence. The results of this study provide direction for intervention efforts to target adolescent goals and family support in order to increase adolescent adherence to cancer treatment regimens. © 2014 by Association of Pediatric Hematology/Oncology Nurses.
Hadjistavropoulos, Thomas; Malloy, David C; Douaud, Patrick; Smythe, William E
The literature on codes of ethics suggests that grammatical and linguistic structures as well as the theoretical ethical orientation conveyed in codes of ethics have implications for the manner in which such codes are received by those bound by them. Certain grammatical and linguistic structures, for example, tend to have an authoritarian and disempowering impact while others can be empowering. The authors analyze and compare the codes of ethics of the Canadian Nurses Association (CNA) and the Canadian Medical Association (CMA) in terms of their ethical orientation and grammatical/linguistic structures. The results suggest that the two codes differ substantially along these two dimensions. The CNA code contains proportionally more statements that provide a rationale for ethical behaviour; the statements of the CMA code tend to be more dogmatic. Functional grammar analysis suggests that both codes convey a strong deontological tone that does not enhance the addressee's ability to engage in discretionary decision-making. The nurses' code nonetheless implies a collaborative relationship with the client, whereas the medical code implies that the patient is the recipient of medical wisdom. The implications of these findings are discussed.
Janssens, Rien; van Delden, Johannes J M; Widdershoven, Guy A M
The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse the guideline's argumentation strategy with which euthanasia is demarcated from palliative sedation. First, we will analyse the guideline's main premise, which entails that palliative sedation is normal medical treatment. After this, we will critically discuss three crucial propositions of the guideline that are used to support this premise: (1) the patient's life expectancy should not exceed 2 weeks; (2) the aim of the physician should be to relieve suffering and (3) expert consultation is optional. We will conclude that, if inherent problematic aspects of palliative sedation are taken seriously, palliative sedation is less normal than it is now depicted in the guideline.
Peck, Kelly R; Roland, Malcolm M; Smitherman, Todd A
Although risk factors for medication-overuse headache have been identified within the general population, most studies have neglected clinical samples. The present study examined the relative and combined associations of these factors with medication-overuse headache in a sample of US adults seeking treatment for primary headache disorders. Treatment-seeking headache patients provided data on demographics, headache variables, psychiatric variables, use of headache medications, and use of other prescription medications and substances. A classification tree selection strategy was utilized within this cross-sectional study to differentiate between those with and without medication-overuse headache, and a final multivariable model assessed their combined utility. Forty-three of 164 participants (26.2%) met diagnostic criteria for medication-overuse headache. Relative to non-medication-overuse headache participants, participants with medication-overuse headache reported greater headache-related disability (odds ratio = 1.09, 95% confidence interval = 1.01-1.18), escape and avoidance responses indicative of fear of pain (odds ratio = 1.07, 95% confidence interval = 1.00-1.15), and use of combination medications for headache (odds ratio = 3.10, 95% confidence interval = 1.51-6.36). The final multivariable model differentiated well between the 2 groups (area under the receiver operating characteristic curve = .78; 95% confidence interval = .71-.86). Items that assess headache-related disability, use of combination medications, and fear of pain help identify patients who are currently overusing acute headache medications and may serve as indicators of treatment progress. Future studies should apply similar analytic approaches longitudinally to identify headache sufferers at risk for medication-overuse headache prior to headache progression. © 2018 American Headache Society.
Jeffrey S Chang
Full Text Available BACKGROUND: Cholangiocarcinoma, including intra- and extrahepatic cholangiocarcinoma, is a rare but highly lethal cancer. Despite effort in finding the risk factors of cholangiocarcinoma, the causes of most cholangiocarcinoma remain unknown. This study utilized a population-based case-control design using data from the National Health Insurance Research Database (NHIRD of Taiwan to assess the medical conditions associated with cholangiocarcinoma. METHODS: 5,157 incident cases of cholangiocarcinoma diagnosed during 2004 to 2008 and 20,628 controls matched to the cases on sex, age, and time of diagnosis (reference date for the controls were identified from the NHIRD. Medical risk factors were ascertained from the NHIRD for each individual. Conditional logistic regression was performed to evaluate the association between cholangiocarcinoma and each medical risk factor. RESULTS: The results showed that factors associated with an increased risk of cholangiocarcinoma included cholangitis, cholelithiasis, cholecystitis, cirrhosis of liver, alcoholic liver disease, chronic non-alcoholic liver disease, hepatitis B, hepatitis C, diabetes, chronic pancreatitis, inflammatory bowel disease, and peptic ulcer. In addition, sex and age differences were observed. CONCLUSIONS: This study confirms the association between cholangiocarcinoma and several less established risk factors, including diabetes, inflammatory bowel disease, hepatitis B, hepatitis C, and peptic ulcer (proxy for the presence of Helicobacter Pylori. Future studies should focus on finding additional environmental and genetic causes of cholangiocarcinoma.
Chung-Delgado, Kocfa; Revilla-Montag, Alejandro; Guillen-Bravo, Sonia; Velez-Segovia, Eduardo; Soria-Montoya, Andrea; Nuñez-Garbin, Alexandra; Silva-Caso, Wilmer; Bernabe-Ortiz, Antonio
Long-term exposure to anti-tuberculosis medication increases risk of adverse drug reactions and toxicity. The objective of this investigation was to determine factors associated with anti-tuberculosis adverse drug reactions in Lima, Peru, with special emphasis on MDR-TB medication, HIV infection, diabetes, age and tobacco use. A case-control study was performed using information from Peruvian TB Programme. A case was defined as having reported an anti-TB adverse drug reaction during 2005-2010 with appropriate notification on clinical records. Controls were defined as not having reported a side effect, receiving anti-TB therapy during the same time that the case had appeared. Crude, and age- and sex-adjusted models were calculated using odds ratios (OR) and 95% confidence intervals (95%CI). A multivariable model was created to look for independent factors associated with side effect from anti-TB therapy. A total of 720 patients (144 cases and 576 controls) were analyzed. In our multivariable model, age, especially those over 40 years (OR = 3.93; 95%CI: 1.65-9.35), overweight/obesity (OR = 2.13; 95%CI: 1.17-3.89), anemia (OR = 2.10; IC95%: 1.13-3.92), MDR-TB medication (OR = 11.1; 95%CI: 6.29-19.6), and smoking (OR = 2.00; 95%CI: 1.03-3.87) were independently associated with adverse drug reactions. Old age, anemia, MDR-TB medication, overweight/obesity status, and smoking history are independent risk factors associated with anti-tuberculosis adverse drug reactions. Patients with these risk factors should be monitored during the anti-TB therapy. A comprehensive clinical history and additional medical exams, including hematocrit and HIV-ELISA, might be useful to identify these patients.
Full Text Available BACKGROUND: Long-term exposure to anti-tuberculosis medication increases risk of adverse drug reactions and toxicity. The objective of this investigation was to determine factors associated with anti-tuberculosis adverse drug reactions in Lima, Peru, with special emphasis on MDR-TB medication, HIV infection, diabetes, age and tobacco use. METHODOLOGY AND RESULTS: A case-control study was performed using information from Peruvian TB Programme. A case was defined as having reported an anti-TB adverse drug reaction during 2005-2010 with appropriate notification on clinical records. Controls were defined as not having reported a side effect, receiving anti-TB therapy during the same time that the case had appeared. Crude, and age- and sex-adjusted models were calculated using odds ratios (OR and 95% confidence intervals (95%CI. A multivariable model was created to look for independent factors associated with side effect from anti-TB therapy. A total of 720 patients (144 cases and 576 controls were analyzed. In our multivariable model, age, especially those over 40 years (OR = 3.93; 95%CI: 1.65-9.35, overweight/obesity (OR = 2.13; 95%CI: 1.17-3.89, anemia (OR = 2.10; IC95%: 1.13-3.92, MDR-TB medication (OR = 11.1; 95%CI: 6.29-19.6, and smoking (OR = 2.00; 95%CI: 1.03-3.87 were independently associated with adverse drug reactions. CONCLUSIONS: Old age, anemia, MDR-TB medication, overweight/obesity status, and smoking history are independent risk factors associated with anti-tuberculosis adverse drug reactions. Patients with these risk factors should be monitored during the anti-TB therapy. A comprehensive clinical history and additional medical exams, including hematocrit and HIV-ELISA, might be useful to identify these patients.
Boonvisudhi, Thummaporn; Kuladee, Sanchai
To study the extent of Internet addiction (IA) and its association with depression in Thai medical students. A cross-sectional study was conducted at Faculty of Medicine, Ramathibodi Hospital. Participants were first- to fifth-year medical students who agreed to participate in this study. Demographic characteristics and stress-related factors were derived from self-rated questionnaires. Depression was assessed using the Thai version of Patient Health Questionnaire (PHQ-9). A total score of five or greater derived from the Thai version of Young Diagnostic Questionnaire for Internet Addiction was classified as "possible IA". Then chi-square test and logistic regression were used to evaluate the associations between possible IA, depression and associated factors. From 705 participants, 24.4% had possible IA and 28.8% had depression. There was statistically significant association between possible IA and depression (odds ratio (OR) 1.92, 95% confidence interval (CI): 1.34-2.77, P-value depression in possible IA group was 1.58 times of the group of normal Internet use (95% CI: 1.04-2.38, P-value = 0.031). Academic problems were found to be a significant predictor of both possible IA and depression. IA was likely to be a common psychiatric problem among Thai medical students. The research has also shown that possible IA was associated with depression and academic problems. We suggest that surveillance of IA should be considered in medical schools.
Brakstad, Odd G; Bonaunet, Kristin
In this study biodegradation of hydrocarbons in thin oil films was investigated in seawater at low temperatures, 0 and 5 degrees C. Heterotrophic (HM) or oil-degrading (ODM) microorganisms enriched at the two temperatures showed 16S rRNA sequence similarities to several bacteria of Arctic or Antarctic origin. Biodegradation experiments were conducted with a crude mineral oil immobilized as thin films on hydrophobic Fluortex adsorbents in nutrient-enriched or sterile seawater. Chemical and respirometric analysis of hydrocarbon depletion showed that naphthalene and other small aromatic hydrocarbons (HCs) were primarily biodegraded after dissolution to the water phase, while biodegradation of larger polyaromatic hydrocarbons (PAH) and C(10)-C(36) n-alkanes, including n-hexadecane, was associated primarily with the oil films. Biodegradation of PAH and n-alkanes was significant at both 0 and 5 degrees C, but was decreased for several compounds at the lower temperature. n-Hexadecane biodegradation at the two temperatures was comparable at the end of the experiments, but was delayed at 0 degree C. Investigations of bacterial communities in seawater and on adsorbents by PCR amplification of 16S rRNA gene fragments and DGGE analysis indicated that predominant bacteria in the seawater gradually adhered to the oil-coated adsorbents during biodegradation at both temperatures. Sequence analysis of most DGGE bands aligned to members of the phyla Proteobacteria (Gammaproteobacteria) or Bacteroidetes. Most sequences from experiments at 0 degree C revealed affiliations to members of Arctic or Antarctic consortia, while no such homology was detected for sequences from degradation experiment run at 5 degrees C. In conclusion, marine microbial communities from cold seawater have potentials for oil film HC degradation at temperatures < or =5 degrees C, and psychrotrophic or psychrophilic bacteria may play an important role during oil HC biodegradation in seawater close to freezing
Neeley, Sabrina M; Clyne, Brian; Resnick-Ault, Daniel
Over the past two decades, there have been increasing calls for physicians to develop the capabilities to lead health care transformation. Many experts and authors have suggested that leadership education should begin during medical school; however, little information exists regarding the presence or nature of undergraduate medical education leadership curricula in the USA. This study sought to determine the prevalence of formal leadership education in US undergraduate medical schools, as well as the delivery methods and degree of student participation. A web-based survey of medical education deans from US allopathic medical schools (N = 144) was administered from November 2014 to February 2015. The survey included questions on the presence of leadership curricula, delivery format, student participation rates, and forms of recognition. Eighty-eight surveys were completed; the majority (85%) of respondents were associate or assistant deans for medical education. Approximately half (54.5%) of respondents reported leadership curricula within their medical schools. Of those, 34.8% (16/46) were required; 32.6% (15/46) were elective; and 32.6% (15/46) indicated both required and elective components. Of schools with formal leadership curricula (n = 48), the common forms of content delivery were: mentoring programs (65.1%); dual degree programs (54.5%); workshops (48.8%); seminar/lecture series (41.9%); courses (41.9%); or single seminars (18.6%). Nineteen percent of institutions offer longitudinal leadership education throughout medical school. Common forms of recognition for leadership education were: course credit (48.8%); dual degrees (37.2%); certificates of completion (18.6%); and transcript notations (7.0%). This study indicates that formal leadership education exists in more than half of US allopathic medical schools, suggesting it is an educational priority. Program format, student participation, delivery methods, and recognition varied considerably
Abdullah I. Almojali
Conclusion: The study documents a statistically significant association between stress and poor sleep quality. A recommendation for the management of medical college is to establish academic counseling centers focusing in promoting good sleep hygiene and strengthening students’ study skills and coping with their stressful environment.
Kusurkar, Rashmi A; Croiset, Gerda; Galindo-Garré, Francisca; Ten Cate, Olle
Students enter the medical study with internally generated motives like genuine interest (intrinsic motivation) and/or externally generated motives like parental pressure or desire for status or prestige (controlled motivation). According to Self-determination theory (SDT), students could differ in their study effort, academic performance and adjustment to the study depending on the endorsement of intrinsic motivation versus controlled motivation. The objectives of this study were to generate motivational profiles of medical students using combinations of high or low intrinsic and controlled motivation and test whether different motivational profiles are associated with different study outcomes. Participating students (N = 844) from University Medical Center Utrecht, the Netherlands, were classified to different subgroups through K-means cluster analysis using intrinsic and controlled motivation scores. Cluster membership was used as an independent variable to assess differences in study strategies, self-study hours, academic performance and exhaustion from study. Four clusters were obtained: High Intrinsic High Controlled (HIHC), Low Intrinsic High Controlled (LIHC), High Intrinsic Low Controlled (HILC), and Low Intrinsic Low Controlled (LILC). HIHC profile, including the students who are interest + status motivated, constituted 25.2% of the population (N = 213). HILC profile, including interest-motivated students, constituted 26.1% of the population (N = 220). LIHC profile, including status-motivated students, constituted 31.8% of the population (N = 268). LILC profile, including students who have a low-motivation and are neither interest nor status motivated, constituted 16.9% of the population (N = 143). Interest-motivated students (HILC) had significantly more deep study strategy (p motivated (LIHC) and low-motivation (LILC) students. The interest-motivated profile of medical students (HILC) is associated with good study hours, deep
Dhillon, Balbir S
.... Although the history of reliability engineering can be traced back to World War II, the application of reliability engineering concepts to medical devices is a fairly recent idea that goes back to the latter part of the 1960s when many publications on medical device reliability emerged. Today, a large number of books on general reliability have been...
Stamouli, Maria-Aggeliki; Balis, Charalampos; Georgakopoulou, Konstantina-Maria
The ability of hospital medical libraries to meet users' needs is a complicated issue and has been examined by many surveys. The aim of this study is to evaluate the satisfaction degree of the users of "Attikon" University General Hospital's medical library. A questionnaire was used to collect the necessary information Although, in general, the users seems to be satisfied, some adjustments, such as up-to-date books, journals and computers, have to be made.
Almojali, Abdullah I; Almalki, Sami A; Alothman, Ali S; Masuadi, Emad M; Alaqeel, Meshal K
Medical students tend to reduce their sleep, in an effort to adjust and cope with their workload and stressful environment. This study estimated the prevalence of and the relationship between poor sleep quality and stress among medical students. This cross-sectional study was conducted using a stratified random sample of male and female medical students in King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia. A self-administered questionnaire was distributed to assess sleep quality using the Pittsburgh Sleep Quality Index, and the stress level by using the Kessler Psychological Distress Scale. A high prevalence of poor sleep quality (76%) and stress (53%) were found, with a statistically significant association (pstress are less likely to have poor sleep quality (OR=0.28, pstress and poor sleep quality. A recommendation for the management of medical college is to establish academic counseling centers focusing in promoting good sleep hygiene and strengthening students' study skills and coping with their stressful environment. Copyright © 2017 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.
Kim, Do Yeun; Lee, Yun Gyoo; Kim, Bong-Seog
This study was conducted to investigate the current role of medical oncologists in cancer care with a focus on increasing the recognition of medical oncology as an independent specialty. Questionnaires modified from the Medical Oncology Status in Europe Survey dealing with oncology structure, resources, research, and patterns of care given by medical oncologists were selected. Several modifications were made to the questionnaire after feedback from the insurance and policy committee of the Korean Association for Clinical Oncology (KACO). The online survey was then sent to KACO members. A total of 214 medical oncologists (45.8% of the total inquiries), including 71 directors of medical oncology institutions, took the survey. Most institutions had various resources, including a medical oncology department (94.1%) and a department of radiation oncology (82.4%). There was an average of four medical oncologists at each institution. Medical oncologists were involved in various treatments from diagnosis to end-of-life care. They were also chemotherapy providers from a wide range of institutions that treated many types of solid cancers. In addition, 86.2% of the institutions conducted research. This is the first national survey in Korea to show that medical oncologists are involved in a wide range of cancer treatments and care. This survey emphasizes the contributions and proper roles of medical oncologists in the evolving health care environment in Korea.
Schmorrow, Dylan D; Solhan, George; Kruse, Amy A
.... Medical technologies have progressed to the degree that portable, rugged, and wireless designs can be conceived of that could give coalition commanders and medical personnel a view of the health...
All medical doctors have an important role to play in the diagnosis, management and prevention of healthcare-associated infection (HCAI). Strengthening the contribution of medical doctors and medical students to HCAI prevention programmes should include measures that enhance knowledge, improve practice and develop appropriate attitudes to the safety and quality of patient care. The Hospital Infection Society (HIS) funded a review of medical education on HCAI throughout medical schools in the UK and the Republic of Ireland. A questionnaire was drafted and circulated to all medical schools and 31 of 38 (82%) responded. The prevalence and transmission of HCAI were taught by 97% and 100% of medical schools, respectively, but the importance of HCAI as a quality and safety issue was covered in only 60% of medical schools. Multiple choice questions (MCQs) and objective structure clinical examinations (OSCEs) were the most popular methods of assessment. Lectures, discussion of cases and practical demonstrations were considered useful by >90% of respondents and online material and log books by 67% and 60%, respectively. More than 80% were willing to share a common pool of educational resources. An agreed curriculum should be developed for educating medical students in HCAI prevention and control, to outline optimum methods for assessment and develop a shared pool of educational resources.
Lebedeva, Elena R; Kobzeva, Natalia R; Gilev, Denis V
BACKGROUND: In our previous study of workers, blood donors and medical students, students stood out with a higher 1-year prevalence of migraine (28%) and tension-type headache (TTH) (74%). General factors associated with headache were common for all groups except low physical activity. The hypoth...
Joffre, Carrillo P; Delgado, Belgica; Kosik, Russell Olive; Huang, Lei; Zhao, Xudong; Su, Tung-Ping; Wang, Shuu-Jiun; Chen, Qi; Fan, Angela Pei-Chen
Ecuador, the smallest of the Andean countries, is located in the northwest portion of South America. The nation's 14.5 million people have a tremendous need for high quality primary care. To describe the profound advances as well as the persistent needs in medical education in Ecuador that have occurred with globalization and with the modernization of the country. Through an extensive search of the literature; medical school data; reports from the Ecuador Ministry of Public Health and Ministry of Education; and information from the National Secretary of Higher Education, Science, and Innovation (SENESCYT), the medical education system in Ecuador has been thoroughly examined. The National System of Higher Education in Ecuador has experienced significant growth over the last 20 years. As of 2009 the system boasts 19 medical schools, all of which offer the required education needed to obtain the title of Physician, but only 12 of which offer postgraduate clinical training. Of these 19 universities, nine are public, five are private and self-financed, and five are private and co-financed. Post-graduate options for medical students include: (1) Clinical specialization, (2) Higher diploma, (3) Course specialization, (4) Master's degree, and (5) PhD degree. The rapid growth of Ecuador's system of medical education has led to inevitable gaps that threaten its ability to sustain itself. Chief among these is the lack of well-trained faculty to supply its medical schools. To ensure an adequate supply of faculty exists, the creation of sufficient postgraduate, sub-specialization, and PhD training positions must be created and maintained.
Full Text Available Aqib Chaudry, Amar Sodha, Ahmed Nur Faculty of Medicine, Imperial College London, London, UK We read with great interest the article by Rouhani et al1 exploring the perceptions, attitudes, and interest of UK medical students toward medical leadership. As medical students who recently completed an intercalated degree in health care management at Imperial College London, we can offer a unique perspective on this important issue.Authors' responseMaral J Rouhani,1 Eleanor J Burleigh,2 Chloe Hobbis,2 Charlotte Dunford,1 Nadir I Osman,3 Christine Gan,1 Norma B Gibbons,1 Hashim U Ahmed,1,4 Saiful Miah1,51Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK; 2Medical School, University of Sheffield, Sheffield, UK; 3Department of Urology, Royal Hallamshire Hospital, Sheffield, UK; 4Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; 5Division of Surgery and Interventional Science, University College London, London, UK We read with great interest the response to our article1 by Chaudry et al. Their group have contemporary insight and valuable experience in this subject which can be attributed to the intercalated degrees they have undertaken in health care management. We are acutely aware that very few UK medical schools actually offer such an intercalated degree. However, we believe the proposal of Singh et al2 of a compulsory health care management BSc is a counterproductive one. Basic science and clinically orientated intercalated degrees expose the medical student to research techniques and methodology. At their very core, they inspire the medical mind and are not designed to instruct all doctors to be academic research scientists, but rather ensure that every clinician’s mind is tuned to continually evaluate standard practice, and ask can we do better? View the original paper by Rouhani and colleagues.
Sorg, Heiko; Knobloch, Karsten
First quantitative evaluation of the requirements for the promotion as associate professor (AP) at German medical faculties. Analysis of the AP-regulations of German medical faculties according to a validated scoring system, which has been adapted to this study. The overall scoring for the AP-requirements at 35 German medical faculties was 13.5±0.6 of 20 possible scoring points (95% confidence interval 12.2-14.7). More than 88% of the AP-regulations demand sufficient performance in teaching and research with adequate scientific publication. Furthermore, 83% of the faculties expect an expert review of the candidate's performance. Conference presentations required as an assistant professor as well as the reduction of the minimum time as an assistant professor do only play minor roles. The requirements for assistant professors to get nominated as an associate professor at German medical faculties are high with an only small range. In detail, however, it can be seen that there still exists large heterogeneity, which hinders equal opportunities and career possibilities. These data might be used for the ongoing objective discussion.
Lally, John; McDonald, Colm
The authors report the case of a 44-year-old man with a long history of chronic enduring schizophrenia who experienced dramatic weight loss after commencing treatment with clozapine, an antipsychotic medication characteristically associated with the greatest degree of weight gain among medical treatments for schizophrenia. He was obese with a body mass index (BMI) of 41.5 kg/m(2), but after commencing clozapine therapy he experienced an improvement in psychotic symptoms and 40% loss of his body weight attained through an altered diet and exercise regime, which resulted in him attaining a normal BMI of 24.8 kg/m(2).
A project was undertaken to research and acquire the instructional sources needed for a course in ethics for community college associate degree nursing students and to develop such a course. Addressed in the individual units of the course were the following topics: bioethics and ethical decision making, basic ethical concepts and principles,…
McGowan, Julie J; Passiment, Morgan; Hoffman, Helene M
As more health information technologies become part of the health care environment, the need for physicians with medical informatics competencies is growing. In 2006, a survey was created to determine the degree to which the Association of American Medical College's Medical School Objectives Project (MSOP) medical informatics competencies had been incorporated into medical school curricula in the United States. a web-based tool was used to create the survey; medical education deans or their designees were requested to complete the survey. Analysis focused on the clinician, researcher, and manager roles of physicians. Seventy usable surveys were returned. Many of the objectives were stated in the schools' respective curricula and the competencies were being evaluated. However, only a few schools taught and assessed the medical informatics objectives that required interaction with health information. To insure that physicians have the knowledge, skills, and attitudes to effectively and efficiently interact with today's health information technologies, more medical informatics concepts need to be included and assessed in all undergraduate medical education curricula in the United States.
Gosmann, Fanny; Nørgaard, Astrid; Rasmussen, Maj-Britt
of transfusion-associated dyspnoea. Vital signs and changes in dyspnoea and blood pressure were registered within the frame of the Early Warning Score, and one case was documented as being transfusion-related in the medical record. No cases were reported to the haemovigilance system. DISCUSSION: The incidence...... to the haemovigilance system. The clinical implications are discussed within the frame of the Early Warning Score. METHODS: We conducted a retrospective audit of electronic hospital medical records of patients receiving blood transfusion in a single medical emergency unit. Patients were admitted during a 6-month period...... and data on symptoms and vital signs were extracted from the records. RESULTS: Of 4,353 consecutively admitted patients, 156 patients were transfused with a total of 411 blood components. The audit identified five cases of transfusion-associated circulatory overload (incidence 3.2%) and four cases...
Matthias, Marianne S; Fukui, Sadaaki; Kukla, Marina; Eliacin, Johanne; Bonfils, Kelsey A; Firmin, Ruth L; Oles, Sylwia K; Adams, Erin L; Collins, Linda A; Salyers, Michelle P
This study explored the association between shared decision making and consumers' illness management skills and consumer-provider relationships. Medication management appointments for 79 consumers were audio recorded. Independent coders rated overall shared decision making, minimum level of shared decision making, and consumer-provider agreement for 63 clients whose visit included a treatment decision. Mental health diagnoses, medication adherence, patient activation, illness management, working alliance, and length of consumer-provider relationships were also assessed. Correlation analyses were used to determine relationships among measures. Overall shared decision making was not associated with any variables. Minimum levels of shared decision making were associated with higher scores on the bond subscale of the Working Alliance Inventory, indicating a higher degree of liking and trust, and with better medication adherence. Agreement was associated with shorter consumer-provider relationships. Consumer-provider relationships and shared decision making might have a more nuanced association than originally thought.
Ordonez, Carlos; Chen, Zhibo
Statistical tests represent an important technique used to formulate and validate hypotheses on a dataset. They are particularly useful in the medical domain, where hypotheses link disease with medical measurements, risk factors, and treatment. In this paper, we propose to compute parametric statistical tests treating patient records as elements in a multidimensional cube. We introduce a technique that combines dimension lattice traversal and statistical tests to discover significant differences in the degree of disease within pairs of patient groups. In order to understand a cause-effect relationship, we focus on patient group pairs differing in one dimension. We introduce several optimizations to prune the search space, to discover significant group pairs, and to summarize results. We present experiments showing important medical findings and evaluating scalability with medical datasets.
Majidi, Roya, E-mail: email@example.com [Department of Physics, Shahid Rajaee Teacher Training University, Lavizan, 16788-15811 Tehran (Iran, Islamic Republic of)
In the present work, we have compared the resistance of the 90 Degree-Sign , 180 Degree-Sign , and 360 Degree-Sign domain walls in the presence of external magnetic field. The calculations are based on the Boltzmann transport equation within the relaxation time approximation. One-dimensional Neel-type domain walls between two domains whose magnetization differs by angle of 90 Degree-Sign , 180 Degree-Sign , and 360 Degree-Sign are considered. The results indicate that the resistance of the 360 Degree-Sign DW is more considerable than that of the 90 Degree-Sign and 180 Degree-Sign DWs. It is also found that the domain wall resistance can be controlled by applying transverse magnetic field. Increasing the strength of the external magnetic field enhances the domain wall resistance. In providing spintronic devices based on magnetic nanomaterials, considering and controlling the effect of domain wall on resistivity are essential.
Zenan, Joan S.
The Association of Academic Health Sciences Libraries' (AAHSL's) involvement in national legislative activities and other advocacy initiatives has evolved and matured over the last twenty-five years. Some activities conducted by the Medical Library Association's (MLA's) Legislative Committee from 1976 to 1984 are highlighted to show the evolution of MLA's and AAHSL's interests in collaborating on national legislative issues, which resulted in an agreement to form a joint legislative task forc...
Mills, Michael D.
The American Association of Medical Dosimetrists (AAMD) designed and directed 2 surveys of the AAMD membership. The first was in 2011 and the second in 2014. There were a number of questions common to both surveys, and this article seeks to evaluate these common questions to determine trends among the professional membership of the AAMD. It is demonstrated that the observed trends are consistent with the goals and objectives established by the leadership of the AAMD and the Medical Dosimetry Certification Board (MDCB) for the medical dosimetry community. In addition, certain challenges and opportunities involving the scope of practice for the medical dosimetry profession are discussed
Mills, Michael D., E-mail: firstname.lastname@example.org
The American Association of Medical Dosimetrists (AAMD) designed and directed 2 surveys of the AAMD membership. The first was in 2011 and the second in 2014. There were a number of questions common to both surveys, and this article seeks to evaluate these common questions to determine trends among the professional membership of the AAMD. It is demonstrated that the observed trends are consistent with the goals and objectives established by the leadership of the AAMD and the Medical Dosimetry Certification Board (MDCB) for the medical dosimetry community. In addition, certain challenges and opportunities involving the scope of practice for the medical dosimetry profession are discussed.
Gan, Lydia L; Frederick, James R
The study identified which of the four facilitators (themselves, agents, insurers, or doctors) consumers are most likely to use when they travel for various medical procedures. A survey conducted between 2011 and 2014 yielded 964 responses. The multinomial logistic regression results showed that being 51-64 years old was positively related to going on their own or using agents to arrange for knee replacements. Having a high school education or less was positively linked to using both agents and insurers to facilitate knee replacements, whereas having a bachelor's degree was negatively associated with going on their own for stem cell therapy.
Valsky, Dan V; Cohen, Sarah M; Lipschuetz, Michal; Hochner-Celnikier, Drorith; Daum, Hagit; Yagel, Itai; Yagel, Simcha
We evaluated primiparous women with clinically diagnosed third- and fourth-degree and anal sphincter tears, to evaluate the rate of levator ani muscle injury compared to primiparous women without sphincter tears. Primiparous women delivering in our maternity ward with intrapartum diagnoses of third- or fourth-degree anal sphincter tears, repaired by the overlapping technique, were recruited to undergo 3-dimensional transperineal sonography of the pelvic floor anatomy, including the anterior and posterior compartments. Primiparas with uncomplicated vaginal deliveries were recruited as a comparison group. Patient files were examined, and maternal backgrounds and delivery and neonatal details were extracted for all patients. Ninety-four women with tears were recruited to the study group, and 464 women with normal vaginal deliveries constituted the comparison group. The groups differed significantly in the rates of levator ani defects: 38 of 94 women (40.4%) in the study group versus 75 of 464 (16.2%) in the comparison group (P tears are associated with levator ani avulsion. Knowledge of complex pelvic floor damage may allow for prompt referral to secondary preventive measures for pelvic floor disorders. © 2016 by the American Institute of Ultrasound in Medicine.
Shaffi Ahamed, Shaik; Enani, Jawaher; Alfaraidi, Lama; Sannari, Lujain; Algain, Rihaf; Alsawah, Zainah; Al Hazmi, Ali
Body dysmorphic disorder (BDD) is a distressing psychiatric disorder. So far there have not been any studies on BDD in Saudi Arabia. The aim of this study was to determine the prevalence of body dysmorphic disorder in female medical students and to investigate whether there is an association between BDD and body features of concern, social anxiety and symptoms of BDD. A cross sectional study was carried out on female medical students of the college of medicine, King Saud University, Riyadh, Saudi Arabia during January to April, 2015. Data were collected using the body image disturbance questionnaire, Body dysmorphic disorder symptomatology and social interaction anxiety scale. Descriptive statistics, bivariate and multivariate analysis were used to analyze the results. Out of 365 students who filled out the questionnaire, 4.4% (95% confidence intervals (CI): 2.54% to 7.04%) were positive for BDD with skin (75%) and fat (68.8%) as the most frequent body features of concern. Ten features (skin, fat, chest, hips, buttocks, arms, legs, lips, fingers, and shoulders) out of twenty-six were significantly associated with BDD. Arms and chest were independently associated with BDD. The odds of presence of body concern related to "arms" was 4.3 (95% C.I: 1.5, 12.1) times more in BDD subjects than non-BDD subjects, while concern about "chest" was 3.8 (1.3, 10.9) times more when compared to non-BDD subjects. No statistically significant association was observed between BDD and social anxiety (P = 0.13). This was the first study conducted in Kingdom of Saudi Arabia (KSA) on female medical students, which quantified the prevalence of BDD and identified the body features associated with it. Body dysmorphic disorder is prevalent in female medical students but it is relatively rare and an unnoticed disorder.
Herrmann-Lingen, Christoph; Brunner, Edgar; Hildenbrand, Sibylle; Loew, Thomas H; Raupach, Tobias; Spies, Claudia; Treede, Rolf-Detlef; Vahl, Christian-Friedrich; Wenz, Hans-Jürgen
The evaluation of medical research performance is a key prerequisite for the systematic advancement of medical faculties, research foci, academic departments, and individual scientists' careers. However, it is often based on vaguely defined aims and questionable methods and can thereby lead to unwanted regulatory effects. The current paper aims at defining the position of German academic medicine toward the aims, methods, and consequences of its evaluation. During the Berlin Forum of the Association of the Scientific Medical Societies in Germany (AWMF) held on 18 October 2013, international experts presented data on methods for evaluating medical research performance. Subsequent discussions among representatives of relevant scientific organizations and within three ad-hoc writing groups led to a first draft of this article. Further discussions within the AWMF Committee for Evaluation of Performance in Research and Teaching and the AWMF Executive Board resulted in the final consented version presented here. The AWMF recommends modifications to the current system of evaluating medical research performance. Evaluations should follow clearly defined and communicated aims and consist of both summative and formative components. Informed peer reviews are valuable but feasible in longer time intervals only. They can be complemented by objective indicators. However, the Journal Impact Factor is not an appropriate measure for evaluating individual publications or their authors. The scientific "impact" rather requires multidimensional evaluation. Indicators of potential relevance in this context may include, e.g., normalized citation rates of scientific publications, other forms of reception by the scientific community and the public, and activities in scientific organizations, research synthesis and science communication. In addition, differentiated recommendations are made for evaluating the acquisition of third-party funds and the promotion of junior scientists. With the
Cummings, Patricia L; Kuo, Tony; Javanbakht, Marjan; Sorvillo, Frank
Few studies have quantified toxoplasmosis mortality, associated medical conditions, and productivity losses in the United States. We examined national multiple cause of death data and estimated productivity losses caused by toxoplasmosis during 2000-2010. A matched case-control analysis examined associations between comorbid medical conditions and toxoplasmosis deaths. In total, 789 toxoplasmosis deaths were identified during the 11-year study period. Blacks and Hispanics had the highest toxoplasmosis mortality compared with whites. Several medical conditions were associated with toxoplasmosis deaths, including human immunodeficiency virus (HIV), lymphoma, leukemia, and connective tissue disorders. The number of toxoplasmosis deaths with an HIV codiagnosis declined from 2000 to 2010; the numbers without such a codiagnosis remained static. Cumulative disease-related productivity losses for the 11-year period were nearly $815 million. Although toxoplasmosis mortality has declined in the last decade, the infection remains costly and is an important cause of preventable death among non-HIV subgroups. © The American Society of Tropical Medicine and Hygiene.
Hammerly, Milton E; Harmon, Larry; Schwaitzberg, Steven D
The past decade has seen intense interest and dramatic change in how hospitals and physician organizations review physician behaviors. The characteristics of successful physicians extend past their technical and cognitive skills. Two of the six core clinical competencies (professionalism and interpersonal/communication skills) endorsed by the Accreditation Council for Graduate Medical Education, the American Board of Medical Specialties, and The Joint Commission require physicians to succeed in measures associated with emotional intelligence (EI). Using 360-degree anonymous feedback surveys to screen for improvement opportunities in these two core competencies enables organizations to selectively offer education to further develop physician EI. Incorporating routine use of these tools and interventions into ongoing professional practice evaluation and focused professional practice evaluation processes may be a cost-effective strategy for preventing disruptive behaviors and increasing the likelihood of success when transitioning to an employed practice model. On the basis of a literature review, we determined that physician EI plays a key role in leadership; teamwork; and clinical, financial, and organizational outcomes. This finding has significant implications for healthcare executives seeking to enhance physician alignment and transition to a team-based delivery model.
West, Lindsey M.
With the rise in advanced-degree seeking women and the minimal research on the dual impact of sexism and role overload, the current study aims to better understand the impact of sexism and role overload on psychological distress in a particular sample of advanced-degree seeking women. Seventy-six female medical student participants (mean age 24.7)…
Nedic Erjavec, Gordana; Uzun, Suzana; Nikolac Perkovic, Matea; Kozumplik, Oliver; Svob Strac, Dubravka; Mimica, Ninoslav; Hirasawa-Fujita, Mika; Domino, Edward F; Pivac, Nela
Cigarette smoking is associated with higher cortisol levels in healthy subjects. In schizophrenia this relationship is not clear. There are divergent results on the association between cortisol with smoking, clinical symptoms and medication in schizophrenia. This study evaluated this association in 196 Caucasian inpatients with schizophrenia (51.30±26.68years old), subdivided into 123 smokers and 73 non-smokers. Basal salivary cortisol levels were measured twice, at 08.00 and 09.00AM, 90-120min after awakening. The effect of smoking on cortisol was evaluated according to current smoking status, the number of cigarettes/day and the nicotine addiction intensity. The influence of clinical symptoms and/or antipsychotic medication on cortisol was determined using the Positive and Negative Syndrome Scale (PANSS), and chlorpromazine equivalent doses. Non-smokers were older, received lower doses of antipsychotics, had higher PANSS scores, and had longer duration of illness than smokers. Salivary cortisol was similar in schizophrenic patients subdivided according to the smoking status, the number of cigarettes/day and nicotine addiction intensity. No significant correlation was found between salivary cortisol and PANSS scores, chlorpromazine equivalent doses, age of onset or the duration of illness. The findings revealed no association between salivary cortisol and smoking, nicotine addiction intensity, or clinical symptoms. Our preliminary data showed no correlation between salivary cortisol and chlorpromazine equivalent doses and/or antipsychotic medication. Our findings suggest that smoking does not affect the cortisol response in schizophrenic patients as it has been shown in healthy individuals. Future studies should investigate a possible desensitization of the stress system to smoking. Copyright © 2017. Published by Elsevier Inc.
Rees, A M; Rothenberg, L; Denison, B
THE PRESENT SYSTEM OF EDUCATION FOR MEDICAL LIBRARY PRACTICE IN THE UNITED STATES CONSISTS OF FOUR MAJOR COMPONENTS: graduate degree programs in library science with specialization in medical librarianship; graduate degree programs in library science with no such specialization; postgraduate internships in medical libraries; continuing education programs. Data are presented illustrating the flow of graduates along these several educational pathways into medical library practice.The relevance of these educational components to the current medical library work force is discussed with reference to manpower data compiled for Ohio. The total number of medical library personnel in Ohio in 1968 is 316. Of this total, only forty-two (approximately 14 percent) have received any formal library training. Seventy persons have only a high school education. From these figures, it is concluded that there is no standard or essential qualification which is universally accepted as educational preparation for work in medical libraries; that the comparative sophistication of the educational programs in medical librarianship has yet to be reflected widely in general medical library practice; that an increasingly large number of non-professional or ancillary personnel are being, and will continue to be, utilized in medical libraries; that large numbers of untrained persons have sole responsibility for medical libraries; and that appropriate educational programs will have to be designed specifically for this type of personnel.
Taha, Haytham; Raji, Salama J.; Khallaf, Abeer; Abu Hija, Seham; Mathew, Raji; Rashed, Hanan; Du Plessis, Christelle; Allie, Zaytoen; Ellahham, Samer
Sheikh Khalifa Medical City (SKMC) in Abu Dhabi is the main tertiary care referral hospital in the United Arab Emirates (UAE) with 560 bed capacity with a high occupancy rate. SKMC senior management has made a commitment to make quality and patient safety a top priority. Preventing health care associated infections, including Catheter Associated Urinary Tract Infection (CAUTI), is a high priority for our hospital. In order to improve CAUTI rates a multidisciplinary task force team was formed and led this performance improvement project. The purpose of this publication is to indicate the quality improvement interventions implemented to reduce CAUTI rates and the outcome of those interventions. We chose to conduct the pilot study in General Medicine as it is the busiest department in the hospital, with an average of 390 patients admitted per month during the study period. The study period was from March 2015 till April 2016. Our aim was to reduce CAUTI rates per 1000 device days in the medical units. Implemented interventions resulted in a reduction of CAUTI from 6.8 per 1000 device days in March 2015 to zero CAUTI in February through April 2016. PMID:28469893
Alfian, Sofa D; Sinuraya, Rano K; Kautsar, Angga P; Abdulah, Rizky
Self-medication is the use of medicines for therapeutic intent without a clinician’s advice or prescription. The National Socioeconomic Survey for Indonesia in 2009 found the percentage of the Indonesians engaging in self-medication is increasing. The objectives of this study were to assess consumers’ expectations regarding service quality provide by pharmacist in self-medication practices and determine the factors associated with self-medication in Bandung, Indonesia. We conduct a cross-sectional survey at eight randomly selected community pharmacies during July-November 2012 and purposely sampled 1,200 costumers purchasing medication at those sites. Subjects reported they understood the information about the medicines given by the pharmacist but still wanted more information and time to consult with the pharmacist about their medicines. Factors associated with self-medication were younger age, male gender, greater education and lower income. The intervention is needed to improve appropriate self-medication.
Problems associated with the organization and planning of medical treatment for radiation accident casualties are considered for different types of radiation accident: whole-body or partial irradiation, external or internal contamination and small or large numbers of cases. The problems posed are ones of competence, urgency and capacity; on the diagnostic side there is the problem of evaluating the exposure or contamination and assessing the resultant damage, while on the treatment side the questions of first aid, conventional treatment and specialized treatment have to be considered. The solutions envisaged involve organization at the local and national levels and planning of medical treatment by skilled, multidisciplinary medical teams. (author)
Loayza H. Maria Paz
Full Text Available Epidemiological research points to the high prevalence of psychiatric disorders among insomniacs. We carried out a cross-sectional study with medical students with the aim of evaluating the association between insomnia and suspicion of psychiatric disorder; 302 medical students were included (184 males and 118 females; mean age = 20.47±1.89 years. The main association was tested by logistic regression analysis. The overall prevalence of positivity in a screening test for psychiatric disorder was 22.19%; and of insomnia, 28.15%. Difficulty initiating sleep (OR=3.45, difficulty maintaining sleep (OR=7.61, falling asleep later (OR=1.99 and waking up earlier (OR=1.91 were associated with suspicion of psychiatric disorder. As a group, the variables difficulty initiating sleep, difficulty maintaining sleep, falling asleep after 11 pm, and waking up before 6 am presented an odds ratio of 5.96 for positivity in the screening for psychiatric disorder. Furthermore, difficulty maintaining sleep (OR=2.24 was associated with "being female," and falling asleep later (OR=0.43 was associated with "being male". These results underscore the importance of determining in what cases difficulty sleeping may have severe clinical repercussions or affect performance.
Duperly, John; Lobelo, Felipe; Segura, Carolina; Sarmiento, Francisco; Herrera, Deisy; Sarmiento, Olga L; Frank, Erica
Background Physician-delivered preventive counseling is important for the prevention and management of chronic diseases. Data from the U.S. indicates that medical students with healthy personal habits have a better attitude towards preventive counseling. However, this association and its correlates have not been addressed in rapidly urbanized settings where chronic disease prevention strategies constitute a top public health priority. This study examines the association between personal health practices and attitudes toward preventive counseling among first and fifth-year students from 8 medical schools in Bogotá, Colombia. Methods During 2006, a total of 661 first- and fifth-year medical students completed a culturally adapted Spanish version of the "Healthy Doctor = Healthy Patient" survey (response rate = 78%). Logistic regression analyses were used to assess the association between overall personal practices on physical activity, nutrition, weight control, smoking, alcohol use (main exposure variable) and student attitudes toward preventive counseling on these issues (main outcome variable), stratified by year of training and adjusting by gender and medical training-related factors (basic knowledge, perceived adequacy of training and perception of the school's promotion on each healthy habit). Results The median age and percentage of females for the first- and fifth-year students were 21 years and 59.5% and 25 years and 65%, respectively. After controlling for gender and medical training-related factors, consumption of ≥ 5 daily servings of fruits and/or vegetables, not being a smoker or binge drinker were associated with a positive attitude toward counseling on nutrition (OR = 4.71; CI = 1.6–14.1; p = 0.006 smoking (OR = 2.62; CI = 1.1–5.9; p = 0.022), and alcohol consumption (OR = 2.61; CI = 1.3–5.4; p = 0.009), respectively. Conclusion As for U.S. physician and medical students, a positive association was found between the personal health habits of
Mantas, John; Ammenwerth, Elske; Demiris, George; Hasman, Arie; Haux, Reinhold; Hersh, William; Hovenga, Evelyn; Lun, K. C.; Marin, Heimar; Martin-Sanchez, Fernando; Wright, Graham
Objective: The International Medical Informatics Association (IMIA) agreed on revising the existing international recommendations in health informatics/medical informatics education. These should help to establish courses, course tracks or even complete programs in this field, to further develop
Haddad, Stephen A; Ruiz-Narváez, Edward A; Cozier, Yvette C; Gerlovin, Hanna; Rosenberg, Lynn; Palmer, Julie R
Circulating levels of vitamin D are generally lower in African Americans compared to U.S. whites, and one prior analysis in a small number of African Americans suggested that, within this population, vitamin D levels may be related to the degree of genetic admixture. We assessed the association of percent European ancestry with serum vitamin D levels in 2183 African American women from the Black Women's Health Study in 2013-2015, whose DNA had been genotyped for ancestry informative markers. ADMIXMAP software was used to estimate percent European versus African ancestry in each individual. In linear regression analyses with adjustment for genotype batch, age, body mass index, supplemental vitamin D use, UVB flux in state of residence, and season of blood draw, each 10% increase in European ancestry was associated with a 0.672 ng/mL increase in serum vitamin D concentration (95% confidence interval 0.173, 1.170). The association was statistically significant only among women who were not taking vitamin D supplements (beta coefficient for 10% increase in European ancestry 0.855, 95% confidence interval 0.139, 1.571). Among African Americans, use of vitamin D supplementation may help to reduce vitamin D deficiency due to genetic ancestry. © The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: email@example.com.
American Association of Community Colleges, 2017
In fall 2015, U.S community colleges enrolled about 7.2 million for-credit students. During the same year, community colleges awarded 806,766 associate degrees and 516,820 certificates. The new Humanities Indicators report from the American Academy of Arts and Sciences shows a significant increase in associate degrees awarded in the humanities,…
Minal S Kale
Full Text Available Low health literacy is associated with low adherence to self-management in many chronic diseases. Additionally, health beliefs are thought to be determinants of self-management behaviors. In this study we sought to determine the association, if any, of health literacy and health beliefs among elderly individuals with COPD.We enrolled a cohort of patients with COPD from two academic urban settings in New York, NY and Chicago, IL. Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Using the framework of the Self-Regulation Model, illness and medication beliefs were measured with the Brief Illness Perception Questionnaire (B-IPQ and Beliefs about Medications Questionnaire (BMQ. Unadjusted analyses, with corresponding Cohen's d effect sizes, and multiple logistic regression were used to assess the relationships between HL and illness and medication beliefs.We enrolled 235 participants, 29% of whom had low health literacy. Patients with low health literacy were more likely to belong to a racial minority group (p<0.001, not be married (p = 0.006, and to have lower income (p<0.001 or education (p<0.001. In unadjusted analyses, patients with low health literacy were less likely to believe they will always have COPD (p = 0.003, Cohen's d = 0.42, and were more likely to be concerned about their illness ((p = 0.04, Cohen's d = 0.17. In analyses adjusted for sociodemographic factors and other health beliefs, patients with low health literacy were less likely to believe that they will always have COPD (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.65-0.94. In addition, the association of low health literacy with expressed concern about medications remained significant (OR: 1.20, 95% CI: 1.05-1.37 though the association of low health literacy with belief in the necessity of medications was no longer significant (OR: 0.92, 95% CI: 0.82-1.04.In this cohort of urban individuals with COPD, low health literacy was
Godfrey Mutashambara Rwegerera
Mar 6, 2017 ... tive of the study was to determine current antidiabetic medication adherence in ...... A systematic review of adherence with medications for diabetes. .... Pascal IGU, Ofoedu JN, Uchenna NP, Nkwa AA, Uchamma GUE.
Karup-Møller, Sven; Makovicky, E.
Phase relations in the dry condensed system Cu-Rh-S were determined at 900, 700, 540 and 500 degrees C. At 900 degrees C, the system contains digenite, four rhodium sulfides (Rh17S15, Rh3S4, Rh2S3 and RhS similar to 3), three ternary sulfides (CuRh2S4, CuxRhS3+x and a fibrous sulfide in the range...
Gleason, Patrick P; Starner, Catherine I; Gunderson, Brent W; Schafer, Jeremy A; Sarran, H Scott
In 2008, specialty medications accounted for 15.1% of total pharmacy benefit medication spending, and per member expenditures have increased by 11.1% annually from 2004 to 2008 within a commercially insured population of 8 million members. Insurers face increasing pressure to control specialty medication expenditures and to rely on increasing member cost share through creation of a fourth copayment tier within the incentive-based formulary pharmacy benefit system. Data are needed on the influence that member out-of-pocket (OOP) expense may have on prescription abandonment (defined as the patient never actually taking possession of the medication despite evidence of a written prescription generated by a prescriber). To explore the relationship between prescription abandonment and OOP expense among individuals newly initiating high-cost medication therapy with a tumor necrosis factor (TNF) blocker or multiple sclerosis (MS) biologic agent. This observational cross-sectional study queried a midwestern and southern U.S. database of 13,172,480 commercially insured individuals to find members with a pharmacy benefit-adjudicated claim for a TNF blocker or MS specialty medication during the period from July 2006 through June 2008. Prescription abandonment was assessed among continuously enrolled members newly initiating TNF blocker or MS therapy. Prescription abandonment was defined as reversal of the adjudicated claim with no evidence of a subsequent additional adjudicated paid claim in the ensuing 90 days. Separate analyses for MS and TNF blocker therapy were performed to assess the association between member OOP expense and abandonment rate using the Cochran-Armitage test for trend and multivariate logistic regression. Members were placed into 1 of the 7 following OOP expense groups per claim: $0-$100, $101-$150, $151-$200, $201-$250, $251-$350, $351-$500, or more than $500. The association of MS or TNF blocker abandonment rate with OOP expense was tested with logistic
Annisa N. Insany
Full Text Available High prevalence of self medication with antibiotics can increase the probability of irrational use of antibiotics which may lead antibiotics resistance. Thus, shifting of behavior is required to minimize the irrational use of antibiotics. This study was aimed to determine the association between public perceived value and self-medication with antibiotics which can be used to develop an intervention model in order to reduce the practice of self-medication with antibiotics. An observational study was conducted during the period of November–December 2014.The subjects were patients who visit primary health care facilities in Bandung. A structured-interview that has been validated was used to investigate the association between perceived value and self-medication behavior based on the Health Belief Model theory (perceived susceptibility, benefits, barrier, and cues to action. Approximately 506 respondents were drawn randomly from 43 community healthcare centers and 8 pharmacies. Data was analyzed by using descriptive statistics and logistic regression (CI 95%, α = 5%. Validity and reliability of the questionnaire were shown with a correlation coefficient of >0.3 and a cronbach-alpha value of 0.719, respectively. We found that 29.45% of respondents practiced self-medication with antibiotics over the last six months. Additionally, there was no significant association between the perceived susceptibility, benefits, barrier, and cues to action with self-medication behavior (p>0.05. Easiness to access antibiotics without prescription was presumed as a factor that contribute to self-medication with antibiotics, therefore strict regulation in antibiotics use is very needed as a basic intervention to decrease self-medication with antibiotic.
Song, Hyuksoon S; Kalet, Adina L; Plass, Jan L
We developed a Self-Regulation Measure for Computer-based learning (SRMC) tailored toward medical students, by modifying Zimmerman's Self-Regulated Learning Interview Schedule (SRLIS) for K-12 learners. The SRMC's reliability and validity were examined in 2 studies. In Study 1, 109 first-year medical students were asked to complete the SRMC. Bivariate correlation analysis results indicated that the SRMC scores had a moderate degree of correlation with student achievement in a teacher-developed test. In Study 2, 58 third-year clerkship students completed the SRMC. Regression analysis results indicated that the frequency of medical students' usage of self-regulation strategies was associated with their general clinical knowledge measured by a nationally standardized licensing exam. These two studies provided evidence for the reliability and concurrent validity of the SRMC to assess medical students' self-regulation as aptitude. Future work should provide evidence to guide and improve instructional design as well as inform educational policy.
Almalki, Sami A; Almojali, Abdullah I; Alothman, Ali S; Masuadi, Emad M; Alaqeel, Meshal K
To assess levels of burnout in medical students, and to explore the influence of extracurricular activities on burnout at a medical school in Saudi Arabia. This cross-sectional study was conducted with first to fourth year medical students at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) in Riyadh, Saudi Arabia. Socio-demographic, burnout level (the Maslach Burnout Inventory-Student Survey, MBI-SS) and participation in extracurricular activities data were collected using a self-administered questionnaire. Statistical analyses were performed using the Pearson's chi-square test and binary logistic regression. From the 306 medical students approached, 249 (81.4%) completed the questionnaire. The level of high burnout was 67.1% (n=167). The study revealed that the majority (62.3%, n=155) of students had high levels of cynicism, 58.6% (n=146) had high levels of emotional exhaustion, and 60.2% (n=150) had low levels of professional efficacy. Most of the students (73.5%, n=183) participated in extracurricular activities, and 112 (45%) students were organizers of extracurricular activities. No significant association was found between burnout levels and the frequency of involvement in extracurricular activities (χ 2 =2.2, df=2, p=0.333). However, students who were organizing extracurricular activities were less likely to have low professional efficacy (OR=0.51, 95% CI: 0.27- 0.96). High levels of burnout were reported at this medical school. Although the burnout level is not significantly associated with the frequency of involvement in extracurricular activities, leading and organizing extracurricular activities might result in lower levels of burnout. Therefore, improving the students' leadership skills should be considered in curriculum planning, and greater emphasis should be placed on the quality of involvement in extracurricular activities rather than the quantity.
Jiménez, Hassel Jimmy; Delgadillo, Lorena; Campuzano de Rolon, Ana; Jiménez, Diana; de Samudio, Angélica; Agüero, Adriana; Radice, César; Jiménez-Britez, Gustavo
Paraguay is a bilingual country and knowledge of the guarani language is an important communication tool for the doctor- patient relationship. To determine the degree of and the factors that influence the knowledge of the Guaraní language in medical students at a University Hospital in Paraguay. Observational, cross-sectional, analytical study in which an anonymous questionnaire was applied to the final year medical students of a University Hospital of Paraguay. The baseline characteristics of the medical students and their degree of knowledge of the Guarani language were described. The association between the characteristics of the students and the degree of knowledge of the Guarani language was evaluated with the Chi square association test and the logistic regression model. We included 264 students in the survey. Eighty two percent come from the capital, 72% made their pre-university studies in the capital; 92% studied Guaraní in primary and secondary education; 67.9% do not interpret Guarani correctly; 8.5% understand and express themselves totally in Guaraní. Of these, 86% refer to have the greater learning of the language in their home; 75.2% of respondents believe that primary and secondary education did not help in learning the language. The degree of knowledge of the language (speaks and understands the Guarani language correctly) varies according to: the origin of the student, the inland regions or the capital (31.25% vs. 2.5%, adjusted OR = 0.24, 95% confidence interval: 0.06 to 0.92, p = 0.003); the location of primary and secondary school: inland versus capital (25.6% vs. 1%, adjusted OR: 0.08, 95% confidence interval: 0.01 to 0.53, p = 0.009). The degree of knowledge of the Guaraní language of the students is lower compared to the general population; those who best understand and express themselves were born or studied in the interior of the country. The majority considers that primary and secondary education contribute little in the learning of
Mishra, Amrita; Banwari, Girish; Yadav, Priyanka
There is scant research on premenstrual syndrome (PMS) and its more severe counterpart, premenstrual dysphoric disorder (PMDD) in Indian females. This study aimed to evaluate symptoms of PMS in medical students and to find the association of sociodemographic variables and lifestyle factors with PMDD. A total of 179 medical students residing in the hostel of an Indian medical college and its affiliated teaching hospital were approached, of which 100 (55.8%) returned the completed questionnaires. Data related to lifestyle factors was collected. Self-screening quiz for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision PMDD and Shortened Premenstrual Assessment Form were used for diagnosis of PMDD and detection of symptomatology, respectively. PMDD was present in 37% of the respondents. It was found at a higher rate in older and postgraduate students. PMDD was significantly associated with lifestyle factors, namely, sleep, physical activity, total tea/coffee intake, and change in tea/coffee and food intake under stress. The most common physical and psychological symptoms were body ache/joint pain and feeling depressed/blue, respectively. PMDD is fairly common in Indian medical students residing in hostel although cultural factors may influence symptom expression. This study suggests that PMDD is associated with lifestyle factors in young, professional, urban women. Modification in lifestyle may thus be an important approach for management of PMS/PMDD. Prospective studies with larger representative samples are needed to validate these findings.
Full Text Available Context: There is scant research on premenstrual syndrome (PMS and its more severe counterpart, premenstrual dysphoric disorder (PMDD in Indian females. This study aimed to evaluate symptoms of PMS in medical students and to find the association of sociodemographic variables and lifestyle factors with PMDD. Subjects and Methods: A total of 179 medical students residing in the hostel of an Indian medical college and its affiliated teaching hospital were approached, of which 100 (55.8% returned the completed questionnaires. Data related to lifestyle factors was collected. Self-screening quiz for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision PMDD and Shortened Premenstrual Assessment Form were used for diagnosis of PMDD and detection of symptomatology, respectively. Results: PMDD was present in 37% of the respondents. It was found at a higher rate in older and postgraduate students. PMDD was significantly associated with lifestyle factors, namely, sleep, physical activity, total tea/coffee intake, and change in tea/coffee and food intake under stress. The most common physical and psychological symptoms were body ache/joint pain and feeling depressed/blue, respectively. Conclusions: PMDD is fairly common in Indian medical students residing in hostel although cultural factors may influence symptom expression. This study suggests that PMDD is associated with lifestyle factors in young, professional, urban women. Modification in lifestyle may thus be an important approach for management of PMS/PMDD. Prospective studies with larger representative samples are needed to validate these findings.
Winker, M A; Flanagin, A; Chi-Lum, B; White, J; Andrews, K; Kennett, R L; DeAngelis, C D; Musacchio, R A
Access to medical information via the Internet has the potential to speed the transformation of the patient-physician relationship from that of physician authority ministering advice and treatment to that of shared decision making between patient and physician. However, barriers impeding this transformation include wide variations in quality of content on the Web, potential for commercial interests to influence online content, and uncertain preservation of personal privacy. To address these issues, the American Medical Association (AMA) has developed principles to guide development and posting of Web site content, govern acquisition and posting of online advertising and sponsorship, ensure site visitors' and patients' rights to privacy and confidentiality, and provide effective and secure means of e-commerce. While these guidelines were developed for the AMA Web sites and visitors to these sites, they also may be useful to other providers and users of medical information on the Web. These principles have been developed with the understanding that they will require frequent revision to keep pace with evolving technology and practices on the Internet. The AMA encourages review and feedback from readers, Web site visitors, policymakers, and all others interested in providing reliable quality information via the Web.
Dodig, D.; Tezak, S.; Kasal, B.; Huic, D.; Medvedec, M.; Loncaric, S.; Grosev, D.; Rozman, B.; Popovic, S.
Medical service is a prerequisite for work license of nuclear installation. Every nuclear installation incorporate in their safety procedure also medical emergency plan. Usually the medical emergency plan consists of several degrees of action: 1. First aid, 2. First medical treatment, 3. Treatment in regional hospital, 4. Treatment in special institution (centre for radiation medicine). This paper discusses organization and activities of Centre for Radiation Medicine and Protection - Clinical Hospital Centre Zagreb
Goto, Michiko; Takemura, Yousuke C
In medical practice, obtaining information regarding patients' undisclosed "feelings of anxiety" or "depressive feelings" is important. The purpose of this study was to determine which interview skills are best suited for eliciting verbal indications of undisclosed feelings, for example anxiety or depressive feelings in patients. Our group videotaped 159 medical interviews at an outpatient department of the Department of Family Medicine, Mie University Hospital (Mie, Japan). Physicians' medical interview skills were evaluated using a Medical Interview Evaluation System and Emotional Information Check Sheet for assessing indications of "feelings of anxiety" or "depressive feelings". We analyzed the relationship between the interview skills and patients' consequent emotional disclosure using generalized linear model (GLIM). The usage of interview skills such as "open-ended questions" "asking the patient's ideas about the meaning of illness" "reflection" and "legitimization" were positively associated with the number of anxiety disclosure, whereas "close-ended questions" and "focused question" were negatively associated. On the other hand, only "respect" was positively associated with the number of depressive disclosures, whereas "surveying question" was negatively associated. The results revealed that there are several interview skills that are effective in eliciting verbal indication of undisclosed "feelings of anxiety" or "depressive feelings".
Given, Joanne E.; Loane, Maria; Luteijn, Johannes M.; Morris, Joan K.; de Jong van den Berg, Lolkje T.W.; Garne, Ester; Addor, Marie‐Claude; Barisic, Ingeborg; de Walle, Hermien; Gatt, Miriam; Klungsoyr, Kari; Khoshnood, Babak; Latos‐Bielenska, Anna; Nelen, Vera; Neville, Amanda J.; O'Mahony, Mary; Pierini, Anna; Tucker, David; Wiesel, Awi
Aims To evaluate congenital anomaly (CA)‐medication exposure associations produced by the new EUROmediCAT signal detection system and determine which require further investigation. Methods Data from 15 EUROCAT registries (1995–2011) with medication exposures at the chemical substance (5th level of Anatomic Therapeutic Chemical classification) and chemical subgroup (4th level) were analysed using a 50% false detection rate. After excluding antiepileptics, antidiabetics, antiasthmatics and SSRIs/psycholeptics already under investigation, 27 associations were evaluated. If evidence for a signal persisted after data validation, a literature review was conducted for prior evidence of human teratogenicity. Results Thirteen out of 27 CA‐medication exposure signals, based on 389 exposed cases, passed data validation. There was some prior evidence in the literature to support six signals (gastroschisis and levonorgestrel/ethinylestradiol (OR 4.10, 95% CI 1.70–8.53; congenital heart disease/pulmonary valve stenosis and nucleoside/tide reverse transcriptase inhibitors (OR 5.01, 95% CI 1.99–14.20/OR 28.20, 95% CI 4.63–122.24); complete absence of a limb and pregnen (4) derivatives (OR 6.60, 95% CI 1.70–22.93); hypospadias and pregnadien derivatives (OR 1.40, 95% CI 1.10–1.76); hypospadias and synthetic ovulation stimulants (OR 1.89, 95% CI 1.28–2.70). Antipropulsives produced a signal for syndactyly while the literature revealed a signal for hypospadias. There was no prior evidence to support the remaining six signals involving the ordinary salt combinations, propulsives, bulk‐forming laxatives, hydrazinophthalazine derivatives, gonadotropin releasing hormone analogues and selective serotonin agonists. Conclusion Signals which strengthened prior evidence should be prioritized for further investigation, and independent evidence sought to confirm the remaining signals. Some chance associations are expected and confounding by indication is possible. PMID
Shirai, Masato; Tsujimura, Akira; Hisasue, Shin-Ichi; Abdelhamed, Amr; Horie, Shiego
Objective The purpose of the present study was to investigate the current state of sexuality education in Japanese medical schools and the association of the position title of Japanese Society for Sexual Medicine (JSSM). Methods We surveyed the four factors, the number of lecture components, the time of curriculum hours, the degree of sufficiency level of the components, and the degree of sufficiency level of the curriculum hours in medical schools in Japan. Also, we have investigated the four factors difference among three groups, Directors, Council, and Non-member of JSSM. Results Of the 80 medical schools, the faculties of the Urological department of 69 medical schools (86%) responded. The mean number of lecture components was 7.8. The number of lecture components of Directors (10.2) had significantly higher than Council (4.7) and Non-member (7.3). There is no significant difference the number of lecture components between Council and Non-member. The mean curriculum hour was 113 minutes. The curriculum hour of Directors (152.6) was significantly longer than Non-member (95.9). There is no significant difference the curriculum hour between Council (106.7) and Non-member. The satisfactory degree of the components was very satisfied (1.5%), satisfied (26.5%), not satisfied (55.9%), and dissatisfied (16.5%) for the faculties. The satisfactory degree of the curriculum hours was very long (0%), long (0%), moderate (50%), short (45.6%), and very short (4.4%) for the faculties. There is no significant difference the satisfactory degree of the components and the curriculum hours among three groups. Conclusions The Directors of JSSM have a positive attitude for sexuality education in Japanese medical schools. While curriculum hour is insufficient for the faculties in half of medical schools, over 70% medical schools answered that the lecture components are insufficient, too. Now we should make every effort to achieve sufficient components for sexuality education. We need
Jeffrey K Yao
Full Text Available The antioxidant defense system, which is known to be dysregulated in schizophrenia, is closely linked to the dynamics of purine pathway. Thus, alterations in the homeostatic balance in the purine pathway may be involved in the pathophysiology of schizophrenia.Breakdown products in purine pathway were measured using high-pressure liquid chromatography coupled with a coulometric multi-electrode array system for 25 first-episode neuroleptic-naïve patients with schizophrenia at baseline and at 4-weeks following initiation of treatment with antipsychotic medication. Associations between these metabolites and clinical and neurological symptoms were examined at both time points. The ratio of uric acid and guanine measured at baseline predicted clinical improvement following four weeks of treatment with antipsychotic medication. Baseline levels of purine metabolites also predicted clinical and neurological symtpoms recorded at baseline; level of guanosine was associated with degree of clinical thought disturbance, and the ratio of xanthosine to guanosine at baseline predicted degree of impairment in the repetition and sequencing of actions.Findings suggest an association between optimal levels of purine byproducts and dynamics in clinical symptoms and adjustment, as well as in the integrity of sensory and motor processing. Taken together, alterations in purine catabolism may have clinical relevance in schizophrenia pathology.
Kawamoto, Ryuichi; Ninomiya, Daisuke; Kasai, Yoshihisa; Kusunoki, Tomo; Ohtsuka, Nobuyuki; Kumagi, Teru; Abe, Masanori
Background In Japan, there is a shortage of young physicians in various specialties; the present situation of general medicine or family medicine (GM/FM) in particular is risky. The factors influencing the career choice of Japanese medical students are poorly understood. This study aims to identify factors related to choosing GM/FM as a career. Methods The study was designed as a cross-sectional survey. Students at one medical school in Japan filled out a questionnaire. Students were asked to state their intended medical specialty, and they rated the importance of specific individual and occupational aspects using a 4-point likert scale. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach‘s alpha coefficients; biserial correlations between the factors and career choices were calculated. Furthermore, multiple linear regression analysis was performed using career choice (GM/FM vs. others) as the criterion variable and the factors plus demographic characteristics as confounding variables. Results Factor analysis produced six factors that explained future career plans. Medical students in this study had a positive and realistic idea about GM/FM, but only 18.8% of them chose GM/FM first as a career. The significant variables associated with choosing GM/FM first as a career were: ‘Admission from hometown’ (β=0.189, P=0.001), ‘Student preparing for the entrance exam’ (β=0.172; P=0.001), ‘Intent for rural practice’ (β=0.123, P=0.016), and ‘Work–life balance’ (β=0.126, P=0.013). While significant variables that were negatively associated with choosing GM/FM were ‘Presence of medical relatives’ (β=−0.107, P=0.037) and ‘Scientific orientation’ (β=−0.125, P=0.013). Conclusions Strategies have been suggested, such as recruiting medical students with significant variables that were associated with choosing GM/FM first as a career. By engaging students early in their choice of career
Kawamoto, Ryuichi; Ninomiya, Daisuke; Kasai, Yoshihisa; Kusunoki, Tomo; Ohtsuka, Nobuyuki; Kumagi, Teru; Abe, Masanori
In Japan, there is a shortage of young physicians in various specialties; the present situation of general medicine or family medicine (GM/FM) in particular is risky. The factors influencing the career choice of Japanese medical students are poorly understood. This study aims to identify factors related to choosing GM/FM as a career. The study was designed as a cross-sectional survey. Students at one medical school in Japan filled out a questionnaire. Students were asked to state their intended medical specialty, and they rated the importance of specific individual and occupational aspects using a 4-point likert scale. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach's alpha coefficients; biserial correlations between the factors and career choices were calculated. Furthermore, multiple linear regression analysis was performed using career choice (GM/FM vs. others) as the criterion variable and the factors plus demographic characteristics as confounding variables. Factor analysis produced six factors that explained future career plans. Medical students in this study had a positive and realistic idea about GM/FM, but only 18.8% of them chose GM/FM first as a career. The significant variables associated with choosing GM/FM first as a career were: 'Admission from hometown' (β=0.189, P=0.001), 'Student preparing for the entrance exam' (β=0.172; P=0.001), 'Intent for rural practice' (β=0.123, P=0.016), and 'Work-life balance' (β=0.126, P=0.013). While significant variables that were negatively associated with choosing GM/FM were 'Presence of medical relatives' (β=-0.107, P=0.037) and 'Scientific orientation' (β=-0.125, P=0.013). Strategies have been suggested, such as recruiting medical students with significant variables that were associated with choosing GM/FM first as a career. By engaging students early in their choice of career, we may be able to increase enthusiasm for this specialty.
Full Text Available Background: In Japan, there is a shortage of young physicians in various specialties; the present situation of general medicine or family medicine (GM/FM in particular is risky. The factors influencing the career choice of Japanese medical students are poorly understood. This study aims to identify factors related to choosing GM/FM as a career. Methods: The study was designed as a cross-sectional survey. Students at one medical school in Japan filled out a questionnaire. Students were asked to state their intended medical specialty, and they rated the importance of specific individual and occupational aspects using a 4-point likert scale. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach‘s alpha coefficients; biserial correlations between the factors and career choices were calculated. Furthermore, multiple linear regression analysis was performed using career choice (GM/FM vs. others as the criterion variable and the factors plus demographic characteristics as confounding variables. Results: Factor analysis produced six factors that explained future career plans. Medical students in this study had a positive and realistic idea about GM/FM, but only 18.8% of them chose GM/FM first as a career. The significant variables associated with choosing GM/FM first as a career were: ‘Admission from hometown’ (β=0.189, P=0.001, ‘Student preparing for the entrance exam’ (β=0.172; P=0.001, ‘Intent for rural practice’ (β=0.123, P=0.016, and ‘Work–life balance’ (β=0.126, P=0.013. While significant variables that were negatively associated with choosing GM/FM were ‘Presence of medical relatives’ (β=−0.107, P=0.037 and ‘Scientific orientation’ (β=−0.125, P=0.013. Conclusions: Strategies have been suggested, such as recruiting medical students with significant variables that were associated with choosing GM/FM first as a career. By engaging students early in their
Alcázar Navarrete, Bernardino; Gómez-Moreno, Gerardo; Aguilar-Salvatierra, Antonio; Guardia, Javier; Romero Palacios, Pedro José
Few studies have assessed the relationships between xerostomia and the use of inhaled corticosteroids (ICS). The main objective of this study was to investigate the prevalence of xerostomia in a respiratory outpatient clinic and its relationship with bronchial asthma and ICS use. A cross-sectional observational study of patients recruited in an outpatient setting divided them according to previous diagnoses of bronchial asthma. Data about pulmonary function, concomitant medication, medical comorbidities, Xerostomia Inventory test (XI test), and the degree of asthma control by ACT (asthma control test) were collected for each patient. A linear regression model was applied, using the XI score as dependent variable and the ACT score as independent variable. The 57 patients were divided into asthmatics (40 patients, 70.2%) and control group without asthma (17, 29.8%). The prevalence of xerostomia was 87.7% (50 patients), with no differences between the study groups or current dose of ICS. In the asthmatic group, patients with uncontrolled asthma had worse XI scores than those with partially or totally controlled asthma (30.43 ± 8.71 vs. 24.92 ± 8.08; P Xerostomia is a common symptom in the ambulatory setting. There is a moderate relationship between the degree of asthma control and the severity of xerostomia. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Papadakis, Maxine A; Teherani, Arianne; Banach, Mary A; Knettler, Timothy R; Rattner, Susan L; Stern, David T; Veloski, J Jon; Hodgson, Carol S
Evidence supporting professionalism as a critical measure of competence in medical education is limited. In this case-control study, we investigated the association of disciplinary action against practicing physicians with prior unprofessional behavior in medical school. We also examined the specific types of behavior that are most predictive of disciplinary action against practicing physicians with unprofessional behavior in medical school. The study included 235 graduates of three medical schools who were disciplined by one of 40 state medical boards between 1990 and 2003 (case physicians). The 469 control physicians were matched with the case physicians according to medical school and graduation year. Predictor variables from medical school included the presence or absence of narratives describing unprofessional behavior, grades, standardized-test scores, and demographic characteristics. Narratives were assigned an overall rating for unprofessional behavior. Those that met the threshold for unprofessional behavior were further classified among eight types of behavior and assigned a severity rating (moderate to severe). Disciplinary action by a medical board was strongly associated with prior unprofessional behavior in medical school (odds ratio, 3.0; 95 percent confidence interval, 1.9 to 4.8), for a population attributable risk of disciplinary action of 26 percent. The types of unprofessional behavior most strongly linked with disciplinary action were severe irresponsibility (odds ratio, 8.5; 95 percent confidence interval, 1.8 to 40.1) and severely diminished capacity for self-improvement (odds ratio, 3.1; 95 percent confidence interval, 1.2 to 8.2). Disciplinary action by a medical board was also associated with low scores on the Medical College Admission Test and poor grades in the first two years of medical school (1 percent and 7 percent population attributable risk, respectively), but the association with these variables was less strong than that with
Niclós, Gracia; Olivar, Teresa; Rodilla, Vicent
The identification of factors which may influence a patient's decision to self-medicate. Descriptive, cross-sectional study of the adult population (at least 16 years old), using data from the 2009 European Health Interview Survey in Spain, which included 22 188 subjects. Logistic regression models enabled us to estimate the effect of each analysed variable on self-medication. In total, 14 863 (67%) individuals reported using medication (prescribed and non-prescribed) and 3274 (22.0%) of them self-medicated. Using logistic regression and stratifying by age, four different models have been constructed. Our results include different variables in each of the models to explain self-medication, but the one that appears on all four models is education level. Age is the other important factor which influences self-medication. Self-medication is strongly associated with factors related to socio-demographic, such as sex, educational level or age, as well as several health factors such as long-standing illness or physical activity. When our data are compared to those from previous Spanish surveys carried out in 2003 and 2006, we can conclude that self-medication is increasing in Spain. © 2017 Royal Pharmaceutical Society.
Kawamoto, Ryuichi; Uemoto, Asuka; Ninomiya, Daisuke; Hasegawa, Youichi; Ohtsuka, Nobuyuki; Kusunoki, Tomo; Kumagi, Teru; Abe, Masanori
In Japan, the maldistribution of physicians between urban and rural areas is increasing. It is important to know the practice location expectations of future physicians. The study was designed as a cross-sectional survey. In 2009-2013, students at a medical school in Japan completed a questionnaire containing 50 items with four-point Likert scales. The students rated the importance of specified individual and occupational aspects. Furthermore, students were asked to state their intention to practice in a rural area. The study sample consisted of 368 students (88.2% response rate). Significant variables that were associated with a positively motivated intent for rural practice were 'presence of a role model' (odds ratio (OR), 5.42; 95% confidence interval (CI), 1.58-18.5), 'admission by school recommendation' (OR, 7.68; 95%CI, 2.14-27.6), 'growing up in a rural area' (OR, 6.16; 95%CI, 1.01-37.6), 'general medicine/family medicine as the first career choice' (OR, 5.88; 95%CI, 2.43-14.2), 'interest in the targeted population' (OR, 16.7; 95%CI, 3.97-69.9), 'memorable experience at a class or clinical rotation' (OR, 3.94; 95%CI, 3.73-416), and 'location of their medical school' (OR, 11.4; 95%CI, 2.79-46.2). The present study suggests that medical schools might recruit students with characteristics associated with intention for rural practice.
Alexeeff, Stacey E.; Yau, Vincent; Qian, Yinge; Davignon, Meghan; Lynch, Frances; Crawford, Phillip; Davis, Robert; Croen, Lisa A.
This study examines medical conditions diagnosed prior to the diagnosis of autism spectrum disorder (ASD). Using a matched case control design with 3911 ASD cases and 38,609 controls, we found that 38 out of 79 medical conditions were associated with increased ASD risk. Developmental delay, mental health, and neurology conditions had the strongest…
Eiland, Lea S; Bell, Edward A; Erramouspe, John
To review the association of priapism with stimulant medications and atomoxetine commonly used in the treatment of attention-deficit/hyperactivity disorder (ADHD). A comprehensive literature search was conducted through PubMed (1966-May 15, 2014) using the search terms priapism, methylphenidate, amphetamine, atomoxetine, attention-deficit disorder with hyperactivity, and pediatrics. Google Scholar, Scopus, and the Food and Drug Administration (FDA) Web site were also searched. References from identified literature were also reviewed. All identified literature focused on ADHD treatment. Literature regarding priapism caused by methylphenidate, amphetamines, and atomoxetine were included. Stimulant medications and atomoxetine have been linked to the occurrence of priapism in children. Specifically, methylphenidate has been implicated in a recent FDA safety announcement warning as a result of 15 case reports (mean age = 12.5 years), and thus, the drug label and medication guides have been updated to reflect this concern. Prolonged erections and priapism occurred with immediate- and long-acting products, dose increases, and drug withdrawal periods. Priapism has also occurred in 4 patients taking amphetamines and one 11-year-old patient taking atomoxetine for ADHD. Priapism has been associated with stimulants, amphetamines, and atomoxetine use for ADHD in children. Providers and health care practitioners should educate male patients prescribed these ADHD medications as well as caregivers regarding the signs, symptoms, and complications with priapism. Discontinuation and evaluation of the medication is warranted if this adverse drug reaction occurs. Depending on the priapism subtype, other products may be initiated or medications not associated with priapism may be utilized. © The Author(s) 2014.
Liu, Enwu; Dyer, Suzanne M; O'Donnell, Lisa Kouladjian; Milte, Rachel; Bradley, Clare; Harrison, Stephanie L; Gnanamanickam, Emmanuel; Whitehead, Craig; Crotty, Maria
To examine associations between cardiovascular system medication use with cognition function and diagnosis of dementia in older adults living in nursing homes in Australia. As part of a cross-sectional study of 17 Australian nursing homes examining quality of life and resource use, we examined the association between cognitive impairment and cardiovascular medication use (identified using the Anatomical Therapeutic Classification System) using general linear regression and logistic regression models. People who were receiving end of life care were excluded. Participants included 541 residents with a mean age of 85.5 years (± 8.5), a mean Psychogeriatric Assessment Scale-Cognitive Impairment (PAS-Cog) score of 13.3 (± 7.7), a prevalence of cardiovascular diseases of 44% and of hypertension of 47%. Sixty-four percent of participants had been diagnosed with dementia and 72% had received cardiovascular system medications within the previous 12 months. Regression models demonstrated the use of cardiovascular medications was associated with lower (better) PAS-Cog scores [Coefficient (β) = -3.7; 95% CI: -5.2 to -2.2; P cardiovascular system medication use and better cognitive status among older adults living in nursing homes. In this population, there may be differential access to health care and treatment of cardiovascular risk factors. This association warrants further investigation in large cohort studies.
Wium-Andersen, M K; Kobylecki, C J; Afzal, S
, income, body mass index, C-reactive protein, hemoglobin, triglycerides, cardiovascular disease, diabetes, and intake of meat and vegetables. Results were performed separately in each study and combined in a meta-analysis. RESULTS: In both studies, high uric acid was associated with lower risk......OBJECTIVE: In the last decade, several studies have suggested that depression is accompanied by increased oxidative stress and decreased antioxidant defenses. We tested the hypothesis that high levels of the antioxidant uric acid are associated with lower risk of hospitalization with depression...... of hospitalization as in-patient or out-patient with depression and antidepressant medication use. A doubling in uric acid was associated with an effect estimate of 0.57 (95% CI 0.49-0.65) and 0.77 (0.73-0.81) for hospitalization with depression and antidepressant medication use. The association was consistent...
Wilson, Michael P; Nordstrom, Kimberly; Anderson, Eric L; Ng, Anthony T; Zun, Leslie S; Peltzer-Jones, Jennifer M; Allen, Michael H
The emergency medical evaluation of psychiatric patients presenting to United States emergency departments (ED), usually termed "medical clearance," often varies between EDs. A task force of the American Association for Emergency Psychiatry (AAEP), consisting of physicians from emergency medicine, physicians from psychiatry and a psychologist, was convened to form consensus recommendations for the medical evaluation of psychiatric patients presenting to U.S.EDs. The task force reviewed existing literature on the topic of medical evaluation of psychiatric patients in the ED and then combined this with expert consensus. Consensus was achieved by group discussion as well as iterative revisions of the written document. The document was reviewed and approved by the AAEP Board of Directors. Eight recommendations were formulated. These recommendations cover various topics in emergency medical examination of psychiatric patients, including goals of medical screening in the ED, the identification of patients at low risk for co-existing medical disease, key elements in the ED evaluation of psychiatric patients including those with cognitive disorders, specific language replacing the term "medical clearance," and the need for better science in this area. The evidence indicates that a thorough history and physical examination, including vital signs and mental status examination, are the minimum necessary elements in the evaluation of psychiatric patients. With respect to laboratory testing, the picture is less clear and much more controversial.
Kadriye O. Lewis, Ed.D.
Full Text Available Online education is increasingly recognized by medical educators as a teaching and learning tool to support formal and continuing medical education. The faculty development team at Cincinnati Childrens Hospital Medical Center (CCHMC in collaboration with the University of Cincinnati College of Education (UCCOE developed an Online Masters Degree in Education program designed to provide healthcare professionals with the educational pedagogy needed to teach more effectively and to conduct educational research. A qualitative case study describes the experiences of four physicians who completed the existing Master’s Degree in Education (Curriculum and Instruction major in a combined in-class/online format. These physicians then helped customize the curriculum for medical education and adapt the program to an all-online format. Each participant benefited from the program in different ways (e.g. improved educational research methods, teaching and technology skills, assessment techniques, performance-based learning. The program introduced new concepts in education that the physician participants were able to adapt to medical education. All participants became more aware of their role as educators, and demonstrated increased understanding of teaching and learning concepts, including the many benefits of online learning for physicians with full-time professional responsibilities.
Vaccarino, Sophie R; Rajji, Tarek K; Gildengers, Ariel G; Waters, Sarah E S; Butters, Meryl A; Menon, Mahesh; Blumberger, Daniel M; Voineskos, Aristotle N; Miranda, Dielle; Mulsant, Benoit H
Older patients with bipolar disorder (BD) present with variable degrees of cognitive impairment. Over time, stress, mood episodes, and comorbidities increase the body's allostatic load. We assessed the extent to which allostatic load vs more traditional measures of medical burden account for the heterogeneity in cognition in this population. Thirty-five older euthymic patients with BD and 30 age-equated, gender-equated, and education-equated comparison participants were administered a comprehensive assessment including a neuropsychological battery, and 9 physiological measures to determine allostatic load. The relationship among allostatic load, medical burden, and cognition was assessed. Compared with the mentally healthy comparators, patients were impaired globally, and in 4 cognitive domains-information-processing speed / executive functioning, delayed memory, language, and visuomotor ability, and presented with greater medical burden but not a different allostatic load. Allostatic load, but not medical burden, was associated with delayed memory performance both in a correlational analysis and in a multivariate regression analysis. Euthymic older patients with BD are impaired on several cognitive domains and have high medical burden. Their memory performance is more strongly associated with allostatic load than with traditional measures of medical burden. These findings need to be replicated and extended longitudinally. Copyright © 2017 John Wiley & Sons, Ltd.
Smidt, Dorte; Torpet, Lis Andersen; Nauntofte, Birgitte
Smidt D, Torpet LA, Nauntofte B, Heegaard KM, Pedersen AML. Associations between labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol 2010; 38: 422-435. © 2010 John Wiley & Sons A/S Abstract - Objective: To investigate...... the associations between age, gender, systemic diseases, medications and labial and whole salivary flow rates in older people. Methods: Unstimulated labial (LS) and unstimulated (UWS) and chewing-stimulated (SWS) whole salivary flow rates were measured in 389 randomly selected community-dwelling Danish women...... and 279 men aged 65-97 years. Systemic diseases, medications (coded according to the Anatomical Therapeutic Chemical (ATC) Classification System), tobacco and alcohol consumption were registered. Results: The number of diseases and medications was higher and UWS lower in the older age groups. On average...
Watanabe, Shuichi; Fukatsu, Takahide; Kanemoto, Kosuke
With the ageing of the general population, demand has grown for measures to prevent hospitalization for dementia, which can exacerbate problems associated with activities of daily living in elderly individuals. Anticholinergic medication has been shown to cause falls, delirium, and cognitive impairment in aged patients. However, the risk of hospitalization associated with the administration of anticholinergics is unclear. We analyzed the records of 61 outpatients (26 men, 35 women; mean age: 78 ± 7 years; mean follow-up period: 420 days) diagnosed with dementia (Alzheimer's disease: n = 45; dementia with Lewy bodies: n = 3; undifferentiated n = 13) and prescribed anti-dementia drugs between May 2013 and December 2014. Medication history was noted, and the patients were divided into two groups according to the Anticholinergic Risk Scale: with risk (n = 13) and without risk (n = 48). Outcome was judged based on an end-point of hospitalization or death. Kaplan-Meier survival and Cox proportional hazard analyses were performed. Eight patients with anticholinergic risk and 12 without anticholinergic risk reached the end-point (P dementia. The Anticholinergic Risk Scale findings were shown to be a strong predictor of hospitalization for patients with dementia. We should evaluate the anticholinergic burden before initiating anti-dementia therapy. © 2018 Japanese Psychogeriatric Society.
Benyamini, Yael; Molcho, Maya Lila; Dan, Uzi; Gozlan, Miri; Preis, Heidi
Rates of medical interventions in childbirth have greatly increased in the Western world. Women's attitudes affect their birth choices. To assess women's attitudes towards the medicalization of childbirth and their associations with women's background as well as their fear of birth and planned and unplanned modes of birth. This longitudinal observational study included 836 parous woman recruited at women's health centres and natural birth communities in Israel. All women filled in questionnaires about attitudes towards the medicalization of childbirth, fear of birth, and planned birth choices. Women at birth. Attitudes towards medicalization were more positive among younger and less educated women, those who emigrated from the former Soviet Union, and those with a more complicated obstetric background. Baseline attitudes did not differ by parity yet became less positive throughout pregnancy only for primiparae. More positive attitudes were related to greater fear of birth. The attitudes were significantly associated with planned birth choices and predicted emergency caesareans and instrumental births. Women form attitudes towards the medicalization of childbirth which may still be open to change during the first pregnancy. More favourable attitudes are related to more medical modes of birth, planned and unplanned. Understanding women's views of childbirth medicalization may be key to understanding their choices and how they affect labour and birth. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Relations between professional medical associations and healthcare industry, concerning scientific communication and continuing medical education: a policy statement from the European Society of Cardiology.
Physicians have an ethical duty to keep up-to-date with current knowledge. Professional medical associations such as the European Society of Cardiology (ESC) support these obligations. In Europe, the costs of continuing medical education (CME) are insufficiently supported from governments and employers; however, medical associations have been criticized for accepting alternative financial support from industry. Medical education and training in research include learning how to assess the quality and reliability of any information. There is some risk of bias in any form of scientific communication including intellectual, professional, and financial and it is essential that in particular, the latter must be acknowledged by full disclosure. It is essential that there is strong collaboration between basic and clinical researchers from academic institutions on the one hand, with engineers and scientists from the research divisions of device and pharmaceutical companies on the other. This is vital so that new diagnostic methods and treatments are developed. Promotion of advances by industry may accelerate their implementation into clinical practice. Universities now frequently exhort their academic staff to protect their intellectual property or commercialize their research. Thus, it is not commercial activity or links per se that have become the target for criticism but the perceived influence of commercial enterprises on clinical decision-making or on messages conveyed by professional medical organizations. This document offers the perspective of the ESC on the current debate, and it recommends how to minimize bias in scientific communications and CME and how to ensure proper ethical standards and transparency in relations between the medical profession and industry. Copyright © 2012. Published by Elsevier España.
Zhang, Sha; Meng, Long; Qiu, Feng; Yang, Jia-Dan; Sun, Shusen
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.
Cummings, Patricia L.; Kuo, Tony; Javanbakht, Marjan; Sorvillo, Frank
Few studies have quantified toxoplasmosis mortality, associated medical conditions, and productivity losses in the United States. We examined national multiple cause of death data and estimated productivity losses caused by toxoplasmosis during 2000–2010. A matched case–control analysis examined associations between comorbid medical conditions and toxoplasmosis deaths. In total, 789 toxoplasmosis deaths were identified during the 11-year study period. Blacks and Hispanics had the highest toxoplasmosis mortality compared with whites. Several medical conditions were associated with toxoplasmosis deaths, including human immunodeficiency virus (HIV), lymphoma, leukemia, and connective tissue disorders. The number of toxoplasmosis deaths with an HIV codiagnosis declined from 2000 to 2010; the numbers without such a codiagnosis remained static. Cumulative disease-related productivity losses for the 11-year period were nearly $815 million. Although toxoplasmosis mortality has declined in the last decade, the infection remains costly and is an important cause of preventable death among non-HIV subgroups. PMID:25200264
Masumoto, Shoichi; Sato, Mikiya; Maeno, Takami; Ichinohe, Yumiko; Maeno, Tetsuhiro
The use of dietary supplements and over-the-counter (OTC) drugs is increasing, and there is adequate concern about potential harmful effects. However, there are limited reports on the concurrent use of nonprescription medications with prescription medications in elderly patients. Therefore, this study was conducted to describe the use of dietary supplements and OTC drugs, and to identify predictors for their use in elderly patients using medications prescribed for chronic diseases. This was a cross-sectional study that enrolled 729 patients aged ≥65 years with chronic diseases, between January and March 2016. Data regarding socio-demographic status, medical condition, number of prescriptions, use of nonprescription medications, and psychological status were collected using a self-administered questionnaire and by review of medical records. Data regarding use of dietary supplements and OTC drugs were analyzed using descriptive statistics. Logistic regression analysis was applied to investigate factors associated with the use of dietary supplements and OTC drugs. The regular use of nonprescription drugs was reported by 32.5% of patients. Vitamins were the most commonly used dietary supplements in elderly patients. Female sex, higher educational qualifications, and good economic status were identified as predictors for the use of nonprescription medications. Concurrent use of nonprescription medications with more than 5 prescription medications was detected in 12.2% of participants. The disclosure rate of the use of nonprescription medications by patients to the physician was 30.3%. The use of dietary supplements and OTC drugs was common in elderly patients with chronic diseases, and its use is associated with sex, education, and economic status. General practitioners (GPs) need to recognize the potential use of nonprescription medications, considering that polypharmacy was common and disclosure rate was low in this study.
Ramani, A; Grammaticos, B; Joshi, N
We examine various second-degree difference equations which have been proposed over the years and according to their authors' claims should be integrable. This study is motivated by the fact that we consider that second-degree discrete systems cannot be integrable due to the proliferation of the images (and pre-images) of the initial point. We show that in the present cases no contradiction exists. In all cases examined, we show that there exists an underlying integrable first-degree mapping which allows us to obtain an appropriate solution of the second-degree one.
Tsai, Shiau-Ting; Han, Chin-Hua; Chen, Li-Fang; Chou, Fan-Hao
The chronic shortage of nursing staffs in hospitals continues to increasingly and negatively impact the ability of medical care systems to deliver effective care and ensure the safety of patients. Bullying is one factor known to exacerbate turnover in the nursing workplace. This study explores workplace bullying and turnover intention among nurses working at a medical center in Southern Taiwan. A cross-sectional and correlation research design was conducted using the Negative Acts Questionnaire-Revised (NAQ-R) and the Turnover Intention Questionnaire. A convenience, purposive sample of 708 nurses was recruited. Inclusion criteria included: holding an RN license, able to communicate in both Mandarin and Hokkienese, >6 months of clinical experience, and an NAQ-R score higher than 23. Data were analyzed using SPSS19.0 software. Approximately 85% of participants had experienced some degree of workplace bullying during the previous 6-month period. The trend of the turnover intention tended to the right at a high degree. A moderate, positive, and significant correlation was found between turnover intention and bullying total scores (r=.39, pturnover intention (15.10%). Based on our findings, we suggest that nurses should enhance their awareness of the negative consequences of workplace bullying. Furthermore, hospitals should implement appropriate mechanisms to decrease the phenomenon of inter-staff bullying, improve the nursing workplace environment, and reduce the rate of turnover intention.
Vogelzangs, N; Duivis, H E; Beekman, A T F; Kluft, C; Neuteboom, J; Hoogendijk, W; Smit, J H; de Jonge, P; Penninx, B W J H
Growing evidence suggests that immune dysregulation may be involved in depressive disorders, but the exact nature of this association is still unknown and may be restricted to specific subgroups. This study examines the association between depressive disorders, depression characteristics and antidepressant medication with inflammation in a large cohort of controls and depressed persons, taking possible sex differences and important confounding factors into account. Persons (18-65 years) with a current (N = 1132) or remitted (N = 789) depressive disorder according to DSM-IV criteria and healthy controls (N = 494) were selected from the Netherlands Study of Depression and Anxiety. Assessments included clinical characteristics (severity, duration and age of onset), use of antidepressant medication and inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α)). After adjustment for sociodemographics, currently depressed men, but not women, had higher levels of CRP (1.33 versus 0.92 mg l(-1), Pdepressed peers. Associations reduced after considering lifestyle and disease indicators--especially body mass index--but remained significant for CRP. After full adjustment, highest inflammation levels were found in depressed men with an older age of depression onset (CRP, TNF-α). Furthermore, inflammation was increased in men using serotonin-norepinephrine reuptake inhibitors (CRP, IL-6) and in men and women using tri- or tetracyclic antidepressants (CRP), but decreased among men using selective serotonin reuptake inhibitors (IL-6). In conclusion, elevated inflammation was confirmed in depressed men, especially those with a late-onset depression. Specific antidepressants may differ in their effects on inflammation.
Full Text Available Despite the rapidly declining number of physician-investigators, there is no consistent structure within medical education so far for involving medical students in research.To conduct an integrated mixed-methods systematic review and meta-analysis of published studies about medical students' participation in research, and to evaluate the evidence in order to guide policy decision-making regarding this issue.We followed the PRISMA statement guidelines during the preparation of this review and meta-analysis. We searched various databases as well as the bibliographies of the included studies between March 2012 and September 2013. We identified all relevant quantitative and qualitative studies assessing the effect of medical student participation in research, without restrictions regarding study design or publication date. Prespecified outcome-specific quality criteria were used to judge the admission of each quantitative outcome into the meta-analysis. Initial screening of titles and abstracts resulted in the retrieval of 256 articles for full-text assessment. Eventually, 79 articles were included in our study, including eight qualitative studies. An integrated approach was used to combine quantitative and qualitative studies into a single synthesis. Once all included studies were identified, a data-driven thematic analysis was performed.Medical student participation in research is associated with improved short- and long- term scientific productivity, more informed career choices and improved knowledge about-, interest in- and attitudes towards research. Financial worries, gender, having a higher degree (MSc or PhD before matriculation and perceived competitiveness of the residency of choice are among the factors that affect the engagement of medical students in research and/or their scientific productivity. Intercalated BSc degrees, mandatory graduation theses and curricular research components may help in standardizing research education during
Boyer, William R; Johnson, Tammie M; Fitzhugh, Eugene C; Richardson, Michael R; Churilla, James R
The purpose of this study was to examine the associations between increasing degrees of insulin resistance (using the homeostatic model assessment of insulin resistance [HOMA-IR]) and two measures of adiposity in a nationally representative sample of euglycemic U.S. adults. Sample included adult participants (≥ 20 years of age) [N = 1586 (body mass index, BMI model), N = 1577 (waist circumference, WC model)] from the 1999-2004 National Health and Nutrition Examination Survey (NHANES). HOMA-IR was categorized into quartiles. BMI and WC were examined continuously as the dependent variables. Following adjustment for covariates, those with HOMA-IR values in the second, third, and fourth quartiles had significantly higher BMIs (P HOMA-IR (P HOMA-IR and BMI (R(2) = 0.4171, P HOMA-IR and WC (R(2) = 0.4826, P HOMA-IR value is associated with higher BMI and WC values in euglycemic subjects.
Soegaard, Marie; Frederiksen, Kirsten; Jensen, Allan
OBJECTIVE: To assess the risk of ovarian cancer in women with first-degree relatives with cancer at one of the four most frequent hereditary sites based on validated cancer diagnoses and to examine the association according to age at diagnosis of ovarian cancer and histology. DESIGN: Case......-control study. SETTING AND POPULATION: First-degree relatives of 554 women with invasive epithelial ovarian cancer and 1,564 controls were included. METHODS: Analyses were performed using multiple logistic regression models. RESULTS: Ovarian cancer in a first-degree relative was significantly associated...... with increased risk of ovarian cancer (OR, 2.4; 95% CI, 1.4-4.1 (mother or sister)). Ovarian cancer in a first-degree relative appeared to be a stronger risk factor for early-onset (cancer than late-onset (OR, 5.3; 95% CI, 2.0-14.1 vs. OR, 1.8; 95% CI, 1.0-3.4). The positive association...
Michael P. Wilson
Full Text Available Introduction: The emergency medical evaluation of psychiatric patients presenting to United States emergency departments (ED, usually termed “medical clearance,” often varies between EDs. A task force of the American Association for Emergency Psychiatry (AAEP, consisting of physicians from emergency medicine, physicians from psychiatry and a psychologist, was convened to form consensus recommendations for the medical evaluation of psychiatric patients presenting to U.S.EDs. Methods: The task force reviewed existing literature on the topic of medical evaluation of psychiatric patients in the ED and then combined this with expert consensus. Consensus was achieved by group discussion as well as iterative revisions of the written document. The document was reviewed and approved by the AAEP Board of Directors. Results: Eight recommendations were formulated. These recommendations cover various topics in emergency medical examination of psychiatric patients, including goals of medical screening in the ED, the identification of patients at low risk for co-existing medical disease, key elements in the ED evaluation of psychiatric patients including those with cognitive disorders, specific language replacing the term “medical clearance,” and the need for better science in this area. Conclusion: The evidence indicates that a thorough history and physical examination, including vital signs and mental status examination, are the minimum necessary elements in the evaluation of psychiatric patients. With respect to laboratory testing, the picture is less clear and much more controversial.
Borracci, Raúl A; Pittaluga, Roberto D; Álvarez Rodríguez, Juan E; Arribalzaga, Eduardo B; Poveda Camargo, Ricardo L; Couto, Juan L; Provenzano, Sergio L
The aim of this study was to identify common factors relating to the academic success of medical students who were distinguished with honors at the Buenos Aires University. In 2011, 142 graduates were surveyed; the questionnaire included 59 questions on their sociodemographic environment, living conditions and social integration, motivation to study, learning capacity and health quality during their career. Compared to other students, these distinguished students more often lived in the city, far from their families; had been educated at private or universitary high schools, their economic needs were financed by their parents, who were on the whole professionals. Most of them were single and childless. The possibility of future employment oportunities (work) did not influence their choice of a medical career, academic success was important to them and they believed that success depended largely on personal effort; they knew how to handle anxiety, were sociable but independent and preferred solid experience to abstract conceptuality in order to obtain information. Our conclusion, within the current system of candidate selection, these results serve to calculate the covert self-selection mechanisms during the career, or in a more restrictive regime, to select those likely to reach academic success due to their privileged ambience. The analysis of demographic factors indicates some degree of inequality for socially disadvantaged students. Perhaps, a selection system based only on intellectual abilities would help identify and support the best candidates regardless of their social context.
Syahmar, Ikrar; Putera, Ikhwanuliman; Istatik, Yun; Furqon, Muhammad A; Findyartini, Ardi
The aim of this study was to identify the preference of Indonesian medical students to work in rural areas, to enroll in the (PTT; which means 'temporary employment') program, and to identify factors that influence their choice of a preferred future practice area. Under the PTT program, doctors are obliged to work as temporary staff on a contract basis for a certain period in a rural area of Indonesia. The study design was cross-sectional and a total sampling method was used. The subjects were year 4 and 5 medical students from the Faculty of Medicine at Universitas Indonesia and had already been exposed to clinical practice rotations within their education program. Students rated the importance of 21 factors influencing their future workplace preference using a questionnaire with a five-point Likert scale. A total of 310 students (83.3%) responded to the questionnaire. The authors found that 27 out of 310 (8.71%) subjects wanted to work in rural areas, while 128 out of 264 (48.5%) students who chose other than rural areas wanted to enroll in the PTT program. A previous experience of living in rural areas seemed to be the only factor favouring students' choice to have future practice in rural areas (adjusted odds ratio (OR) 3.20, 95% confidence interval (CI) 1.27-8.08, =0.01). Factors that influenced respondents to say they didn't intend to practice rurally were the influence of spouse (adjusted OR 0.38, 95%CI 0.16-0.89, =0.03), and the opportunities for career advancement (adjusted OR 0.28, 95%CI 0.11-0.73, =0.009). The choice of enrollment in the PTT program was positively associated with opportunity for an academic career (adjusted OR 2.39, 95%CI 1.27-4.50, =0.007) and negatively associated with proximity to family/friends (adjusted OR 0.38, 95%CI 0.22-0.65, 0.001). Only 8.7% of the students were interested in rural areas for their future practice location. Multiple factors were associated with students' interest to choose a career in rural areas later, after
Bitterman, Noemi; Shalev, Ilana
In light of changes in the medical profession, the different requirements placed on physicians and the evolving needs of the healthcare system, the need arose to examine the medical education curriculum in Israel. This survey, conducted by the Samuel Neaman Institute for Science and Technology, summarizes 20 years of medical education in Israel's four medical schools, as the first stage in mapping the existing state of medical education in Israel and providing a basis for decision-making on future medical education programs. To characterize the academic background of graduates, evaluate their attitudes towards current and alternative medical education programs, and examine subgroups among graduates according to gender, medical school, high school education, etc. The survey included graduates from all four Israeli medical schools who graduated between the years 1981 and 2000 in a sample of 1:3. A questionnaire and stamped return envelope were sent to every third graduate; the questionnaire included open and quantitative questions graded on a scale of 1 to 5. The data were processed for the entire graduate population and further analyzed according to subgroups such as medical schools, gender, high school education, etc. The response rate was 41.3%. The survey provided a demographic profile of graduates over a 20 year period, their previous educational and academic background, additional academic degrees achieved, satisfaction, and suggestions for future medical education programs. The profile of the medical graduates in Israel is mostly homogenous in terms of demographics, with small differences among the four medical schools. In line with recommendations of the graduates, and as an expression of the changing requirements in the healthcare system and the medical profession, the medical schools should consider alternative medical education programs such as a bachelor's degree in life sciences followed by MD studies, or education programs that combine medicine with
Georgina E. Crichton
Full Text Available Abstract Background Both depression and the metabolic syndrome (MetS are two major public health issues. The aim of this study was to examine associations between depressive symptoms, the use of antidepressant medications, and the prevalence of MetS. Methods Cross-sectional analyses were undertaken on 970 participants from the Maine-Syracuse Study. Depressive symptoms were measured using two self-reported depression scales, the Center for Epidemiological Studies Depression Scale (CES-D, and the Zung self-rating depression scale. Antidepressant medication use was also self-reported. MetS was defined according to the recent harmonized criteria. Results The risk of MetS were approximately 79 and 86 % higher for those in the highest quartile for the CESD and the Zung (CES-D: OR = 1.79, p = 0.003; Zung: OR = 1.71, p = 0.006, compared to those in the lowest quartile. With adjustment for socio-demographic variables, lifestyle factors and C-reactive protein (CRP, risk was attenuated, but remained statistically significant for the CES-D. In those who reported using antidepressant medication, the odds of having MetS were over 2-fold higher (OR = 2.22, p < 0.001, fully adjusted model, compared to those who did not use antidepressants. Both measures of depressed mood were also associated with low high density-lipoprotein (HDL cholesterol levels. Antidepressant use was associated with elevated fasting plasma glucose concentrations, hypertension, and low HDL-cholesterol. Conclusion Depressive symptoms and the use of antidepressant medications are associated with the prevalence of MetS, and with some of the individual components of the syndrome.
Nationaler Kompetenzbasierter Lernzielkatalog Medizin (NKLM für Deutschland: Zusammenarbeit der Gesellschaft für Medizinische Ausbildung (GMA und des Medizinischen Fakultätentages (MFT [National Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM in Germany: Cooperation of the Association for Medical Education (GMA and the Association of Medical Faculties in Germany (MFT
Hahn, Eckhart G.
Full Text Available [english] The Framework for Qualifications of the European Higher Education Area (FQ-EHEA; Bologna Process and the European Qualifications Framework for Lifelong Learning (EQF-LLL; Lisbon Process are competence-driven frameworks for vocational and higher education programmes in need for defined learning objectives. In the field of medical education, The Netherlands and Switzerland have developed national catalogues for undergraduate medical training, which are competence-based and compatible with a two-cycle curriculum comprised of a Bachelor in Medicine and a Master in Medicine. In Germany, virtually all medical organizations, last not least the Association of Medical Faculties (MFT, have voted against the application of the two-cycle (and the three-cycle curriculum to medical undergraduate education. A standstill of the European processes will not be accepted in the political arena, and a proposition was made by the Conference of German Ministers of Higher Education to develop a medical qualification framework for Germany, asking the Association for Medical Education (GMA and the MFT to join forces. This is not possible without consented national learning objectives derived from the professional context of physicians. The GMA has teamed up with the MFT to develop National Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM in Germany (see Figure 1 to fulfill these needs.
Waqas, Ahmed; Rehman, Abdul; Malik, Aamenah; Muhammad, Umer; Khan, Sarah; Mahmood, Nadia
Ego defense mechanisms are unconscious psychological processes that help an individual to prevent anxiety when exposed to a stressful situation. These mechanisms are important in psychiatric practice to assess an individual's personality dynamics, psychopathologies, and modes of coping with stressful situations, and hence, to design appropriate individualized treatment. Our study delineates the relationship of ego defense mechanisms with anxiety, depression, and academic performance of Pakistani medical students. This cross-sectional study was done at CMH Lahore Medical College and Fatima Memorial Hospital Medical and Dental College, both in Lahore, Pakistan, from December 1, 2014 to January 15, 2015. Convenience sampling was used and only students who agreed to take part in this study were included. The questionnaire consisted of three sections: 1) Demographics, documenting demographic data and academic scores on participants' most recent exams; 2) Hospital Anxiety and Depression Scale (HADS); and 3) Defense Style Questionnaire-40 (DSQ-40). The data were analyzed with SPSS v. 20. Mean scores and frequencies were calculated for demographic variables and ego defense mechanisms. Bivariate correlations, one-way ANOVA, and multiple linear regression were used to identify associations between academic scores, demographics, ego defense mechanisms, anxiety, and depression. A total of 409 medical students participated, of whom 286 (70%) were females and 123 (30%) were males. Mean percentage score on the most recent exams was 75.6% in medical students. Bivariate correlation revealed a direct association between mature and neurotic ego defense mechanisms and academic performance, and an indirect association between immature mechanisms and academic performance. One-way ANOVA showed that moderate levels of anxiety (P academic performance. There was a significant association between academic performance and ego defense mechanisms, anxiety, and depression levels in our
Han, Paul K J; Williams, Andrew E; Haskins, Amy; Gutheil, Caitlin; Lucas, F Lee; Klein, William M P; Mazor, Kathleen M
Aversion to "ambiguity"-uncertainty about the reliability, credibility, or adequacy of information-about medical tests and treatments is an important psychological response that varies among individuals, but little is known about its nature and extent. The purpose of this study was to examine how individual-level ambiguity aversion relates to important health cognitions related to different cancer screening tests. A survey of 1,074 adults, ages 40 to 70 years, was conducted in four integrated U.S. healthcare systems. The Ambiguity Aversion in Medicine (AA-Med) scale, a measure of individual differences in aversion to ambiguity (AA) about medical tests and treatments, was administered along with measures of several cancer screening-related cognitions: perceived benefits and harms of colonoscopy, mammography, and PSA screening, and ambivalence and future intentions regarding these tests. Multivariable analyses were conducted to assess the associations between AA-Med scores and cancer screening cognitions. Individual-level AA as assessed by the AA-Med scale was significantly associated (P ambiguity. Individual-level AA constitutes a measurable, wide-ranging cognitive bias against medical intervention, and more research is needed to elucidate its mechanisms and effects. ©2014 American Association for Cancer Research.
Haren, Matthew T.; Malmstrom, Theodore K.; Banks, William A.; Patrick, Ping; Miller, Douglas K.; Morley, John E.
Background Changes in androgen levels and associations with chronic disease, physical and neuropsychological function and disability in women over the middle to later years of life are not well understood and have not been extensively studied in African-American women. Aims The present cross-sectional analysis reports such levels and associations in community dwelling, African American women aged 49 – 65 years from St. Louis, Missouri. Methods A home-based physical examination and a health status questionnaire were administered to randomly sampled women. Body composition (DEXA), lower limb and hand-grip muscle strength, physical and neuropsychological function and disability levels were assessed. Blood was drawn and assayed for total testosterone (T), sex hormone-binding globulin (SHBG), dehydroepiandrosterone-sulfate (DHEAS), oestradiol (E2), adiponectin, leptin, triglycerides, glucose, C-reactive protein (CRP) and cytokine receptors (sIL2r, sIL6r, sTNFr1 & sTNFr2). Multiple linear regression modelling was used to identify the best predictors of testosterone, DHEAS and Free Androgen Index (T/SHBG). Results Seventy-four percent of women were menopausal and a quarter of these were taking oestrogen therapy. DHEAS and E2 declined between the ages of 49 and 65 years, whereas total T, SHBG and FAI remained stable. Total T and DHEAS levels were strongly correlated. In this population sample there were no independent associations of either total T or FAI with indicators of functional limitations, disability or clinically relevant depressive symptoms. Unlike total T and FAI, lower DHEAS levels was independently associated with both higher IADL scores (indicating a higher degree of physical disability) and higher CESD scores (indicating a higher degree of clinically relevant depressive symptoms). Conclusion There is an age-related decline in serum DHEAS in African-American women. Lower DHEAS levels appear to be associated with a higher degree of physical disability and
Al Jumah K
Full Text Available Khalaf Al Jumah,1 Mohamed Azmi Hassali,2 Dalal Al Qhatani,1 Kamal El Tahir3 1Department of Pharmacy, Al Amal Psychiatric Hospital, Riyadh, Saudi Arabia; 2School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 3College of Pharmacy, King Saud University, Riyadh, Saudi Arabia Background: Several studies have investigated the factors associated with adherence to antidepressants, with inconsistent conclusions. However, no similar study has investigated this issue among patients diagnosed with major depressive disorder in Saudi Arabia. The aim of this study is to explore patients’ adherence to antidepressant medications, and the factors associated with adherence.Methods: A non-experimental cross-sectional design was used to measure adherence to antidepressants among major depressive disorder patients, and the factors associated with adherence. The patients were recruited from the outpatient clinic at the Al-Amal Complex for Mental Health in Riyadh, Saudi Arabia, between August 2013 and January 2014. Eligible participants met with one of the research coordinators for assessment of their adherence. Adherence was investigated indirectly by use of the Morisky Medication Adherence Scale, and patients’ beliefs were assessed through the Beliefs about Medicine Questionnaire. Information about the severity of their depression, demographics, and other study variables were collected.Results: A total of 403 patients met the inclusion criteria and participated in the study. Of those, 203 (50.37% were females, while the remaining 200 (49.6% were males. There was an average age of 39 years (standard deviation, ±11 years. Half of the patients (52.9% reported low adherence to their antidepressant medication, with statistically significant differences between the low adherence and high adherence scores relating to sex, age, and duration of illness. Conclusion: Low medication adherence is a common problem among major depressive disorder
Melo, Gilberto; Dutra, Kamile Leonardi; Rodrigues Filho, Rubens; de Oliveira Lira Ortega, Adriana; Porporatti, André Luís; Dick, Bruce; Flores-Mir, Carlos; De Luca Canto, Graziela
The purpose of this study was to systematically review the literature for studies that investigated the association between use of psychotropic medications and presence of sleep bruxism (SB). Observational studies were selected in a two-phase process. Searches were performed on six electronic databases and a grey literature search was conducted on three databases. SB diagnosis was based on questionnaires or clinical examinations; no polysomnography exams were performed. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Overall quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development and Evaluation criteria. Five analytical cross-sectional studies were included, evaluating antidepressants, anticonvulsants, and psychostimulants. One study was judged as low risk of bias, three as moderate risk, and one high risk. Antidepressants were evaluated in adult populations only; duloxetine (Odds Ratio [OR]=2.16; 95% Confidence Interval [95%CI]=1.12-4.17), paroxetine (OR=3.63; 95%CI=2.15-6.13) and venlafaxine (OR=2.28; 95%CI=1.34-3.86) were positively associated with SB risk. No increased odds of SB were observed considering use of citalopram, escitalopram, fluoxetine, mirtazapine, and sertraline. With regard to anticonvulsants, only barbiturates were associated with SB in children (OR=14.70; 95%CI =1.85-116.90), while no increased odds were observed for benzodiazepine, carbamazepine, and valproate. The only psychostimulant evaluated was methylphenidate and an association with SB was observed in adolescents (OR=1.67; 95%CI=1.03-2.68). Findings from this SR suggested that medications such as duloxetine, paroxetine, venlafaxine, barbiturates, and methylphenidate might be associated with SB; however, overall quality of evidence was considered very low and, therefore, caution is recommended. This article is protected by copyright. All rights reserved. This
Jagul Huma Lashari
Full Text Available This study identifies the status of postgraduate students at the master degree level regarding their degree completion in the three public sector universities at Jamshoro Education City. The status is identified by analyzing enrolment of the postgraduate and comparing it with rate of their degree completion. In addition, the paper also discusses their characteristics which lead them towards the degree completion. For this paper, enrolment of the postgraduate students at the master level is compared with the degree completion rate of 2008 academic session only. The result shows the obvious difference between enrolment and rate of the degree completion. In total 417 postgraduate students were enrolled in 2008 session, however, only 60 (14% of students have completed their postgraduate degrees. Those who have completed their degrees, with respect to universities 6% students belong to US (University of Sindh, 22% belong to MUET (Mehran University of Engineering & Technology and 8% students belong to LUMHS (Liaquat University of Medical & Health Sciences. The demographical data of the postgraduate students has also shown some variations like gender, age, employment, and financial resources. In addition, the research requirements also vary for different postgraduate students. The research requirements include lab based, field based and library based resources. The characteristics of the postgraduate students of three public sector universities including financial resources, employment status, and working organization also show differences with each-other in terms of the degree completion.
Tomioka, Kimiko; Kurumatani, Norio; Hosoi, Hiroshi
Little is known concerning the lifestyle habits and health conditions in community-dwelling elderly who do not get medical care. We investigated the cross-sectional association between medical expenses (ME) and intellectual activity (IA) in community-dwelling older Japanese. Self-administered questionnaires were mailed to all residents born between 1945 and 1949 and covered by A City's medical insurance system (n = 19,354). Independent variables including health behaviors, oral health, social capital, neighborhood environment, and physical and mental functioning were included in the questionnaires. Medical fee receipts were used to evaluate ME for fiscal 2014, and respondents were classified into no, low, medium, and high ME groups. Higher-level functional capacity was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence, which is comprised of three subscales: instrumental activities of daily living, IA, and social role. Poisson regression models were used to examine the association of ME with IA, with the low ME group as reference. Questionnaires were returned by 12,747 individuals (response rate 65.9%). The no ME group had the lowest response rate, the worst lifestyle behaviors, and the lowest social capital, but no problems with neighborhood environment. Higher-level functional capacity, especially IA, was reduced in both the high ME and no ME groups. After adjustments for age, gender, health insurance, accessibility to public facilities in their residential area, family size, body mass index, and physical and mental functioning, the prevalence ratio (PR) for impaired IA lost its significance in the high ME group (PR 0.97, 95% confidence interval 0.90-1.05), but remained significant in the no ME group (1.19, 1.08-1.31). After additional adjustments for health behaviors (i.e., health checks, smoking, fitness, and dietary variety), the PR of the no ME group was attenuated towards the null (1.08, 0.98-1.20). Community
O'Mahony, Siobhain M; Sbayeh, Amgad; Horgan, Mary; O'Flynn, Siun; O'Tuathaigh, Colm M P
An improved understanding of the relationship between anatomy learning performance and approaches to learning can lead to the development of a more tailored approach to delivering anatomy teaching to medical students. This study investigated the relationship between learning style preferences, as measured by Visual, Aural, Read/write, and Kinesthetic (VARK) inventory style questionnaire and Honey and Mumford's learning style questionnaire (LSQ), and anatomy and clinical skills assessment performance at an Irish medical school. Additionally, mode of entry to medical school [undergraduate/direct-entry (DEM) vs. graduate-entry (GEM)], was examined in relation to individual learning style, and assessment results. The VARK and LSQ were distributed to first and second year DEM, and first year GEM students. DEM students achieved higher clinical skills marks than GEM students, but anatomy marks did not differ between each group. Several LSQ style preferences were shown to be weakly correlated with anatomy assessment performance in a program- and year-specific manner. Specifically, the "Activist" style was negatively correlated with anatomy scores in DEM Year 2 students (rs = -0.45, P = 0.002). The "Theorist" style demonstrated a weak correlation with anatomy performance in DEM Year 2 (rs = 0.18, P = 0.003). Regression analysis revealed that, among the LSQ styles, the "Activist" was associated with poorer anatomy assessment performance (P learning styles contribute little to variation in academic performance in medical students. Anat Sci Educ 9: 391-399. © 2016 American Association of Anatomists. © 2016 American Association of Anatomists.
Teherani, Arianne; Hodgson, Carol S; Banach, Mary; Papadakis, Maxine A
In a previous study, we showed that unprofessional behavior in medical school was associated with subsequent disciplinary action. This study expands on that work by identifying the domains of unprofessional behavior that are most problematic. In this retrospective case-control study, negative comments were extracted from student files for 68 case (disciplined) and 196 matched control (nondisciplined) physicians. Comments were analyzed qualitatively and subsequently quantified. The relationship between domains of behavior and disciplinary action was established through chi-square tests and multivariate analysis of variance. Three domains of unprofessional behavior emerged that were related significantly to later disciplinary outcome: (1) poor reliability and responsibility, (2) lack of self-improvement and adaptability, and (3) poor initiative and motivation. Three critical domains of professionalism associated with future disciplinary action have been defined. These findings could lead to focused remediation strategies and policy decisions.
Zenan, Joan S
The Association of Academic Health Sciences Libraries' (AAHSL's) involvement in national legislative activities and other advocacy initiatives has evolved and matured over the last twenty-five years. Some activities conducted by the Medical Library Association's (MLA's) Legislative Committee from 1976 to 1984 are highlighted to show the evolution of MLA's and AAHSL's interests in collaborating on national legislative issues, which resulted in an agreement to form a joint legislative task force. The history, work, challenges, and accomplishments of the Joint MLA/AAHSL Legislative Task Force, formed in 1985, are discussed.
de Jong, Jelte T. A.; Kleijn, Gijs A. Verdoes; Erben, Thomas; Hildebrandt, Hendrik; Kuijken, Konrad; Sikkema, Gert; Brescia, Massimo; Bilicki, Maciej; Napolitano, Nicola R.; Amaro, Valeria; Begeman, Kor G.; Boxhoorn, Danny R.; Buddelmeijer, Hugo; Cavuoti, Stefano; Getman, Fedor; Grado, Aniello; Helmich, Ewout; Huang, Zhuoyi; Irisarri, Nancy; La Barbera, Francesco; Longo, Giuseppe; McFarland, John P.; Nakajima, Reiko; Paolillo, Maurizio; Puddu, Emanuella; Radovich, Mario; Rifatto, Agatino; Tortora, Crescenzo; Valentijn, Edwin A.; Vellucci, Civita; Vriend, Willem-Jan; Amon, Alexandra; Blake, Chris; Choi, Ami; Conti, Ian Fenech; Gwyn, Stephen D. J.; Herbonnet, Ricardo; Heymans, Catherine; Hoekstra, Henk; Klaes, Dominik; Merten, Julian; Miller, Lance; Schneider, Peter; Viola, Massimo
Context. The Kilo-Degree Survey (KiDS) is an ongoing optical wide-field imaging survey with the OmegaCAM camera at the VLT Survey Telescope. It aims to image 1500 square degrees in four filters (ugri). The core science driver is mapping the large-scale matter distribution in the Universe, using weak lensing shear and photometric redshift measurements. Further science cases include galaxy evolution, Milky Way structure, detection of high-redshift clusters, and finding rare sources such as strong lenses and quasars. Aims: Here we present the third public data release and several associated data products, adding further area, homogenized photometric calibration, photometric redshifts and weak lensing shear measurements to the first two releases. Methods: A dedicated pipeline embedded in the Astro-WISE information system is used for the production of the main release. Modifications with respect to earlier releases are described in detail. Photometric redshifts have been derived using both Bayesian template fitting, and machine-learning techniques. For the weak lensing measurements, optimized procedures based on the THELI data reduction and lensfit shear measurement packages are used. Results: In this third data release an additional 292 new survey tiles (≈300 deg2) stacked ugri images are made available, accompanied by weight maps, masks, and source lists. The multi-band catalogue, including homogenized photometry and photometric redshifts, covers the combined DR1, DR2 and DR3 footprint of 440 survey tiles (44 deg2). Limiting magnitudes are typically 24.3, 25.1, 24.9, 23.8 (5σ in a 2'' aperture) in ugri, respectively, and the typical r-band PSF size is less than 0.7''. The photometric homogenization scheme ensures accurate colours and an absolute calibration stable to ≈2% for gri and ≈3% in u. Separately released for the combined area of all KiDS releases to date are a weak lensing shear catalogue and photometric redshifts based on two different machine
Menard, Lauren Ann
Dwindling American financial satisfaction and growing college degree attainment were revealed in national social survey data spanning more than four decades (N = 57,061). Against these backdrops, associations between being financially satisfied and having a college degree grew stronger in each decade, with the strongest association between…
Shindel, Alan W.; Ando, Kathryn A.; Nelson, Christian J.; Breyer, Benjamin N.; Lue, Tom F.; Smith, James F.
Purpose To determine factors associated with students’ comfort in addressing patients’ sexuality in the clinical context. Method The authors invited students enrolled in MD-degree-granting and osteopathic medical schools in the United States and Canada to participate in an anonymous Internet survey between February and July 2008. The survey assessed ethnodemographic factors and sexual history. Respondents also completed the Center for Epidemiologic Studies Depression Scale. Male respondents completed the International Index of Erectile Function and the Premature Ejaculation Diagnostic Tool. Female respondents completed the Female Sexual Function Index and the Index of Sex Life. The authors used descriptive statistics, ANOVA, and multivariable logistic regression to analyze responses. Results The authors’ analyses included 2,261 completed survey responses: 910 from men, 1,343 from women, and 8 from individuals who self-identified as “other” gendered. Over 53% of respondents (n = 1,206) stated that they felt they had not received sufficient training in medical school to address sexual concerns clinically. Despite this, 81% of students (n = 1,827) reported feeling comfortable dealing with their patients’ sexuality issues. Students with limited sexual experience, students at risk for sexual problems, and students who felt that they had not been trained adequately were less likely to report being comfortable talking to patients about sexual health issues. Conclusions Perception of inadequate sexuality training in medical school and personal issues pertaining to sex may be associated with students’ difficulty in addressing patients’ sexuality. Adequate training is preeminently associated with feeling comfortable addressing patients’ sexuality and should be a priority for medical education. PMID:20671459
Shindel, Alan W; Ando, Kathryn A; Nelson, Christian J; Breyer, Benjamin N; Lue, Tom F; Smith, James F
To determine factors associated with students' comfort in addressing patients' sexuality in the clinical context. The authors invited students enrolled in MD-degree-granting and osteopathic medical schools in the United States and Canada to participate in an anonymous Internet survey between February and July 2008. The survey assessed ethnodemographic factors and sexual history. Respondents also completed the Center for Epidemiologic Studies Depression Scale. Male respondents completed the International Index of Erectile Function and the Premature Ejaculation Diagnostic Tool. Female respondents completed the Female Sexual Function Index and the Index of Sex Life. The authors used descriptive statistics, ANOVA, and multivariable logistic regression to analyze responses. The authors' analyses included 2,261 completed survey responses: 910 from men, 1,343 from women, and 8 from individuals who self-identified as "other" gendered. Over 53% of respondents (n = 1,206) stated that they felt they had not received sufficient training in medical school to address sexual concerns clinically. Despite this, 81% of students (n = 1,827) reported feeling comfortable dealing with their patients' sexuality issues. Students with limited sexual experience, students at risk for sexual problems, and students who felt that they had not been trained adequately were less likely to report being comfortable talking to patients about sexual health issues. Perception of inadequate sexuality training in medical school and personal issues pertaining to sex may be associated with students' difficulty in addressing patients' sexuality. Adequate training is preeminently associated with feeling comfortable addressing patients' sexuality and should be a priority for medical education.
Agogo, George O; Ramsey, Christine M; Gnjidic, Danijela; Moga, Daniela C; Allore, Heather
ABSTRACTBackground:Longitudinal studies of older adults are characterized by high dropout rates, multimorbid conditions, and multiple medication use, especially proximal to death. We studied the association between multiple medication use and incident dementia diagnoses including Alzheimer's disease (AD), vascular dementia (VD), and Lewy-body dementia (LBD), simultaneously accounting for dropout. Using the National Alzheimer's Coordinating Center data with three years of follow-up, a set of covariate-adjusted models that ignore dropout was fit to complete-case data, and to the whole-cohort data. Additionally, covariate-adjusted joint models with shared random effects accounting for dropout were fit to the whole-cohort data. Multiple medication use was defined as polypharmacy (⩾ five medications), hyperpolypharmacy (⩾ ten medications), and total number of medications. Incident diagnoses were 2,032 for AD, 135 for VD, and 139 for LBD. Percentages of dropout at the end of follow-up were as follows: 71.8% for AD, 81.5% for VD, and 77.7% for LBD. The odds ratio (OR) estimate for hyperpolypharmacy among those with LBD versus AD was 2.19 (0.78, 6.15) when estimated using complete-case data and 3.00 (1.66, 5.40) using whole-cohort data. The OR reduced to 1.41 (0.76, 2.64) when estimated from the joint model accounting for dropout. The OR for polypharmacy using complete-case data differed from the estimates using whole-cohort data. The OR for dementia diagnoses on total number of medications was similar, but non-significant when estimated using complete-case data. Reasons for dropout should be investigated and appropriate statistical methods should be applied to reduce bias in longitudinal studies among high-risk dementia cohorts.
Broeders, Joris A.; Bredenoord, Albert J.; Hazebroek, Eric J.; Broeders, Ivo A.; Gooszen, Hein G.; Smout, André J.
Objective: To investigate differences in effects of 270 degrees (270 degrees LPF) and 360 degrees laparoscopic posterior fundoplication (360 degrees LPF) on reflux characteristics and belching. Background: Three hundred sixty degrees LPF greatly reduces the ability of the stomach to vent ingested
Nakaya, N; Nakamura, T; Tsuchiya, N; Tsuji, I; Hozawa, A; Tomita, H
Chronic diseases increase the risk of unemployment even in non-disaster settings; therefore, in post-disaster settings, special attention needs to be paid to the employment status of those suffering from chronic diseases. To examine the association between chronic disease and the risk of unemployment in a disaster area. This cross-sectional study was conducted in Shichigahama Town, Miyagi, north-eastern Japan, where had been severely inundated by the 2011 tsunami. Logistic regression analyses were used to evaluate the association between undergoing medical treatment for a combination of chronic diseases (stroke, cancer, myocardial infarction and angina) and unemployment risk. Confounders such as psychological distress and levels of daily life activity were considered. Among the 2588 individuals studied, there was a statistically significant association between undergoing medical treatment for chronic disease and the risk of unemployment [odds ratio (OR) = 1.7, 95% confidence interval (CI) 1.02-2.7, P unemployment risk was observed only in participants with a higher degree of psychological distress and/or poorer levels of daily life activity. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Full Text Available Abstract Background As socioeconomic health inequalities persist and widen, the health effects of adversity are a constant presence in the daily work of physicians. Gruen and colleagues suggest that, in responding to important population health issues such as this, defining those areas of professional obligation in contrast to professional aspiration should be on the basis of evidence and feasibility. Drawing this line between obligation and aspiration is a part of the work of professional medical colleges and associations, and in doing so they must respond to members as well as a range of other interest groups. Our aim was to explore the usefulness of Gruen's model of physician responsibility in defining how professional medical colleges and associations should lead the profession in responding to socioeconomic health inequalities. Methods We report a case study of how the Royal Australian College of General Practitioners is responding to the issue of health inequalities through its work. We undertook a consultation (80 interviews with stakeholders internal and external to the College and two focus groups with general practitioners and program and policy review of core programs of College interest and responsibility: general practitioner training and setting of practice standards, as well as its work in public advocacy. Results Some strategies within each of these College program areas were seen as legitimate professional obligations in responding to socioeconomic health inequality. However, other strategies, while potentially professional obligations within Gruen's model, were nevertheless contested. The key difference between these lay in different moral orientations. Actions where agreement existed were based on an ethos of care and compassion. Actions that were contested were based on an ethos of justice and human rights. Conclusion Colleges and professional medical associations have a role in explicitly leading a debate about values
Russell, Maria P.
Outlines work accomplished at the 1998 National Communication Association Summer Conference, presenting a model for a professional master's-degree program in public relations that integrates outcomes, assessment, curriculum, and pedagogy. Outlines program outcomes, curriculum, essential curriculum-content areas, pedagogical approaches, and…
Muroi, Maki; Shen, Jay J; Angosta, Alona
Registered nurses (RNs) play an important role in safe medication administration and patient safety. This study examined a total of 1276 medication error (ME) incident reports made by RNs in hospital inpatient settings in the southwestern region of the United States. The most common drug class associated with MEs was cardiovascular drugs (24.7%). Among this class, anticoagulants had the most errors (11.3%). The antimicrobials was the second most common drug class associated with errors (19.1%) and vancomycin was the most common antimicrobial that caused errors in this category (6.1%). MEs occurred more frequently in the medical-surgical and intensive care units than any other hospital units. Ten percent of MEs reached the patients with harm and 11% reached the patients with increased monitoring. Understanding the contributing factors related to MEs, addressing and eliminating risk of errors across hospital units, and providing education and resources for nurses may help reduce MEs. Copyright © 2016 Elsevier Inc. All rights reserved.
Gao, Bo, E-mail: email@example.com [Shandong Medical Imaging Research Institute, Medical School of Shandong University, Jinan, Shandong 250021 (China); Division of MRI, Department of Radiology, Yantai Yuhuangding Hospital, Yantai, 264000 Shandong (China); Liu, Feng-li [Division of MRI, Department of Radiology, Yantai Yuhuangding Hospital, Yantai, 264000 Shandong (China); Zhao, Bin, E-mail: firstname.lastname@example.org [Shandong Medical Imaging Research Institute, Medical School of Shandong University, Jinan, Shandong 250021 (China)
Purpose: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity characterized by headache, blurred vision and seizures with typical parieto-occipital predominantly vasogenic edema, occasionally with cytotoxic edema. The association between the degree and type of edema in PRES with biochemical parameter, especially serum lactate dehydrogenase, has not been determined. Material and methods: Thirty-five patients with typical clinical symptoms and characteristic MR imaging findings of PRES were included in this study. The extent of brain edema was graded on the anatomical distribution by 2 observers blinded to patients’ clinical record, as well as the type of brain edema determined on DWI and ADC map. The levels of biochemical parameters were correlated with the degree of edema and compared between different types of edema. Results: Serum LDH concentrations between patients with cytotoxic edema and with vasogenic components were not statistically different (NWU test, U = 93.0, Z = 1.818, P = 0.069). Only serum lactate dehydrogenase (LDH) concentration was significantly correlated with the score of brain edema distribution (Spearman's rho correlation, r = 0.721, P = 0.00). No relationship was found between other biochemical parameters and the degree and type of brain edema. Conclusion: Increased serum LDH level, which plays an essential role in endothelial injury, may be a potential risk factor for the development of edema in PRES.
Gao, Bo; Liu, Feng-li; Zhao, Bin
Purpose: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity characterized by headache, blurred vision and seizures with typical parieto-occipital predominantly vasogenic edema, occasionally with cytotoxic edema. The association between the degree and type of edema in PRES with biochemical parameter, especially serum lactate dehydrogenase, has not been determined. Material and methods: Thirty-five patients with typical clinical symptoms and characteristic MR imaging findings of PRES were included in this study. The extent of brain edema was graded on the anatomical distribution by 2 observers blinded to patients’ clinical record, as well as the type of brain edema determined on DWI and ADC map. The levels of biochemical parameters were correlated with the degree of edema and compared between different types of edema. Results: Serum LDH concentrations between patients with cytotoxic edema and with vasogenic components were not statistically different (NWU test, U = 93.0, Z = 1.818, P = 0.069). Only serum lactate dehydrogenase (LDH) concentration was significantly correlated with the score of brain edema distribution (Spearman's rho correlation, r = 0.721, P = 0.00). No relationship was found between other biochemical parameters and the degree and type of brain edema. Conclusion: Increased serum LDH level, which plays an essential role in endothelial injury, may be a potential risk factor for the development of edema in PRES
Juan F. Saldarriaga
Full Text Available Labor absenteeism due to medical cause has unfavorable implications for everybody. The employee suffers with the disease, the company loses productivity and society suffers delays in its economical and social growth. The study of this problem is obviously necessary in order to achieve an appropriate prevention and control of it. Objective: to explore the behavior of absenteeism by medical causes and its associated factors among the afﬁliates to the health program in the University of Antioquia, Colombia. Methods: frequency, duration, costs and causes of absenteeism are studied in relation to sex, age and physical activity as a regular behavior. Relative risk and its 95% conﬁdence intervals are estimated. Results: respiratory diseases are the ﬁrst cause of labor medical handicap. Absenteeism is higher in women. RR 1.65 (CI 95% 1.53-1.77. It has a close relationship to age RR 1.25 (CI 95% 1.12-1.38 and to sedentariness RR 2.17 (IC 95% 1.72-2.73.
Bassett, Andrew Mark; Brosnan, Caragh; Southgate, Erica; Lempp, Heidi
There has been much interest in the transitions along the medical education continuum. However, little is known about how students from non-traditional backgrounds experience both the move to, and through Medical School, and their ambitions post-graduation. This research sought to understand the transitional journey into, and through undergraduate medical education, and future career aspirations for first-in-family (FiF) medical students. Based on a interpretivist epistemological perspective, 20 FiF students from one English Medical School participated in semi-structured interviews. Participants were identified according to purposive inclusion criteria and were contacted by email via the student association at the Medical School and academic year leaders. The team approach to the thematic analysis enhanced the findings credibility. This research was part of an international collaboration. In the first transition, 'The Road to Medical School', a passion for science with an interest in people was a motivator to study medicine. Participants' parents' shared the elation of acceptance into Medical School, however, the support from school/college teachers was a mixed experience. In 'The Medical School Journey' transition, knowledge about the medical curriculum was variable. 'Fitting' in at Medical School was a problem for some, but studying for an elite degree elevated social status for many study participants. A source of support derived from senior medical student peers, but a medical degree could sacrifice students' own health. In the final transition, 'Future Plans', a medical career was perceived to have intrinsic value. Clarity about future aspirations was related to clinical experience. For some, career trajectories were related to a work-life balance and future NHS working conditions for Junior Doctors. The transitions highlighted in this article have important implications for those educators interested in a life cycle approach to widening participation in
Ercolani, Marco G; Vohra, Ravinder S; Carmichael, Fiona; Mangat, Karanjit; Alderson, Derek
To evaluate this impact on male and female English medical graduates by estimating the total time and amount repaid on loans taken out with the UK's Student Loans Company (SLC). UK. 4286 respondents with a medical degree in the Labour Force Surveys administered by the Office for National Statistics (ONS) between 1997 and 2014. Age-salary profiles were generated to estimate the repayment profiles for different levels of initial graduate debt. 2195 female and 2149 male medical graduates were interviewed by the ONS. Those working full-time (73.1% females and 96.1% males) were analysed in greater depth. Following standardisation to 2014 prices, average full-time male graduates earned up to 35% more than females by the age of 55. The initial graduate debt from tuition fees alone amounts to £39,945.69. Owing to interest charges on this debt the average full-time male graduate repays £57,303 over 20 years, while the average female earns less and so repays £61,809 over 26 years. When additional SLC loans are required for maintenance, the initial graduate debt can be as high as £81,916 and, as SLC debt is written off 30 years after graduation, the average female repays £75,786 while the average male repays £110,644. Medical graduates on an average salary are unlikely to repay their SLC debt in full. This is a consequence of higher university fees and as SLC debt is written off 30 years after graduation. This results in the average female graduate repaying more when debt is low, but a lower amount when debt is high compared to male graduates. 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.
Full Text Available Introduction: The purpose of this study was to examine whether the combination of atypical and typical antipsychotic medications is related with metabolism and cognitive functions in the same manner and degree as taking medications of one kind only, i.e. atypical or typical.
Relations between professional medical associations and the health-care industry, concerning scientific communication and continuing medical education: a policy statement from the European Society of Cardiology.
Physicians have an ethical duty to keep up-to-date with current knowledge. Professional medical associations such as the European Society of Cardiology (ESC) support these obligations. In Europe, the costs of continuing medical education (CME) are insufficiently supported from governments and employers; however, medical associations have been criticized for accepting alternative financial support from industry. Medical education and training in research include learning how to assess the quality and reliability of any information. There is some risk of bias in any form of scientific communication including intellectual, professional, and financial and it is essential that in particular, the latter must be acknowledged by full disclosure. It is essential that there is strong collaboration between basic and clinical researchers from academic institutions on the one hand, with engineers and scientists from the research divisions of device and pharmaceutical companies on the other. This is vital so that new diagnostic methods and treatments are developed. Promotion of advances by industry may accelerate their implementation into clinical practice. Universities now frequently exhort their academic staff to protect their intellectual property or commercialize their research. Thus, it is not commercial activity or links per se that have become the target for criticism but the perceived influence of commercial enterprises on clinical decision-making or on messages conveyed by professional medical organizations. This document offers the perspective of the ESC on the current debate, and it recommends how to minimize bias in scientific communications and CME and how to ensure proper ethical standards and transparency in relations between the medical profession and industry.
Full Text Available Aim: With the resolution from April 28, 2014, the Bavarian state government in Germany decided to found a new medical school at Augsburg University, thereby requiring the development of a competency-based medical curriculum.Methods: Two interdisciplinary groups developed a spiral curriculum (following Harden employing the model of Thumser-Dauth & Öchsner. The curriculum focuses on specifically defined competencies: medical expertise, independent scientific reasoning, argumentation and scholarship, as well as communication skills.Results: The spiral curriculum was developed as a hybrid curriculum. Its modular structure incorporates the mandatory subjects required by the German regulations for medical licensure (Approbationsordnung into organ- and system-centered blocks which are integrated both horizontally and vertically. Basic preclinical sciences are covered in the blocks “Movement,” “Balance” and “Contact.” The clinical sciences are organized according to six pillars (conservative medicine, surgical medicine, men’s-women’s-children’s medicine, the senses, the nervous system and the mind, and general medicine which students revisit three times each over the course of the program. A longitudinal clinical course incorporates interdisciplinary education. A particular focus is on scientific education encompassing a longitudinal course in the sciences (including interdisciplinary classes with other university departments, block practicums, and two scientific projects.Conclusion: It is not only the degree of integration und intensity of the Augsburg University undergraduate medical degree program, but also its targeted advancement of academic, social and communication skills that have not yet been realized to such an extent elsewhere in Germany. On July 8, 2016, the German Council of Science and Humanities unanimously gave this concept a positive evaluation. Future research will examine and evaluate the Augsburg medical curriculum
Kumar, Ganesh S.; Jain, Animesh; Hegde, Supriya
Background and Objective: Depression among medical students is an area of increasing concern worldwide. This study aimed to assess the prevalence of depression and its associated factors among medical students. Materials and Methods: A stratified random sample of 400 students was assessed using Beck Depression Inventory by investigators. Associations between depression and class of studying, social factors like alcohol use, drug addiction, family problems, family history of depression, and st...
Clark, Peter A.; Capuzzi, Kevin; Fick, Cameron
Summary Marijuana is classified by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no accepted medical use. However, recent studies have shown that medical marijuana is effective in controlling chronic non-cancer pain, alleviating nausea and vomiting associated with chemotherapy, treating wasting syndrome associated with AIDS, and controlling muscle spasms due to multiple sclerosis. These studies state that the alleviating benefits of marijuana outweigh the negative ...
Kadoya, Noriyuki; Karasawa, Kumiko; Sumida, Iori; Arimura, Hidetaka; Yamada, Syogo
To standardize educational programs and clinical training for medical physics students, the Japanese Board for Medical Physicist Qualification (JBMP) began to accredit master's, doctorate, and residency programs for medical physicists in 2012. At present, 16 universities accredited by the JBMP offer 22 courses. In this study, we aimed to survey the current status of educational programs and career paths of students after completion of the medical physicist program in Japan. A questionnaire was sent in August 2014 to 32 universities offering medical physicist programs. The questionnaire was created and organized by the educational course certification committee of the JBMP and comprised two sections: the first collected information about the university attended, and the second collected information about characteristics and career paths of students after completion of medical physicist programs from 2008 to 2014. Thirty universities (16 accredited and 14 non-accredited) completed the survey (response rate 94 %). A total of 209, 40, and 3 students graduated from the master's, doctorate, and residency programs, respectively. Undergraduates entered the medical physicist program constantly, indicating an interest in medical physics among undergraduates. A large percentage of the students held a bachelor's degree in radiological technology (master's program 94 %; doctorate program 70 %); graduates obtained a national radiological technologist license. Regarding career paths, although the number of the graduates who work as medical physicist remains low, 7 % with a master's degree and 50 % with a doctorate degree worked as medical physicists. Our results could be helpful for improving the medical physicist program in Japan.
Miller, Carol J.; Crain, Susan J.
This study examines undergraduate law-based degree programs in the 404 U.S. universities with undergraduate degrees in business that had Association to Advance Collegiate Schools of Business (AACSB) accreditation in 2005. University Web sites were used to identify and compare law-based undergraduate programs inside business to law-related programs…
Cleland, Jennifer; Johnston, Peter W; French, Fiona H; Needham, Gillian
Little is known about the relationship between the career preferences of medical students and the medical schools at which they are enrolled. Our aim was to explore this relationship early in students' medical training. Year 1 (2009-2010) medical students at the five Scottish medical schools were invited to take part in a career preference questionnaire survey. Questions were asked about demographic factors, career preferences and influencing factors. The response rate was 87.9% (883/1005). No significant differences were found among medical schools with regard to first-choice specialty. Surgery (22.5%), medicine (19.0%), general practice (17.6%) and paediatrics (16.1%) were the top career choices. Work-life balance, perceived aptitude and skills, intellectual satisfaction, and amount of patient contact were rated as the most important job-related factors by most respondents. Few differences were found among schools in terms of the impact of job-related factors on future career preferences. Students for whom the work-life balance was extremely important (odds ratio [OR]=0.6) were less likely to prefer surgery. Students for whom the work-life balance (OR=2.2) and continuity of care (OR=2.1) were extremely important were more likely to prefer general practice. Students' early career preferences were similar across the five medical schools. These preferences result from the interplay among demographic factors and the perceived characteristics of the various specialties. Maintaining a satisfactory work-life balance is very important to tomorrow's doctors, and the data hint that this may be breaking down some of the traditional gender differences in specialty choice. Longitudinal work is required to explore whether students' career preferences change as they progress through medical school and training. © Blackwell Publishing Ltd 2012.
... Updated American Veterinary Medical Association Guidelines for the Euthanasia of Animals: 2013 Edition... for the Euthanasia of Animals: 2013 Edition (Guidelines). The NIH is seeking input from the public on... updated AVMA Guidelines for the Euthanasia of Animals: 2013 Edition must be submitted electronically at...
Crisford, Paul; Winzenberg, Tania; Venn, Alison; Schultz, Martin; Aitken, Dawn; Cleland, Verity
To identify factors associated with non-medical health professionals' engagement in physical activity (PA) promotion. Five electronic databases were searched for studies including practising health professionals (excluding medical doctors), a PA promotion practice measure, a test of association between potential influencing factors and PA promotion practice, and written in English. Two researchers independently screened studies and extracted data. Extracted data were synthesized in a tabular format with a narrative summary (thematic analysis). Thirty studies involving 7734 non-medical health professionals were included. Self-efficacy in PA promotion, positive beliefs in the benefits of PA, assessing patients' PA, and PA promotion training were the main factors associated with engaging in PA promotion. Lack of remuneration was not associated. Common study limitations included a lack of information on non-responders, data collection by survey only and limited reliability or validity testing of measurements. There are common factors influencing PA promotion, but the absence of studies from some health professions, limitations related to study measures, and the lack of randomised controlled intervention trials highlights the need for further research. The factors identified may prove useful for guiding the development of strategies to encourage greater engagement in PA promotion by health professionals. Copyright © 2018 Elsevier B.V. All rights reserved.
Our knowledge of medical practice in medieval Islam is still scanty. It is mostly derived from normative sources, textbooks and deontological texts, which rather depict an ambitious ideal to be followed than the social reality of the average physician. Moreover, deontological regulations in Arabic medical literature are to a large degree shaped by traditional conceptions. The present article, which is based on three so-called mirrors for physicians dating from the 9th to the 12th century AD, attempts to give a provisional outline of possible Greek sources beyond the well-known Hippocratic writings on medical ethics and deontology and a first assessment of topics which seem to be original with the Arabic authors.
Dumbauld, Jill; Black, Michelle; Depp, Colin A; Daly, Rebecca; Curran, Maureen A; Winegarden, Babbi; Jeste, Dilip V
With a growing need for developing future physician scientists, identifying characteristics of medical students who are likely to benefit from research training programs is important. This study assessed if specific learning styles of medical students, participating in federally funded short-term research training programs, were associated with research self-efficacy, a potential predictor of research career success. Seventy-five first-year medical students from 28 medical schools, selected to participate in two competitive NIH-supported summer programs for research training in aging, completed rating scales to evaluate learning styles at baseline, and research self-efficacy before and after training. We examined associations of individual learning styles (visual-verbal, sequential-global, sensing-intuitive, and active-reflective) with students' gender, ranking of medical school, and research self-efficacy. Research self-efficacy improved significantly following the training programs. Students with a verbal learning style reported significantly greater research self-efficacy at baseline, while visual, sequential, and intuitive learners demonstrated significantly greater increases in research self-efficacy from baseline to posttraining. No significant relationships were found between learning styles and students' gender or ranking of their medical school. Assessments of learning styles may provide useful information to guide future training endeavors aimed at developing the next generation of physician-scientists. © 2014 Wiley Periodicals, Inc.
... Medical Library Association Honors FNLM and NIH MedlinePlus Magazine Past Issues / Summer 2011 Table of Contents MLA ... From You We want your feedback on the magazine and ideas for future issues, as well as ...
Baker, Jamie; Tucker, Debra; Raynes, Edilberto; Aitken, Florence; Allen, Pamela
Medical dosimetry education occupies a specialized branch of allied health higher education. Noted international shortages of health care workers, reduced university funding, limitations on faculty staffing, trends in learner attrition, and increased enrollment of nontraditional students force medical dosimetry educational leadership to reevaluate current admission practices. Program officials wish to select medical dosimetry students with the best chances of successful graduation. The purpose of the quantitative ex post facto correlation study was to investigate the relationship between applicant characteristics (cumulative undergraduate grade point average (GPA), science grade point average (SGPA), prior experience as a radiation therapist, and previous academic degrees) and the successful completion of a medical dosimetry program, as measured by graduation. A key finding from the quantitative study was the statistically significant positive correlation between a student's previous degree and his or her successful graduation from the medical dosimetry program. Future research investigations could include a larger research sample, representative of more medical dosimetry student populations, and additional studies concerning the relationship of previous work as a radiation therapist and the effect on success as a medical dosimetry student. Based on the quantitative correlation analysis, medical dosimetry leadership on admissions committees could revise student selection rubrics to place less emphasis on an applicant's undergraduate cumulative GPA and increase the weight assigned to previous degrees.
Baker, Jamie, E-mail: email@example.com [Medical Dosimetry Program, School of Health Professions, The University of Texas MD Anderson Cancer Center School of Health Professions, Houston, TX (United States); Tucker, Debra [Arizona State University, Phoenix, AZ (United States); Raynes, Edilberto [University of Phoenix, Phoenix, AZ (United States); Aitken, Florence [University of Nevada, Las Vegas, NV (United States); Allen, Pamela [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (United States)
Medical dosimetry education occupies a specialized branch of allied health higher education. Noted international shortages of health care workers, reduced university funding, limitations on faculty staffing, trends in learner attrition, and increased enrollment of nontraditional students force medical dosimetry educational leadership to reevaluate current admission practices. Program officials wish to select medical dosimetry students with the best chances of successful graduation. The purpose of the quantitative ex post facto correlation study was to investigate the relationship between applicant characteristics (cumulative undergraduate grade point average (GPA), science grade point average (SGPA), prior experience as a radiation therapist, and previous academic degrees) and the successful completion of a medical dosimetry program, as measured by graduation. A key finding from the quantitative study was the statistically significant positive correlation between a student's previous degree and his or her successful graduation from the medical dosimetry program. Future research investigations could include a larger research sample, representative of more medical dosimetry student populations, and additional studies concerning the relationship of previous work as a radiation therapist and the effect on success as a medical dosimetry student. Based on the quantitative correlation analysis, medical dosimetry leadership on admissions committees could revise student selection rubrics to place less emphasis on an applicant's undergraduate cumulative GPA and increase the weight assigned to previous degrees.
... contain a verified diagnosis of leukemia, the Radiation Exposure Compensation Program will notify the... Cancer Institute can make a diagnosis of leukemia to a reasonable degree of medical certainty: (i) Bone... COMPENSATION ACT Eligibility Criteria for Claims Relating to Leukemia § 79.16 Proof of medical condition. (a...
Minami, Christina A; Sheils, Catherine R; Pavey, Emily; Chung, Jeanette W; Stulberg, Jonah J; Odell, David D; Yang, Anthony D; Bentrem, David J; Bilimoria, Karl Y
The US medical malpractice system assumes that the threat of liability should deter negligence, but it is unclear whether malpractice environment affects health care quality. We sought to explore the association between state malpractice environment and postoperative complication rates. This observational study included Medicare fee-for-service beneficiaries undergoing one of the following operations in 2010: colorectal, lung, esophageal, or pancreatic resection, total knee arthroplasty, craniotomy, gastric bypass, abdominal aortic aneurysm repair, coronary artery bypass grafting, or cystectomy. The state-specific malpractice environment was measured by 2010 medical malpractice insurance premiums, state average award size, paid malpractice claims/100 physicians, and a composite malpractice measure. Outcomes of interest included 30-day readmission, mortality, and postoperative complications (eg sepsis, myocardial infarction [MI], pneumonia). Using Medicare administrative claims data, associations between malpractice environment and postoperative outcomes were estimated using hierarchical logistic regression models with hospital random-intercepts. Measures of malpractice environment did not have significant, consistent associations with postoperative outcomes. No individual tort reform law was consistently associated with improved postoperative outcomes. Higher-risk state malpractice environment, based on the composite measure, was associated with higher likelihood of sepsis (odds ratio [OR] 1.22; 95% CI 1.07 to 1.39), MI (OR 1.14; 95% CI 1.06 to 1.23), pneumonia (OR 1.09; 95% CI 1.03 to 1.16), acute renal failure (OR 1.15; 95% CI 1.08 to 1.22), deep vein thrombosis/pulmonary embolism (OR 1.22; 95% CI 1.13 to 1.32), and gastrointestinal bleed (OR 1.18; 95% CI 1.08 to 1.30). Higher risk malpractice environments were not consistently associated with a lower likelihood of surgical postoperative complications, bringing into question the ability of malpractice lawsuits to
Carter, Laura; Wilson, Stephen; Tumer, Erwin G
The purpose of this retrospective chart review was to document sedation and analgesic medications administered preoperotively, intraoperatively, and during postanesthesia care for children undergoing dental rehabilitation using general anesthesia (GA). Patient gender, age, procedure type performed, and ASA status were recorded from the medical charts of children undergoing GA for dental rehabilitation. The sedative and analgesic drugs administered pre-, intra-, and postoperatively were recorded. Statistical analysis included descriptive statistics and cross-tabulation. A sample of 115 patients with a mean age of 64 (+/-30) months was studied; 47% were females, and 71% were healthy. Over 80% of the patients were administered medications primarily during pre- and intraoperative phases, with fewer than 25% receiving medications postoperatively. Morphine and fentanyl were the most frequently administered agents intraoperatively. The procedure type, gender, and health status were not statistically associated with the number of agents administered. Younger patients, however, were statistically more likely to receive additional analgesic medications. Our study suggests that a minority of patients have postoperative discomfort in the postanesthesia care unit; mild to moderate analgesics were administered during intraoperative phases of dental rehabilitation.
This article describes the role of transnational anti-apartheid activism in South Africa, Britain and the United States in generating international moral outrage over the readmission of the Medical Association of South Africa (MASA) to the World Medical Association (WMA), which had taken place in 1981 after it had withdrawn from that body in 1976. It discusses an example of a controversy where an international health organisation (IHO) lost moral authority as a result of being accused of white supremacy and a pro-American engagement in Cold War politics. At the time of its readmission to the WMA, the MASA was controversial because of its failure to strike off its membership roll one of the doctors implicated the death in detention of Black Consciousness leader Steve Biko in 1977. It details how these activists viewed the American Medical Association as having campaigned for the MASA's readmission. The WMA's readmission of the MASA cost the former its relationships with the World Health Organisation (WHO) and the British Medical Association - a dispute which continued until South Africa's democratic transition of 1994. With its focus on transnational activism in relation to the WMA and the effects of activists' allegations of racism on its internal politics, this article contributes to the literature on the history of IHOs. Ultimately, this controversy shows the deficiency of international medical professional associations as ethical arbitrators of last resort.
Conti, A A
Medical terms occupy growing spaces in dictionaries and the media daily propose a great number of medical words. Nevertheless scientific data regarding the actual degree of comprehension of medical terminology on the part of lay users are scanty. Aim of this study was the evaluation, in a group of young motivated graduates, of the degree of understanding of a set of medical terms normally adopted by physicians in specialistic language, and also used when speaking with patients. Nine medical terms used by physicians in daily practice were selected (“aphasia”, “edema”, “erythema”, “fibrillation”, “fibroma”, “jaundice”, “paraplegia”, “polypus”, “sclerosis”) and they were administered in paper form to eighteen young graduates, non-health operators who were asked to furnish one definition for each of the terms. A subsequent structured oral discussion integrated the recorded written findings. Erythema and fibrillation were the most well-known and understood terms. Among the selected medical terms, the more difficult ones to understand were sclerosis and jaundice. Interesting features emerged from the characterization of the site attributed to some of the investigated terms, in particular edema was mainly perceived as the pulmonary one, fibroma was more often interpreted as a benign tumor localized in the uterus and polypus was more frequently associated with its collocation in the nose. The participants involved in this quali-quantitative survey demonstrated a general good knowledge and comprehension of the medical terms proposed. Some limits in knowledge documented in this group, however, indicate that the use of medical terminology needs more clarification within the doctor-patient context. Such clarification appears even more mandatory in subjects with low scholastic-education levels.
Full Text Available The factors enhancing mucocoele development in dogs remain poorly understood. A 7-year-old female spayed Miniature Schnauzer was presented to the Massey University Veterinary Teaching Hospital for progressive lethargy, inappetance and abdominal discomfort. Initial physical examination findings revealed a moderate degree of cranial abdominal pain, with subsequent diagnostic tests confirming the patient as having diabetes mellitus, with a concurrent marked hypertriglyceridaemia. In an attempt to localise the source of pain, an ultrasound examination of the abdomen was performed, revealing a marked degree of gallbladder sludge. With appropriate medical management including ursodeoxycholic acid and insulin therapy, the patient stabilised and was discharged. With persistence of clinical signs three months later, progression of the gallbladder sludge towards mucocoele development was suspected. Exploratory laparotomy was instigated, and an emergency cholecystectomy was performed. This case report therefore entails a suspected gallbladder mucocoele that developed in a diabetic patient with previously diagnosed biliary sludge. A unique feature of this case report is the presence of diabetes mellitus, which has been suggested to be a causative factor in the development of gallbladder mucocoeles. It is also hypothesised that gallbladder sludge and mucocoeles are associated, however it is yet to be ascertained whether this association is causal or contributory. The authors examined the possible relationship between this endocrinopathy and biliary sludge, and their possible effects on mucocoele development. Specific associated factors to sludge formation are also examined. The medical and surgical management of gallbladder mucocoeles is discussed.
Perreault, Michel; Mitchell, Emma; Touré, El Hadj; Fleury, Marie-Josée; Caron, Jean
Sleep medication is often reported as one of the most highly used psychotropic drugs in terms of past-year prevalence. Since their use often varies according to the characteristics of individuals, it is important to better understand these particular utilization patterns. The study aims to develop a typology of sleep medication users' characteristics, including their associated mental health and substance use. Residents from the epidemiological area of south-west Montreal, Quebec aged 15 years and older responded to a questionnaire in 2009 and 2011. Among the 1822 people who participated at both T1 and T2, 306 (17%) reported use of medication to help them sleep. These participants were selected for cluster analysis based on five variables related to mental health. The identified clusters were then tested for association with sociodemographic, psychosocial, and service use characteristics. A three-cluster solution emerged: 1) older individuals without mental health problems, drug use or psychotropic medication use; 2) individuals with elevated psychological distress, drug use and low social support, and 3) individuals with mood and anxiety disorders, using services for mental health and taking two or more psychotropic medications. The results establish the significance of problems related to mental health in differentiating sleep medication users. Consideration of these differences may improve the ability of health professionals to provide services that are better suited for patients, including interventions that increase the ability to cope with stress (cluster 2) and more integrated services for those with concurrent disorders (cluster 3).
Schwartz, Lisa M; Woloshin, Steven; Andrews, Alice; Stukel, Therese A
To determine whether the quality of press releases issued by medical journals can influence the quality of associated newspaper stories. Retrospective cohort study of medical journal press releases and associated news stories. We reviewed consecutive issues (going backwards from January 2009) of five major medical journals (Annals of Internal Medicine, BMJ, Journal of the National Cancer Institute, JAMA, and New England Journal of Medicine) to identify the first 100 original research articles with quantifiable outcomes and that had generated any newspaper coverage (unique stories ≥100 words long). We identified 759 associated newspaper stories using Lexis Nexis and Factiva searches, and 68 journal press releases using Eurekalert and journal website searches. Two independent research assistants assessed the quality of journal articles, press releases, and a stratified random sample of associated newspaper stories (n=343) by using a structured coding scheme for the presence of specific quality measures: basic study facts, quantification of the main result, harms, and limitations. Proportion of newspaper stories with specific quality measures (adjusted for whether the quality measure was present in the journal article's abstract or editor note). We recorded a median of three newspaper stories per journal article (range 1-72). Of 343 stories analysed, 71% reported on articles for which medical journals had issued press releases. 9% of stories quantified the main result with absolute risks when this information was not in the press release, 53% did so when it was in the press release (relative risk 6.0, 95% confidence interval 2.3 to 15.4), and 20% when no press release was issued (2.2, 0.83 to 6.1). 133 (39%) stories reported on research describing beneficial interventions. 24% mentioned harms (or specifically declared no harms) when harms were not mentioned in the press release, 68% when mentioned in the press release (2.8, 1.1 to 7.4), and 36% when no press release
Brod, Richard I.
This report presents the results of the ninth survey of foreign language entrance and degree requirements in United States colleges and universities that grant a bachelor of arts degree. The survey was conducted in 1974 by the Modern Language Association, and was directed at foreign language department chairmen. Responses were received from 98.8…
Full Text Available The Medical Library Association (MLA held its 117th annual meeting in Seattle, Washington, May 26–31, 2017, at the Washington State Convention Center. The meeting theme was “Dream, Dare, Do.”
Kunac, Desireé L; Tatley, Michael V
Despite the traditional focus being adverse drug reactions (ADRs), pharmacovigilance centres have recently been identified as a potentially rich and important source of medication error data. To identify medication errors in the New Zealand Pharmacovigilance database (Centre for Adverse Reactions Monitoring [CARM]), and to describe the frequency and characteristics of these events. A retrospective analysis of the CARM pharmacovigilance database operated by the New Zealand Pharmacovigilance Centre was undertaken for the year 1 January-31 December 2007. All reports, excluding those relating to vaccines, clinical trials and pharmaceutical company reports, underwent a preventability assessment using predetermined criteria. Those events deemed preventable were subsequently classified to identify the degree of patient harm, type of error, stage of medication use process where the error occurred and origin of the error. A total of 1412 reports met the inclusion criteria and were reviewed, of which 4.3% (61/1412) were deemed preventable. Not all errors resulted in patient harm: 29.5% (18/61) were 'no harm' errors but 65.5% (40/61) of errors were deemed to have been associated with some degree of patient harm (preventable adverse drug events [ADEs]). For 5.0% (3/61) of events, the degree of patient harm was unable to be determined as the patient outcome was unknown. The majority of preventable ADEs (62.5% [25/40]) occurred in adults aged 65 years and older. The medication classes most involved in preventable ADEs were antibacterials for systemic use and anti-inflammatory agents, with gastrointestinal and respiratory system disorders the most common adverse events reported. For both preventable ADEs and 'no harm' events, most errors were incorrect dose and drug therapy monitoring problems consisting of failures in detection of significant drug interactions, past allergies or lack of necessary clinical monitoring. Preventable events were mostly related to the prescribing and
Loponen, Tiina; Lallukka, Tea; Holstila, Ansku; Lahti, Jouni
Physical activity level and overweight have shown associations with mental health problems but it is not known whether the risk of mental health problems due to overweight varies by physical activity. We examined joint association of physical activity and overweight with subsequent psychotropic medication among 40-60-year-old employees. The questionnaire survey data were derived from Helsinki Health Study baseline postal questionnaires in 2000-02 among employees of the City of Helsinki aged 40-60 years (n = 8960, response rate 67%). Baseline survey data were linked with prospective register data on prescribed psychotropic medication (ATC-codes N05 and N06, except N06D) among those with written consent (74%) for such linkage. The analyses included 6169 responders (78% women, corresponding to the target population). We divided participants into six groups according to their baseline self-reported body mass index and leisure-time physical activity using physically highly active normal-weight participants as a reference group. We used Cox regression analysis adjusted for age, gender, psychotropic medication prior to baseline, and socioeconomic position, marital status, working conditions, limiting long-standing illness, alcohol use, and smoking. At baseline, 49% were overweight and 23% were physically inactive. After adjusting for age and gender, inactive normal-weight (hazard ratio (HR) 1.3, 95% CI 1.1-1.5), moderately active overweight (HR 1.3, 95% CI 1.1-1.5) and inactive overweight (HR 1.4, 95% CI 1.2-1.6) had higher risk for any psychotropic medication compared with group of highly active normal-weight. After adjusting for prior medication, only the inactive overweight group had higher risk (HR 1.4, 95% CI 1.2-1.6). Other covariates made but a minor contribution to the examined associations. For antidepressants the associations were somewhat stronger than for sedatives. Both normal-weight and physical activity help prevent psychotropic medication but physical
Sri-On, Jiraporn; Chang, Yuchiao; Curley, David P; Camargo, Carlos A; Weissman, Joel S; Singer, Sara J; Liu, Shan W
Hospital crowding and emergency department (ED) boarding are large and growing problems. To date, there has been a paucity of information regarding the quality of care received by patients boarding in the ED compared with the care received by patients on an inpatient unit. We compared the rate of delays and adverse events at the event level that occur while boarding in the ED vs while on an inpatient unit. This study was a secondary analysis of data from medical record review and administrative databases at 2 urban academic teaching hospitals from August 1, 2004, through January 31, 2005. We measured delayed repeat cardiac enzymes, delayed partial thromboplastin time level checks, delayed antibiotic administration, delayed administration of home medications, and adverse events. We compared the incidence of events during ED boarding vs while on an inpatient unit. Among 1431 patient medical records, we identified 1016 events. Emergency department boarding was associated with an increased risk of home medication delays (risk ratio [RR], 1.54; 95% confidence interval [CI], 1.26-1.88), delayed antibiotic administration (RR, 2.49; 95% CI, 1.72-3.52), and adverse events (RR, 2.36; 95% CI, 1.15-4.72). On the contrary, ED boarding was associated with fewer delays in repeat cardiac enzymes (RR, 0.17; 95% CI, 0.09-0.27) and delayed partial thromboplastin time checks (RR, 0.54; 95% CI, 0.27-0.96). Compared with inpatient units, ED boarding was associated with more medication-related delays and adverse events but fewer laboratory-related delays. Until we can eliminate ED boarding, it is critical to identify areas for improvement. Copyright © 2014 Elsevier Inc. All rights reserved.
Growth Disparity between Medical Research and Medical Services in India. British rulers opened hospitals for modern medicine; medical colleges; nurses schools etc. in the 19th century to the joyous welcome of natives. During the same period, they set up Indian Research Fund Association two years ahead of the MRC of ...
Babowitch, Jacklyn D; Sheinfil, Alan Z; Woolf-King, Sarah E; Vanable, Peter A; Sweeney, Shannon M
Viral suppression, a critical component of HIV care, is more likely when individuals initiate antiretroviral therapy (ART) early in disease progression and maintain optimal levels of adherence to ART regimens. Although several studies have documented the negative association of depressive symptoms with ART adherence, less is known about how depressed mood relates to intentional versus unintentional lapses in adherence as well as the mechanisms underlying this association. The purpose of the current study was to examine the association of depressive symptoms with ART adherence, assessed as a multidimensional construct. Secondarily, this study conducted preliminary indirect path models to determine if medication self-efficacy could explain the depressed mood-adherence relationship. Depressive symptoms were not associated with 95% ART taken, self-reported viral load, deliberate adjustments to ART regimens or skipped ART doses. However, the indirect association of depressive symptoms via decrements in medication self-efficacy was significant for 95% ART taken, self-reported viral load and skipped ART doses, but not deliberate changes to ART regimens. In this sample of HIV-positive outpatients, there is evidence to support medication self-efficacy as a potential mechanism underlying the association between depressive symptoms and ART adherence. Additional longitudinal studies are needed to formally examine medication taking self-efficacy as a mediator.
Wright, Eric; Darer, Jonathan; Tang, Xiaoqin; Thompson, Jason; Tusing, Lorraine; Fossa, Alan; Delbanco, Tom; Ngo, Long; Walker, Jan
Background In surveys, interviews, and focus groups, patients taking medications and offered Web portal access to their primary care physicians? (PCPs) notes report improved adherence to their regimens. However, objective confirmation has yet to be reported. Objective To evaluate the association between patient Internet portal access to primary care physician visit notes and medication adherence. Methods This study is a retrospective comparative analysis at one site of the OpenNotes quasi-exp...
Full Text Available Background. This study compared comorbidity-related medical care cost associated with different types of cancer, by examining breast (N=287, colon (N=272, stomach (N=614, and lung (N=391 cancer patients undergoing surgery. Methods. Using medical benefits claims data, we calculated Charlson Comorbidity Index (CCI and total medical cost. The effect of comorbidity on the medical care cost was investigated using multiple regression and logistic regression models and controlling for demographic characteristics and cancer stage. Results. The treatment costs incurred by stomach and colon cancer patients were 1.05- and 1.01-fold higher, respectively, in patients with higher CCI determined. For breast cancer, the highest costs were seen in those with chronic obstructive pulmonary disease (COPD, but the increase in cost reduced as CCI increased. Colon cancer patients with diabetes mellitus and a CCI = 1 score had the highest medical costs. The lowest medical costs were incurred by lung cancer patients with COPD and a CCI = 2 score. Conclusion. The comorbidities had a major impact on the use of medical resources, with chronic comorbidities incurring the highest medical costs. The results indicate that comorbidities affect cancer outcomes and that they must be considered strategies mitigating cancer’s economic and social impact.
Hellerstein, David J.; Little, Suzanne A. S.; Samstag, Lisa Wallner; Batchelder, Sarai; Muran, J. Christopher; Fedak, Michael; Kreditor, David; Rosenthal, Richard N.; Winston, Arnold
Patients with dysthymia have been shown to respond to treatment with antidepressant medications, and to some degree to psychotherapy. Even patients successfully treated with medication often have residual symptoms and impaired psychosocial functioning. The authors describe