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Sample records for bla medical review

  1. The Frequency of blaVIM, blaIMP, blaKPC and blaNDM Carbapenemase Genes in Clinical Isolates of Klebsiella Pneumoniae in Kermanshah Medical Centers

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    A Zare

    2015-11-01

    Full Text Available Background: Carbapenemase genes have been spread among strains of Klebsiella pneumoniae that make them resistant to carbapenems. Hence, the present study aimed to study the prevalence of carbapenmase genes within K. pneumoniae isolates in Kermanshah medical centers. Methods: Sixty isolates of K. pneumoniae were collected and identified using API kit. Then, antibiotic susceptibility of isolates was determined using a disk diffusion method. The carbapenems-resistant isolates were screened for carbapenemases production using the Modified Hodge Test (MHT. The carbapenemase genes of blaVIM, blaIMP, KPC and blaNDM were detected by PCR test . Results: Out of 60 isolates, 4 isolates were resistant to carbapenem antibiotics, but only one isolate was demonstrated to be positive for carbapenemases by MHT phenotypic testing. The gene of blaVIM was detected in three isolates by PCR, though other genes were not found in the isolates. Within the isolates, 6.67% and 100% were resistant to carbapenem and ampicillin, respectively. Conclusion: The study findings revealed that dissemination rate of carbapenemase genes was not reported to be high among isolates of K. pneumoniae in Kermanshah. Only blaVIM gene was probably more frequent than other tested genes. Since most isolates examined in this study were susceptible to carbapenem antibiotics, these antibiotics are still regarded as effective drugs against infections caused by K. pneumoniae.

  2. Program for reviewing returned medications.

    Science.gov (United States)

    Gilliand, B F; Stanislav, G H; Constantin, J J; Schwinghammer, T L

    1992-04-01

    A program for reviewing medication doses returned to the pharmacy department is described. Discrepancies concerning returned doses at a teaching hospital led to the creation of a returned-dose log sheet. A pharmacist enters the patient's name, medication, and administration schedule and forwards a copy to the charge nurse on the patient's unit, who records the reasons for the return. A pharmacist then uses the form to resolve any discrepancies in the pharmacy records and follows up if necessary. Monthly summaries of the forms are prepared. After a pilot phase and educational feedback, the rate of return of log sheets by nurses increased to 95%. It took nurses about 10 minutes per unit to complete a form, and pharmacists required 15 to 20 minutes for completion and follow-up. The percentage of dispensed doses that were returned decreased from 1.1% during the first month of the full program to 0.4% during the eighth month. The most common reason given by nurses for returned doses was that the dose had already been charted as having been given. The therapeutic classifications most frequently represented by the returns were gastrointestinal drugs, cardiovascular drugs, anti-infective agents, and electrolytic, caloric, and water balance drugs. The use of a log sheet to document and explain the return of scheduled doses to the pharmacy department improved communication, resolved discrepancies in the records, and reduced the rate of returns. PMID:1595723

  3. Bibliographic reviews in Cuban medical journals.

    OpenAIRE

    Lucitere Rodríguez González

    2008-01-01

    Background: Bibliographic reviews acquire great importance in the specific context of medical publications; however, some editorial facts can affect their scientific value. Objective: To characterize the bibliographic reviews published by some Cuban medical journals. Methods: The most recent reviews (10) were analyzed by means of an exploratory, retrospective and descriptive study. Selected from 5 electronic medical journals, summing up 50 articles. The following variables were studied: artic...

  4. Medical nanobiosensors: A tutorial review

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    Hamideh Razavi

    2015-04-01

    Full Text Available A sensitive monitoring of biological analytes, such as biomolecules (protein, lipid, DNA and RNA, and biological cells (blood cell, virus and bacteria, is essential to assess and avoid risks for human health. Nanobiosensors, analytical devices that combine a biologically sensitive element with a nanostructured transducer, are being widely used for molecular detection of biomarkers associated with diagnosis of disease and detection of infectious organisms. Nanobiosensors show certain advantages over laboratory and many field methods due to their inherent specificity, simplicity and quick response. In this review, recent progress in the development of nanobiosensors in medicine is illuminated. In addition, this article reviews different kinds of bio-receptors and transducers employed in nanobiosensors. In the last section, overview of the development and application of various nanomaterials and nanostructures in biosensing has been provided. Considering all of these aspects, it can be stated that nanobiosensors offer the possibility of diagnostic tools with increased sensitivity, specificity, and reliability for medical applications.  

  5. Co-Carriage of blaKPC-2 and blaNDM-1 in Clinical Isolates of Pseudomonas aeruginosa Associated with Hospital Infections from India.

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    Deepjyoti Paul

    Full Text Available Global spread of KPC poses to be a serious threat complicating treatment options in hospital settings. The present study investigates the genetic environment of blaKPC-2 among clinical isolates of Pseudomonas aeruginosa from a tertiary referral hospital of India. The study isolates were collected from different wards and clinics of Silchar Medical College and Hospital, India, from 2012-2013. The presence of blaKPC was confirmed by genotypic characterization followed by sequencing. Cloning of the blaKPC-2 gene was performed and the genetic environment of this gene was characterized as well. Transferability of the resistance gene was determined by transformation assay and Southern hybridization. Additionally, restriction mapping was also carried out. Two isolates of P. aeruginosa were found to harbor blaKPC-2, were resistant towards aminoglycosides, quinolone and β-lactam-β-lactamase inhibitor combination. In both the isolates, the resistance determinant was associated with class 1 integron and horizontally transferable. Both the isolates were co-harboring blaNDM-1. The first detection of this integron mediated blaKPC-2 coexisting with blaNDM-1 in P. aeruginosa from India is worrisome, and further investigation is required to track the gene cassette mediated blaKPC-2 in terms of infection control and to prevent the spread of this gene in hospitals as well as in the community.

  6. Escherichia coli of sequence type 3835 carrying bla NDM-1, bla CTX-M-15, bla CMY-42 and bla SHV-12.

    Science.gov (United States)

    Feng, Yu; Yang, Ping; Xie, Yi; Wang, Xiaohui; McNally, Alan; Zong, Zhiyong

    2015-01-01

    New Delhi metallo-β-lactamase (NDM) represents a serious challenge for treatment and public health. A carbapenem-resistant Escherichia coli clinical strain WCHEC13-8 was subjected to antimicrobial susceptibility tests, whole genome sequencing and conjugation experiments. It was resistant to imipenem (MIC, >256 μg/ml) and meropenem (MIC, 128 μg/ml) and belonged to ST3835. bla NDM-1 was the only carbapenemase gene detected. Strain WCHEC13-8 also had a plasmid-borne AmpC gene (bla CMY-42) and two extended-spectrum β-lactamase genes (bla CTX-M-15 and bla SHV-12). bla NDM-1 and bla SHV-12 were carried by a 54-kb IncX3 self-transmissible plasmid, which is identical to plasmid pNDM-HF727 from Enterobacter cloacae. bla CMY-42 was carried by a 64-kb IncI1 plasmid and bla CTX-M-15 was located on a 141-kb plasmid with multiple F replicons (replicon type: F36:A4:B1). bla CMY-42 was in a complicated context and the mobilisation of bla CMY-42 was due to the transposition of ISEcp1 by misidentifying its right-end boundary. Genetic context of bla NDM-1 in strain WCHEC13-8 was closely related to those on IncX3 plasmids in various Enterobacteriaceae species in China. In conclusion, a multidrug-resistant ST3835 E. coli clinical strain carrying bla NDM-1, bla CTX-M-15, bla CMY-42 and bla SHV-12 was identified. IncX3 plasmids may be making a significant contribution to the dissemination of bla NDM among Enterobacteriaceae in China. PMID:26194736

  7. Relation between blaTEM, blaSHV and blaCTX-M genes and acute urinary tract infections

    Institute of Scientific and Technical Information of China (English)

    Sima Sadat Seyedjavadi; Mehdi Goudarzi; Fattaneh Sabzehali

    2016-01-01

    Objective: To survey the frequency of blaTEM, blaSHV and blaCTX-M genotypes in extended-spectrum b-lactamase (ESBL)-producing Escherichia coli (E. coli) isolated from hospitalized patients with urinary tract infection and the determination of their antibiotic resistance patterns. Methods: During 11-month study, 100 ESBL-producing E. coli were collected from 330 patients who met the definition of urinary tract infection. The phenotypic identification of ESBL was confirmed by double disk synergy test and combined disk diffusion test. In vitro, susceptibility to ESBL isolates than 14 antimicrobial agents was performed by Kirby-Bauer disk diffusion method. The frequency of blaTEM, blaSHV and blaCTX-M ESBL-producing E. coli was assessed by PCR method. Results: The frequency of ESBL-producing E. coli was 40.8%. In vitro, susceptibility to ESBL-producing E. coli showed that the majority of isolates were highly susceptible to amikacin (74%) and imipenem (91%). The rates of resistance to other antibiotics varied from 33% to 96%. Through 100 tested isolates, the prevalence of blaTEM, blaSHV and blaCTX-M genes was determined to be 67%, 45% and 74% respectively. In comparison with other bla genes, the frequency of blaCTX-M was strikingly high. Conclusions: Due to the increase of E. coli with multiple ESBL genes, continuous sur-veillance in order to use appropriate antibiotics and the control of infections is necessary.

  8. MEDICATED CHEWING GUMS- UPDATED REVIEW

    OpenAIRE

    Naik Heema

    2010-01-01

    Chewing gums are mobile drug delivery systems. It is a potentially useful means of administering drugs either locally or systemically via, the oral cavity. The medicated chewing gum has through the years gained increasing acceptance as a drug delivery system. Several ingredients are now incorporated in medicated chewing gum, e.g. Fluoride for prophylaxis of dental caries, chlorhexidine as local disinfectant, nicotine for smoking cessation, aspirin as an analgesic, and caffeine as a stay alert...

  9. The Medical Record Review and Resident Education

    Science.gov (United States)

    Schuller, Arthur B.; Stotz, Ronald

    1977-01-01

    With data from mother-infant pairs during the puerperium as an example, three possibilities for using the medical record review are discussed: (1) as a means of specifying objectives for patient care and trainee competence; (2) for assessing trainee progress and teaching program effectiveness; and (3) for assessing the effects of medical science…

  10. 10 CFR 26.183 - Medical review officer.

    Science.gov (United States)

    2010-01-01

    ..., conducting a medical interview with the donor, reviewing the donor's medical history, or reviewing any other... 10 Energy 1 2010-01-01 2010-01-01 false Medical review officer. 26.183 Section 26.183 Energy... Determining Fitness § 26.183 Medical review officer. (a) Qualifications. The MRO shall be knowledgeable...

  11. Magnetically driven medical devices: a review.

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    Sliker, Levin; Ciuti, Gastone; Rentschler, Mark; Menciassi, Arianna

    2015-01-01

    A widely accepted definition of a medical device is an instrument or apparatus that is used to diagnose, prevent or treat disease. Medical devices take a broad range of forms and utilize various methods to operate, such as physical, mechanical or thermal. Of particular interest in this paper are the medical devices that utilize magnetic field sources to operate. The exploitation of magnetic fields to operate or drive medical devices has become increasingly popular due to interesting characteristics of magnetic fields that are not offered by other phenomena, such as mechanical contact, hydrodynamics and thermodynamics. Today, there is a wide range of magnetically driven medical devices purposed for different anatomical regions of the body. A review of these devices is presented and organized into two groups: permanent magnetically driven devices and electromagnetically driven devices. Within each category, the discussion will be further segregated into anatomical regions (e.g., gastrointestinal, ocular, abdominal, thoracic, etc.). PMID:26295303

  12. A Systematic Review on Medication Errors

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    Karthikeyan M

    2015-11-01

    Full Text Available Medication Errors (MEs are a common cause for iatrogenic adverse events. A systematic review of MEs in prescribing, transcribing, dispensing, administration and documentation in adults and children was done. We included all types of studies that reported the incidence of medication errors or identified the causes of MEs, either in adults or children. All healthcare professionals have a responsibility in identifying contributing factors to medication errors and to use that information to further reduce their occurrence. Developing countries urgently need to introduce professional programmes to improve prescribing skills and knowledge of prescribers, and to encourage nurses to improve their quality of drug administration.

  13. Critical Review: Medical Students' Motivation after Failure

    Science.gov (United States)

    Holland, Chris

    2016-01-01

    About 10% of students in each years' entrants to medical school will encounter academic failure at some stage in their programme. The usual approach to supporting these students is to offer them short term remedial study programmes that often enhance approaches to study that are orientated towards avoiding failure. In this critical review I will…

  14. Morphological Techniques for Medical Images: A Review

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    Isma Irum

    2012-08-01

    Full Text Available Image processing is playing a very important role in medical imaging with its versatile applications and features towards the development of computer aided diagnostic systems, automatic detections of abnormalities and enhancement in ultrasonic, computed tomography, magnetic resonance images and lots more applications. Medical images morphology is a field of study where the medical images are observed and processed on basis of geometrical and changing structures. Medical images morphological techniques has been reviewed in this study underlying the some human organ images, the associated diseases and processing techniques to address some anatomical problem detection. Images of Human brain, bone, heart, carotid, iris, lesion, liver and lung have been discussed in this study.

  15. Developing medical geology in Uruguay: a review.

    Science.gov (United States)

    Mañay, Nelly

    2010-05-01

    Several disciplines like Environmental Toxicology, Epidemiology, Public Health and Geology have been the basis of the development of Medical Geology in Uruguay during the last decade. The knowledge and performance in environmental and health issues have been improved by joining similar aims research teams and experts from different institutions to face environmental problems dealing with the population's exposure to metals and metalloids and their health impacts. Some of the Uruguayan Medical Geology examples are reviewed focusing on their multidisciplinary approach: Lead pollution and exposed children, selenium in critically ill patients, copper deficiency in cattle and arsenic risk assessment in ground water. Future actions are also presented. PMID:20623004

  16. Developing Medical Geology in Uruguay: A Review

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    Nelly Mañay

    2010-04-01

    Full Text Available Several disciplines like Environmental Toxicology, Epidemiology, Public Health and Geology have been the basis of the development of Medical Geology in Uruguay during the last decade. The knowledge and performance in environmental and health issues have been improved by joining similar aims research teams and experts from different institutions to face environmental problems dealing with the population’s exposure to metals and metalloids and their health impacts. Some of the Uruguayan Medical Geology examples are reviewed focusing on their multidisciplinary approach: Lead pollution and exposed children, selenium in critically ill patients, copper deficiency in cattle and arsenic risk assessment in ground water. Future actions are also presented.

  17. Medical imaging technology reviews and computational applications

    CERN Document Server

    Dewi, Dyah

    2015-01-01

    This book presents the latest research findings and reviews in the field of medical imaging technology, covering ultrasound diagnostics approaches for detecting osteoarthritis, breast carcinoma and cardiovascular conditions, image guided biopsy and segmentation techniques for detecting lung cancer, image fusion, and simulating fluid flows for cardiovascular applications. It offers a useful guide for students, lecturers and professional researchers in the fields of biomedical engineering and image processing.

  18. Analytical review of medical mobile diagnostic systems

    OpenAIRE

    Kordiyak, D.; Shakhovska, N.

    2016-01-01

    This article analyzes the mobile medical diagnostic systems and compare them with the proposed HealthTracker system based on smart watch Apple Watch. Before the development of the system HealthTracker, there was conducted a review and analysis of existing similar systems to identify common and distinctive features of the future system. This analysis will improve HealthTracker system, based on the strengths and weaknesses of existing systems and help identify and justify the key benefits an...

  19. Strategic Review of Medical Training and Career Structure Interim Report

    OpenAIRE

    Department of Health

    2013-01-01

    Click here to download Strategic Review of Medical Training and Career Structure Interim Report PDF 44kb Click here to download Strategic Review of Medical Training and Career Structure Terms of Reference PDF 59KB

  20. Molecular detection of metallo-β-lactamase genes, blaIMP-1, blaVIM-2 and blaSPM-1 in imipenem resistant Pseudomonas aeruginosa isolated from clinical specimens in teaching hospitals of Ahvaz, Iran

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    Mojtaba Moosavian

    2015-10-01

    Full Text Available Background and Objectives: Carbapenem resistant Pseudomonas aeruginosa is a serious cause of nosocomial infections.The main purpose of the study is to determine the prevalence rate of imipenem resistant Pseudomonas aeruginosa carryingmetallo- beta- lactamase (MBL genes.Material and Methods: 236 Pseudomonas aeruginosa isolates were collected from teaching hospitals of Ahvaz Universityof Medical Sciences during a period of 9 months in 2012. These strains were identified using conventional microbiologicaltests. The susceptibility of isolates to antibiotics were assessed using disk diffusion test. The IMP-EDTA combination diskphenotypic test was performed for detection of MBL producing strains. Finally, polymerase chain reaction (PCR wasperformed to detect MBL genes, blaIMP-1, blaVIM-2 and blaSPM-1 in imipenem resistant strains.Results: Out of 236 examined isolates, 122 isolates (51.4% were resistant to imipenem. The IMP-EDTA combination testshowed that among 122 imipenem resistant strains, 110 strains (90% were phenotipically MBL producers. Additionally, theresults of PCR method showed that 2 strains (1.6% and 67strains (55% of imipenem resistant Pseudomonas aeruginosaisolates contained blaVIM-2 and blaIMP-1 genes respectively. No SPM-1gene was found in the examined samples.Conclusion: Resistance of P. aeruginosa isolates to imipenem due to MBL enzymes is increasing in Ahavaz. Becauseof clinical significance of this kind of resistance, rapid detection of MBL producing strains and followed by appropriatetreatment is necessary to prevent the spreading of these organisms.

  1. Critical review: medical students' motivation after failure.

    Science.gov (United States)

    Holland, Chris

    2016-08-01

    About 10 % of students in each years' entrants to medical school will encounter academic failure at some stage in their programme. The usual approach to supporting these students is to offer them short term remedial study programmes that often enhance approaches to study that are orientated towards avoiding failure. In this critical review I will summarise the current theories about student motivation that are most relevant to this group of students and describe how they are enhanced or not by various contextual factors that medical students experience during their programme. I will conclude by suggesting ways in which support programmes for students who have encountered academic failure might be better designed and researched in the future. PMID:26443085

  2. Detection of P. aeruginosa harboring bla CTX-M-2, bla GES-1 and bla GES-5, bla IMP-1 and bla SPM-1 causing infections in Brazilian tertiary-care hospital

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    Polotto Milena

    2012-08-01

    Full Text Available Abstract Background Nosocomial infections caused by Pseudomonas aeruginosa presenting resistance to beta-lactam drugs are one of the most challenging targets for antimicrobial therapy, leading to substantial increase in mortality rates in hospitals worldwide. In this context, P. aeruginosa harboring acquired mechanisms of resistance, such as production of metallo-beta-lactamase (MBLs and extended-spectrum beta-lactamases (ESBLs have the highest clinical impact. Hence, this study was designed to investigate the presence of genes codifying for MBLs and ESBLs among carbapenem resistant P. aeruginosa isolated in a Brazilian 720-bed teaching tertiary care hospital. Methods Fifty-six carbapenem-resistant P. aeruginosa strains were evaluated for the presence of MBL and ESBL genes. Strains presenting MBL and/or ESBL genes were submitted to pulsed-field gel electrophoresis for genetic similarity evaluation. Results Despite the carbapenem resistance, genes for MBLs (blaSPM-1 or blaIMP-1 were detected in only 26.7% of isolates. Genes encoding ESBLs were detected in 23.2% of isolates. The blaCTX-M-2 was the most prevalent ESBL gene (19.6%, followed by blaGES-1 and blaGES-5 detected in one isolate each. In all isolates presenting MBL phenotype by double-disc synergy test (DDST, the blaSPM-1 or blaIMP-1 genes were detected. In addition, blaIMP-1 was also detected in three isolates which did not display any MBL phenotype. These isolates also presented the blaCTX-M-2 gene. The co-existence of blaCTX-M-2 with blaIMP-1 is presently reported for the first time, as like as co-existence of blaGES-1 with blaIMP-1. Conclusions In this study MBLs production was not the major mechanism of resistance to carbapenems, suggesting the occurrence of multidrug efflux pumps, reduction in porin channels and production of other beta-lactamases. The detection of blaCTX-M-2,blaGES-1 and blaGES-5 reflects the recent emergence of ESBLs among antimicrobial resistant P. aeruginosa and

  3. Medical applications of infrared thermography: A review

    Science.gov (United States)

    Lahiri, B. B.; Bagavathiappan, S.; Jayakumar, T.; Philip, John

    2012-07-01

    Abnormal body temperature is a natural indicator of illness. Infrared thermography (IRT) is a fast, passive, non-contact and non-invasive alternative to conventional clinical thermometers for monitoring body temperature. Besides, IRT can also map body surface temperature remotely. Last five decades witnessed a steady increase in the utility of thermal imaging cameras to obtain correlations between the thermal physiology and skin temperature. IRT has been successfully used in diagnosis of breast cancer, diabetes neuropathy and peripheral vascular disorders. It has also been used to detect problems associated with gynecology, kidney transplantation, dermatology, heart, neonatal physiology, fever screening and brain imaging. With the advent of modern infrared cameras, data acquisition and processing techniques, it is now possible to have real time high resolution thermographic images, which is likely to surge further research in this field. The present efforts are focused on automatic analysis of temperature distribution of regions of interest and their statistical analysis for detection of abnormalities. This critical review focuses on advances in the area of medical IRT. The basics of IRT, essential theoretical background, the procedures adopted for various measurements and applications of IRT in various medical fields are discussed in this review. Besides background information is provided for beginners for better understanding of the subject.

  4. Discovery of bla(OXA-199, a chromosome-based bla(OXA-48-like variant, in Shewanella xiamenensis.

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    Zhiyong Zong

    Full Text Available INTRODUCTION: bla(OXA-48 is a globally emerging carbapenemase-encoding gene. The progenitor of bla(OXA-48 appears to be a Shewanella species. The presence of the bla(OXA-48-like gene was investigated for two Shewanella xiamenensis strains. METHODS: Strain WCJ25 was recovered from post-surgical abdominal drainages, while S4 was the type strain of S. xiamenensis. Species identification for WCJ25 was established by sequencing the 16S rDNA and gyrB genes. PCR was used to screen the bla(OXA-48-like genes and to obtain their complete sequences. A phylogenetic tree of the bla(OXA-48-like genes was constructed. The genetic context of the bla(OXA-48-like gene in strain WCJ25 was investigated by inverse PCR using self-ligated AseI- or RsaI-restricted WCJ25 DNA fragments as template, while that in strain S4 was determined by PCR mapping using that in WCJ25 as template. RESULTS: A new bla(OXA-48 variant, designated bla(OXA-48b, with four silent nucleotide differences from the bla(OXA-48 (designated bla(OXA-48a found in the Enterobacteriaceae was identified in strain S4. Strain WCJ25 had a new bla(OXA-48-like variant, bla(OXA-199, with five nucleotide differences from bla(OXA-48a and bla(OXA-48b. The OXA-199 protein has three amino acid substitutions (H37Y, V44A and D153G compared with OXA-48. Both bla(OXA-48b and bla(OXA-199 were found adjacent to genes encoding a peptidase (indicated as orf, a protein of unknown function (sprT, an endonuclease I (endA, and a ribosomal RNA methyl transferase (rsmE upstream and to transcriptional regulator gene lysR and an acetyl-CoA carboxylase-encoding gene downstream. In addition, the insertion sequence ISShes2 was found inserted downstream of bla(OXA-199 but not of bla(OXA-48b. The 26 bp sequences upstream and 63 bp downstream of bla(OXA-48a, bla(OXA-48b and bla(OXA-199 were identical. CONCLUSIONS: bla(OXA-48a, bla(OXA-48b and bla(OXA-199 might have a common origin, suggesting that the bla(OXA-48a gene found in the

  5. [Quality of German medical services: a review].

    Science.gov (United States)

    Braun, J; Robbers, J; Lakomek, H-J

    2016-02-01

    In the current draft of the law on the reform of the support structures of hospital provision (German Hospital Structure Law) the future quality of provision is highly significant. Quality assurance measures are mandatory for hospitals. The Federal General Committee was legally charged with developing the relevant quality indicators for structural, procedural and outcome quality that are designed to form the criteria and the basis for planning decisions in the federal states. This involves a paradigm shift in quality assurance measures in hospitals. In the future, subject to the verified quality, this should have an influence on hospital planning, and the funding or regulation of hospital departments should also adhere to this prescribed quality. This review reveals the course of quality or quality assurance measures in medical services in Germany. The status of the institutions responsible for the quality of care in hospitals and the significance of quality indicators are explained. PMID:26744187

  6. Review of medical reports on pedophilia.

    Science.gov (United States)

    Hughes, John R

    2007-10-01

    The present report is a review of all 554 papers published on Medline on pedophilia. The first discussion is the history of the disorder from ancient Greece to the present time, especially the influence of the liberal country of the Netherlands, the North American Man-Boy Love Association, and the sexual crisis in the Catholic Church. One important question is the relationship between homosexual pedophilia and adult homosexuality. Evidence for and against this relationship is presented. Next discussed are the characteristics of the victim and the long lasting serious effects of sexual abuse. Laboratory correlations are included, especially phallometric tests in order to objectively measure the physical responses to sexual stimuli. Electrophysiological and radiographic tests are also mentioned, including electroencephalography, computed tomography, magnetic resonance imaging, and positron emission tomography scans. An important section is the characterization of pedophiles with emphasis on their frequent previous sexual abuse, their past, their present, and their anticipated future. The final topic is treatment of this disorder with surgery, medication, behavioral therapy and the combination of medication and behavioral therapy. PMID:17502450

  7. Expert Involvement and Adherence to Medical Evidence in Medical Mobile Phone Apps: A Systematic Review

    OpenAIRE

    Subhi, Yousif; Bube, Sarah Hjartbro; Rolskov Bojsen, Signe; Skou Thomsen, Ann Sofia; Konge, Lars

    2015-01-01

    Background Both clinicians and patients use medical mobile phone apps. Anyone can publish medical apps, which leads to contents with variable quality that may have a serious impact on human lives. We herein provide an overview of the prevalence of expert involvement in app development and whether or not app contents adhere to current medical evidence. Objective To systematically review studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phon...

  8. Medical Complications of Tattoos: A Comprehensive Review.

    Science.gov (United States)

    Islam, Parvez S; Chang, Christopher; Selmi, Carlo; Generali, Elena; Huntley, Arthur; Teuber, Suzanne S; Gershwin, M Eric

    2016-04-01

    Tattoos are defined as the introduction of exogenous pigments into the dermis in order to produce a permanent design. This process may occur unintentional or may be deliberately administered for cosmetic or medical reasons. Tattoos have been around for over 5000 years and over time have evolved to represent a common cosmetic practice worldwide. Currently, adverse reactions are relatively rare and generally unpredictable and predominantly include immune-mediated reactions and skin infections. Along with better healthcare standards and more stringent public health mandates such as the provision of disposable needles, major infectious complications related to hepatitis and human retroviral infections have decreased significantly. When they do occur, skin infections are most frequently associated with Staphylococcus aureus or Streptococcus pyogenes. The aim of this study is to review the types and rates of medical complications of permanent tattoos. PubMed search and search dates were open ended. Acute local inflammation is the most common complication, but infections, allergic contact dermatitis, and other inflammatory or immune responses that are not well-characterized may occur. As many patients with immune reactions to tattoos do not react on skin or patch testing, it is postulated that the antigens contained in dyes or pigments are such small molecules that they need to be haptenized in order to become immunogenic. Red ink is associated more frequently with long-term reactions, including granulomatous and pseudolymphomatous phenomena or morphea-like lesions and vasculitis. Exacerbation of preexisting psoriasis, atopic dermatitis, and pyoderma gangrenosum may occur after tattooing. There is no well-defined association between cancer and tattoos. The treatment of tattoo-related complications may include local destructive measures (cryotherapy, electro-surgery, dermabrasion, chemical destruction, ablative laser destruction), surgical excision, and thermolysis of the

  9. Identification of blaOXA-51, blaOXA-58, blaDIM-1 and blaVIM carbapenemase genes in hospital enterobacteriaceae isolates from Sierra Leone

    Science.gov (United States)

    We describe the results of a molecular epidemiological survey of 15 carbapenemase-encoding genes from a recent collection of clinical isolates. The most salient findings revealed that (i) 60% of the isolates harbored multiple carbapenemase genes, (ii) the blaDIM-1 gene that has only been reported in...

  10. Magnetic particles in medical research - a review

    International Nuclear Information System (INIS)

    Magnetic (or magnetizable) particles have assumed increasing importance in medical and biological research since 1966 when the effect of a magnetic field on the movement of suspended particles was initially studied. In fields like haematology, cell biology, microbiology, biochemistry and immunoassays, they currently provide the basis for separation techniques, which previously relied on gravitational forces. The body cells (e.g., blood cells) can be made magnetic by incubating them in a medium containing several Fe/sub 3/O/sub 4/ particles, which are adsorbed to the membrane surfaces. Some bacteria (also called magnetostatic bacteria) respond to externally applied magnetic lines of force due to their intracellular magnetic particles. These properties are useful in the isolation of these cells/bacteria. In biochemistry magnetic particles are used to immobilize enzymes without any loss of enzyme activity. The immobilized enzymes can facilitate the separation of end products without extensive instrumentation. In immunoassays the antibodies are covalently linked to polymer coated iron oxide particles. An electromagnet is used to sediment these particles after reaction. This excludes the use of centrifuge to separate antigen-antibody complexes. In pharmacy and pharmacology the magnetic particles are important in drug transport. In techniques like ferrography, nuclear magnetic resonance imaging (NMRI), spectroscopic studies and magnetic resonance imaging (MRI) the magnetic particles serve as contrast agents and give clinically important spatial resolution. Magnetic particles also find extensive applications in cancer therapy, genetic engineering, pneumology, nuclear medicine, radiology and many other fields. This article reviews these applications. (author)

  11. Gendered specialities during medical education: a literature review

    NARCIS (Netherlands)

    Alers, M.; Leerdam, L. van; Dielissen, P.; Lagro-Janssen, A.

    2014-01-01

    The careers of male and female physicians indicate gender differences, whereas in medical education a feminization is occurring. Our review aims to specify gender-related speciality preferences during medical education. A literature search on gender differences in medical students' speciality prefer

  12. ZOOPHARMACOGNOSY (ANIMAL SELF MEDICATION): A REVIEW

    OpenAIRE

    Shrivastava Rounak; Khare Apoorva; Agrawal Shweta

    2011-01-01

    Self-medication is a specific therapeutic behavioral change in response to disease or parasitism. The empirical literature on self-medication has so far focused entirely on identifying cases of self-medication in which particular behaviors are linked to therapeutic outcomes. The term “zoopharmacognosy” is relatively new to the pharmacy field. This term is introduced in 1987. And it means animal self medication. It is the self medication process by an animal for any disease or wound by any pla...

  13. Self-Medication Practice with Nonprescription Medication among University Students: A review of the literature

    OpenAIRE

    Dedy Almasdy; Azmi Sharrif

    2011-01-01

    Objective: To review the literature relating to self-medicationpractice with nonprescription medication among universitystudents.Methods: A narrative review of studies on self-medicationpractice with nonprescription medication among universitystudent was performed. An extensive literature search wasundertaken using indexing services available at UniversitiSains Malaysia (USM) library. The following keywords wereused for the search: self-care, self-medication, over-thecountermedicine, nonpresc...

  14. Medical Marijuana and Driving: a Review

    OpenAIRE

    Neavyn, Mark J.; Blohm, Eike; Babu, Kavita M.; Bird, Steven B.

    2014-01-01

    Medical marijuana remains a highly debated treatment regimen despite removal of state penalties against care providers prescribing the drug and patients treated with the drug in many areas of the USA. The utility of marijuana in specific medical conditions has been studied at length, but its effects on driving performance and risk of motor vehicle collision remain unclear. As with other medications that affect psychomotor function, the healthcare provider should be informed of the potential r...

  15. Use of methylphenidate among medical students: a systematic review

    OpenAIRE

    Guilherme Finger; Emerson Rodrigues da Silva; Asdrubal Falavigna

    2013-01-01

    OBJECTIVE: To review the effects of methylphenidate on cognitive enhancement, memory, and performance in medical students. METHODS: A review of four databases (LILACS, PubMed, ScienceDirect, and SciELO), analyzing the title and of all articles published between 1990 and 2012 in English, Portuguese, and Spanish. Selected articles were read in entirety, including in the review those that met the established criteria. RESULTS: The prevalence of use among medical students reached 16%, with no gen...

  16. Pharmacist-led medication review in an acute admissions unit

    DEFF Research Database (Denmark)

    Hansen, Trine Graabæk; Bonnerup, Dorthe Krogsgaard; Kjeldsen, Lene Juel;

    2015-01-01

    Objectives Over the last decades, several papers have evaluated clinical pharmacy interventions in hospital settings with conflicting findings as results. Medication reviews are frequently a central component of these interventions. However, the term ‘medication review’ covers a plethora of...... data, (2) collection of information about the patient's medical treatment, (3) patient interview, (4) critical examination of the patient's medications and (5) recommendations for the hospital physician.Conclusions We have provided a detailed description of a procedure for pharmacist-led medication...... review. We do so, not to provide or advocate a single one-size-fits-all solution, but in an attempt to inspire a debate of the practical approach on how to execute a systematic medication review in order to develop and expand clinical pharmacy and achieve better patient outcomes....

  17. Developing Medical Geology in Uruguay: A Review

    OpenAIRE

    Nelly Mañay

    2010-01-01

    Several disciplines like Environmental Toxicology, Epidemiology, Public Health and Geology have been the basis of the development of Medical Geology in Uruguay during the last decade. The knowledge and performance in environmental and health issues have been improved by joining similar aims research teams and experts from different institutions to face environmental problems dealing with the population’s exposure to metals and metalloids and their health impacts. Some of the Uruguayan Medical...

  18. A systematic review of publications studies on medical tourism

    Science.gov (United States)

    Masoud, Ferdosi; Alireza, Jabbari; Mahmoud, Keyvanara; Zahra, Agharahimi

    2013-01-01

    Introduction: Medical tourism for any study area is complex. Materials and Methods: Using full articles from other databases, Institute for Scientific Information (ISI), Science Direct, Emerald, Oxford, Magiran, and Scientific Information Database (SID), to examine systematically published articles about medical tourism in the interval 2000-2011 paid. Articles were obtained using descriptive statistics and content analysis categories were analyzed. Results: Among the 28 articles reviewed, 11 cases were a kind of research articles, three cases were case studies in Mexico, India, Hungary, Germany, and Iran, and 14 were case studies, review documents and data were passed. The main topics of study included the definition of medical tourism, medical tourists’ motivation and development of medical tourism, ethical issues in medical tourism, and impact on health and medical tourism marketing. Conclusion: The findings indicate the definition of medical tourism in various articles, and medical tourists are motivated. However, most studies indicate the benefits of medical tourism in developing countries and more developed countries reflect the consequences of medical tourism. PMID:24251287

  19. Assessment in undergraduate medical education: a review of course exams

    OpenAIRE

    Vanderbilt, Allison A.; Feldman, Moshe; Wood, Issac K.

    2013-01-01

    Introduction: The purpose of this study is to describe an approach for evaluating assessments used in the first 2 years of medical school and report the results of applying this method to current first and second year medical student examinations. Methods: Three faculty members coded all exam questions administered during the first 2 years of medical school. The reviewers discussed and compared the coded exam questions. During the bi-monthly meetings, all differences in coding were resolved w...

  20. Needs Assessment in Postgraduate Medical Education: A Review

    OpenAIRE

    Ratnapalan, Savithiri; Hilliard, Robert I.

    2009-01-01

    Although the concept of needs assessment in continuing medical education is well accepted, there is limited information on needs assessment in postgraduate medical education. We discuss the learning needs of postgraduate trainees and review the various methods of needs assessment such as: questionnaire surveys, interviews, focus groups, chart audits, chart-stimulated recall, standardized patients, and environmental scans in the context of post graduate medical education. Keywords: residents, ...

  1. Needs Assessment in Postgraduate Medical Education:A Review

    OpenAIRE

    Dr. Savithiri Ratnapalan MRCP,FRCPC,

    2002-01-01

    Although the concept of needs assessment in continuing medical education is well ac-cepted, there is limited information on needs assessment in postgraduate medical education. We discuss the learning needs of postgraduate trainees and review the various methods of needs as-sessment such as: questionnaire surveys, interviews, focus groups, chart audits, chart-stimulated recall, standardized patients, and environmental scans in the context of post graduate medical edu-cation.

  2. Clinical medical librarianship: a review of the literature.

    OpenAIRE

    Cimpl, K

    1985-01-01

    The history and evolution of clinical medical librarianship are analyzed and traditional and modified approaches, including LATCH, are reviewed. Cost and evaluation methods are outlined, indicating benefits and disadvantages of clinical medical librarian (CML) programs. The future of CMLs is explored.

  3. Prevalence of blaTEM , blaSHV and blaCTX-M genes in clinical isolates of Escherichia coli and Klebsiella pneumoniae from Northeast India

    Directory of Open Access Journals (Sweden)

    Arijit Bora

    2014-01-01

    Full Text Available Aim: This study was carried out to determine the presence of blaTEM , blaSHV and blaCTX-M genes in extended-spectrum β-lactamase (ESBL producing Escherichia coli (E. coli and Klebsiella pneumoniae (K. pneumoniae at a tertiary care referral hospital in Northeast India. Materials and Methods: A total of 270 E. coli and 219 K. pneumoniae isolates were recovered during the period between August 2009 and July 2010. Kirby-Bauer disk diffusion method was performed to determine the antibiotic resistance pattern. Screening and phenotypic confirmatory test for ESBL production were performed using standard disc diffusion methods. Each of the initial ESBL screening test isolate was investigated for the presence of blaTEM , blaSHV and blaCTX-M genes via polymerase chain reaction (PCR using gene-specific primers. Results: Phenotypic confirmatory test able to detect ESBL production in 73.58% of E. coli and 67.24% of K. pneumoniae. However, PCR amplification showed the presence of one or more ESBL genes in each of the initial ESBL screening positive isolate. Among three ESBL genotypes, the most prevalent genotype was found to be blaCTX-M in E. coli (88.67% and blaTEM in K. pneumoniae (77.58% ESBL producing isolates. Majority of ESBL producing isolates possess more than one ESBL genes. Conclusion: This study constituted a primer report on high prevalence of blaTEM and blaCTX-M genes in ESBL producing isolates of E. coli and K. pneumoniae and denotes the need of more extensive studies on these antibiotic genes to determine the magnitude of the problem of antibiotic resistance exiting in this locality.

  4. Home Medication Reviews in a Patient Care Experience for Undergraduate Pharmacy Students

    OpenAIRE

    Basheti, Iman A.; Qunaibi, Eyad A.; Aburuz, Salah; Samara, Sundos; Bulatova, Nailya R.

    2013-01-01

    Objectives. To evaluate the effectiveness of conducting medication management reviews (MMRs) and home medication reviews (HMRs) on improving undergraduate pharmacy students' pharmaceutical care skills and clinical knowledge.

  5. blaCTX-M Genes in Escherichia coli Strains from Croatian Hospitals Are Located in New (blaCTX-M-3a) and Widely Spread (blaCTX-M-3a and blaCTX-M-15) Genetic Structures▿

    OpenAIRE

    Literacka, Elżbieta; Bedenic, Branka; Baraniak, Anna; Fiett, Janusz; Tonkic, Marija; Jajic-Bencic, Ines; Gniadkowski, Marek

    2009-01-01

    CTX-M-producing Escherichia coli isolates from three Croatian hospitals were analyzed. All blaCTX-M-15 genes and one blaCTX-M-3a gene resided in widely spread ISEcp1 transposition modules, but other blaCTX-M-3a genes were in a new configuration with two IS26 copies, indicating a new event of gene mobilization from a Kluyvera ascorbata genome. The study confirmed the role of the E. coli ST131 clonal group with IncFII-type plasmids in the spread of blaCTX-M-15 and of IncL/M pCTX-M3-type plasmid...

  6. Self-Medication Practice with Nonprescription Medication among University Students: a review of the literature

    Directory of Open Access Journals (Sweden)

    Dedy Almasdy

    2011-09-01

    Full Text Available Objective: To review the literature relating to self-medicationpractice with nonprescription medication among universitystudents.Methods: A narrative review of studies on self-medicationpractice with nonprescription medication among universitystudent was performed. An extensive literature search wasundertaken using indexing services available at UniversitiSains Malaysia (USM library. The following keywords wereused for the search: self-care, self-medication, over-thecountermedicine, nonprescription medicine, minor illnesses,minor ailment, university population and communitypharmacy. Electronic databases searched were Science Direct,Medline, ISI Web of Knowledge, Inside Web, JSTOR, SpringerLink, Proquest, Ebsco Host and Google Scholar. Theseelectronic databases were searched for full text paperspublished in English.Results: Eleven studies were identified. In general, the reviewhas shown that self-medication practice with nonprescriptionmedication highly prevalence among university students. Thereasons for self-medication are vary among this populationand the main symptoms leading to self-medication areheadache or minor pain; fever, flu, cough, or cold; anddiarrhoea.The common medication is analgesic, antipyreticproducts, cough and cold remedies, anti allergy andvitamins or minerals. The sources of the medicines arepharmacy, home medicine cabinet, supermarket/shopand other person such as family, friend, neighbours andclassmates. The sources of drug information are familymember, previous experience, pharmacy salesman,doctor or nurse, advertisement and others. The reviewalso has shown that the self-medication practice couldhave many problems.Conclusions: The review provides insights about theself-medication practices among the university students.These practices were highly prevalence among universitystudents. The symptoms leading to self-medication arevary, thus the medication used and the medicationsources. It needs an adequate drug information

  7. Occurrence of co-existing bla VIM-2 and bla NDM-1 in clinical isolates of Pseudomonas aeruginosa from India

    OpenAIRE

    Paul, Deepjyoti; Dhar (Chanda), Debadatta; Maurya, Anand Prakash; MISHRA, Shweta; Sharma, Gauri Dutt; Chakravarty, Atanu; Bhattacharjee, Amitabha

    2016-01-01

    Background bla VIM-2 harboring Pseudomonas aeruginosa has been reported worldwide and considered as the most prevalent metallo-β-lactamase after NDM which are found horizontally transferable and mostly associated with integron gene cassettes. The present study investigates the genetic background, transmission dynamics as well as stability of bla VIM-2 in clinical isolates of P. aeruginosa harbor bla NDM-1 as well which were collected from October 2012 to September 2013. Methods Two P. aerugin...

  8. Comparison of medication reconciliation and medication review: errors and clinical importance

    DEFF Research Database (Denmark)

    Bjeldbak-Olesen, Mette; Danielsen, Anja Gadsbølle; Tomsen, Dorthe Vilstrup;

    2013-01-01

    of Cardiology, Hillerød Hos­pital. Medication reconciliation compared the prescriptions in patient records, an electronic medication system (EMS) and in discharge summaries (DS). The medication review was based on the EMS. The two methods were performed on the same data material. To assess the clinical...... importance of the errors, a four-point scale was applied. Results: A total of 75 patient records were included. In all, 198 discrepancies were identified by medication reconcili­ation, 2.6 per patient. The most frequent discrepancies were omission of a drug in the DS and discrepancy between the drugs noted...

  9. Mobile Learning in Medical Education: Review.

    Science.gov (United States)

    Walsh, Kieran

    2015-10-01

    In the past several years, mobile learning made rapid inroads into the provision of medical education. There are significant advantages associated with mobile learning. These include high access, low cost, more situated and contextual learning, convenience for the learner, continuous communication and interaction between learner and tutor and between learner and other learners, and the ability to self-assess themselves while learning. Like any other form of medical pedagogy, mobile learning has its downsides. Disadvantages of mobile learning include: inadequate technology, a risk of distraction from learning by using a device that can be used for multiple purposes, and the potential for breakdown in barriers between personal usage of the mobile device and professional or educational use. Despite these caveats, there is no question but that mobile learning offers much potential. In the future, it is likely that the strategy of mobile first, whereby providers of e-learning think of the user experience on a mobile first, will result in learners who increasingly expect that all e-learning provision will work seamlessly on a mobile device. PMID:26949301

  10. Review of Session 6: Medical Physics

    Science.gov (United States)

    Fukuda, Shigekazu

    2014-01-01

    Medical physics is very important in carbon ion radiotherapy, as it is in conventional radiotherapy using X-rays and in estimation of exposed dose in the space environment. High-energy ion beams such as carbon beams have physical characteristics such as the Bragg curve, high LET, and nuclear reactions producing fragmentations. Therefore, understanding these properties well is essential for further development of carbon radiotherapy and manned space activity. We invited, therefore, the following six presentations relevant to issues ranging from the measurement of fragmentations, lineal energy distributions using the microdosimetric approach, and neutron dose with active beam delivery of carbon-ion therapy, to the depth–dose distribution of various ions inside a human head phantom.

  11. A systematic review of publications studies on medical tourism

    OpenAIRE

    Masoud, Ferdosi; Alireza, Jabbari; Mahmoud, Keyvanara; Zahra, Agharahimi

    2013-01-01

    Introduction: Medical tourism for any study area is complex. Materials and Methods: Using full articles from other databases, Institute for Scientific Information (ISI), Science Direct, Emerald, Oxford, Magiran, and Scientific Information Database (SID), to examine systematically published articles about medical tourism in the interval 2000-2011 paid. Articles were obtained using descriptive statistics and content analysis categories were analyzed. Results: Among the 28 articles reviewed, 11 ...

  12. Physical activity counseling in medical school education: a systematic review

    OpenAIRE

    Dacey, Marie L.; Kennedy, Mary A.; Polak, Rani; Edward M Phillips

    2014-01-01

    Background: Despite a large evidence base to demonstrate the health benefits of regular physical activity (PA), few physicians incorporate PA counseling into office visits. Inadequate medical training has been cited as a cause for this. This review describes curricular components and assesses the effectiveness of programs that have reported outcomes of PA counseling education in medical schools.Methods: The authors systematically searched MEDLINE, EMBASE, PsychINFO, and ERIC databases for art...

  13. Evaluating an interprofessional disease state and medication management review model.

    Science.gov (United States)

    Hoti, Kreshnik; Forman, Dawn; Hughes, Jeffery

    2014-03-01

    There is lack of literature data reporting an incorporation of medication management reviews in students' interprofessional education (IPE) and practice programs in aged care settings. This pilot study reports how an interprofessional disease state and medication management review program (DSMMR) was established in a residential aged care facility in Perth, Western Australia. Students from the professions of nursing, pharmacy and physiotherapy focused on a wellness check in the areas of cognition, falls and continence while integrating a medication management review. Students' attitudes were explored using a pre- and post-placement questionnaire. Students indicated positive experience with the IPE DSMMR program which also resulted in their positive attitudinal shift towards IPE and practice. These findings indicated that aged care can be a suitable setting for student interprofessional programs focusing on DSMMR. PMID:24246025

  14. The medical ethnobotany of Lesotho: a review

    Directory of Open Access Journals (Sweden)

    A. Moteetee

    2011-12-01

    Full Text Available Traditional healing in Lesotho is reviewed, focusing on four aspects: 1, cultural practices; 2, traditional health care practitioners; 3, dosage forms; 4, the materia medica. Cultural practices are strongly associated with the belief that intangible forces are responsible for human happiness and misery. A total of 303 plant species are used medicinally (including 25 alien species, representing eight pteridophyte and 75 angiosperm families, of which the most important are Asteraceae, Fabaceae, Hyacinthaceae, Apocynaceae, Scrophulariaceae, Lamiaceae and Poaceae. Dicoma anomala (used mainly for digestive ailments and Artemisia afra (used mainly for respiratory ailments appear to be the best known and most widely used medicinal plants amongst a total of 37 species that have been cited four or more times in the literature. About 50 species are variously employed for magic and sorcery. There are no new species records but 36 new uses are reported. Our conclusion is that the medicinal plants of Lesotho are relatively well recorded and that this review will allow detailed comparisons with other African healing cultures.

  15. Detection of bla KPC-2 in Proteus mirabilis in Brazil

    Directory of Open Access Journals (Sweden)

    Adriane Borges Cabral

    2015-02-01

    Full Text Available INTRODUCTION : Infections caused by Klebsiella pneumoniae carbapenemase (KPC-producing isolates pose a major worldwide public health problem today. METHODS : A carbapenem-resistant Proteus mirabilis clinical isolate was investigated for plasmid profiles and the occurrence of β-lactamase genes. RESULTS : The isolate exhibited resistance to ertapenem and imipenem and was susceptible to meropenem, polymyxin, and tigecycline. Five plasmids were identified in this isolate. DNA sequencing analysis revealed the presence of bla KPC-2 and bla TEM-1 genes. An additional PCR using plasmid DNA confirmed that bla KPC-2 was present in one of these plasmids. Conclusions: We report the detection of bla KPC-2 in P. mirabilis in Brazil for the first time. This finding highlights the continuous transfer of bla KPC between bacterial genera, which presents a serious challenge to the prevention of infection by multidrug-resistant bacteria.

  16. Assessment in undergraduate medical education: a review of course exams

    Directory of Open Access Journals (Sweden)

    Allison A. Vanderbilt

    2013-03-01

    Full Text Available Introduction: The purpose of this study is to describe an approach for evaluating assessments used in the first 2 years of medical school and report the results of applying this method to current first and second year medical student examinations. Methods: Three faculty members coded all exam questions administered during the first 2 years of medical school. The reviewers discussed and compared the coded exam questions. During the bi-monthly meetings, all differences in coding were resolved with consensus as the final criterion. We applied Moore's framework to assist the review process and to align it with National Board of Medical Examiners (NBME standards. Results: The first and second year medical school examinations had 0% of competence level questions. The majority, more than 50% of test questions, were at the NBME recall level. Conclusion: It is essential that multiple-choice questions (MCQs test the attitudes, skills, knowledge, and competency in medical school. Based on our findings, it is evident that our exams need to be improved to better prepare our medical students for successful completion of NBME step exams.

  17. Peer review and refereeing in medicine and medical sciences

    Directory of Open Access Journals (Sweden)

    Ajao Oluwole

    1997-01-01

    Full Text Available Every academic scientist will come into contact with peer review process either as a reviewer of others work, or as an author whose work is being reviewed by others, or as an applicant for research grant. Historically, peer review process came at various times to various journals for a variety of reasons in haphazard manner. Many forms of criticisms have been made against the process of peer review, and some critics do not believe that the process prevents the publication of flawed articles and fraudulent research. Despite the criticisms, there are advantages of peer review. At present in medical journalism peer review process is an indispensable entity for assessing manuscripts intended for publication.

  18. Peer review and refereeing in medicine and medical sciences.

    Science.gov (United States)

    Ajao, O G

    1997-09-01

    Every academic scientist will come into contact with peer review process either as a reviewer of others work, or as an author whose work is being reviewed by others, or as an applicant for research grant. Historically, peer review process came at various times to various journals for a variety of reasons in haphazard manner. Many forms of criticisms have been made against the process of peer review, and some critics do not believe that the process prevents the publication of flawed articles and fraudulent research. Despite the criticisms, there are advantages of peer review. At present in medical journalism peer review process is an indispensable entity for assessing manuscripts intended for publication. PMID:19864786

  19. Causes of academic failure of medical and medical sciences students in Iran: a systematic review

    OpenAIRE

    Azari, Sheida; Baradaran, Hamid Reza; Fata, Ladan

    2015-01-01

    Background: Academic failure of medical and medical sciences students is one of the major problems of higher education centers in many countries. This study aims to collect and compare relevant researches in this field in Iran. Methods: The appropriate keywords were searched in the national and international databases, and the findings were categorized into related and non-related articles accordingly. Results: Only 22 articles were included in this systematic review. In terms of content anal...

  20. The future of medical diagnostics: review paper

    LENUS (Irish Health Repository)

    Jerjes, Waseem K

    2011-08-23

    Abstract While histopathology of excised tissue remains the gold standard for diagnosis, several new, non-invasive diagnostic techniques are being developed. They rely on physical and biochemical changes that precede and mirror malignant change within tissue. The basic principle involves simple optical techniques of tissue interrogation. Their accuracy, expressed as sensitivity and specificity, are reported in a number of studies suggests that they have a potential for cost effective, real-time, in situ diagnosis. We review the Third Scientific Meeting of the Head and Neck Optical Diagnostics Society held in Congress Innsbruck, Innsbruck, Austria on the 11th May 2011. For the first time the HNODS Annual Scientific Meeting was held in association with the International Photodynamic Association (IPA) and the European Platform for Photodynamic Medicine (EPPM). The aim was to enhance the interdisciplinary aspects of optical diagnostics and other photodynamic applications. The meeting included 2 sections: oral communication sessions running in parallel to the IPA programme and poster presentation sessions combined with the IPA and EPPM posters sessions.

  1. Teaching history taking to medical students: a systematic review

    OpenAIRE

    Keifenheim, Katharina E.; Teufel, Martin; Ip, Julianne; Speiser, Natalie; Leehr, Elisabeth J.; Zipfel, Stephan; Herrmann-Werner, Anne

    2015-01-01

    Background This paper is an up-to-date systematic review on educational interventions addressing history taking. The authors noted that despite the plethora of specialized training programs designed to enhance students‘ interviewing skills there had not been a review of the literature to assess the quality of each published method of teaching history taking in undergraduate medical education based on the evidence of the program’s efficacy. Methods The databases PubMed, PsycINFO, Google Schola...

  2. Stress Management in Medical Education: A Review of the Literature.

    Science.gov (United States)

    Shapiro, Shauna L.; Shapiro, Daniel E.; Schwartz, Gary E. R.

    2000-01-01

    Review of clinical studies providing empirical data on stress management programs in medical education found that student participants in such programs demonstrated improved immunologic functioning, decreased depression and anxiety, increased spirituality and empathy, enhanced knowledge of alternative therapies, improved knowledge of stress…

  3. Medication review in hospitalised patients to reduce morbidity and mortality

    DEFF Research Database (Denmark)

    Christensen, Mikkel; Lundh, Andreas

    2013-01-01

    Pharmacotherapy in the elderly population is complicated by several factors that increase the risk of drug related harms and poorer adherence. The concept of medication review is a key element in improving the quality of prescribing and the prevention of adverse drug events. While no generally...

  4. Ethics and policy of medical brain drain: a review.

    Science.gov (United States)

    Kollar, Eszter; Buyx, Alena

    2013-01-01

    Health-worker migration, commonly called "medical brain drain", refers to the mass migration of trained and skilled health professionals (doctors, nurses, midwives) from low-income to high-income countries. This is currently leaving a significant number of poor countries, particularly in sub-Saharan Africa, with critical staff shortages in the healthcare sector. A broad consensus exists that, where medical brain drain exacerbates such shortages, it is unethical, and this review presents the main arguments underpinning this view. Notwithstanding the general agreement, which policies are justifiable on ethical grounds to tackle brain drain and how best to go about implementing them remains controversial. The review offers a discussion of the specific ethical issues that have to be taken into account when deciding which policy measures to prioritise and suggests a strategy of policy implementation to address medical brain drain as a matter of urgency. PMID:24163012

  5. Solid state dosimeters used in medical physics 'A review'

    International Nuclear Information System (INIS)

    Many solid-state detectors have been successfully used to perform the quality control and in vivo dosimetry in medical physics, both in diagnostic radiology and radiotherapy, as they have high sensitivity in a small volume; most of them do not require electrical connection and have dosimetric characteristics of interest such as: good accuracy and reproducibility, as well as a response independent of the energy of radiation, some of them. For this reason, the selection of an appropriate detector for use in medical physics must take into account the energy mass absorption coefficient relative to water for photon sources and the mass stopping power relative to water for beta emitters and electron beams in the energy range of interest in medical physics, as well as the effective atomic number of materials that constitute them. This paper presents a review of the dosimetric characteristics of the solid state dosimeters most suitable for use in medical physics.

  6. Use of methylphenidate among medical students: a systematic review

    Directory of Open Access Journals (Sweden)

    Guilherme Finger

    2013-06-01

    Full Text Available OBJECTIVE: To review the effects of methylphenidate on cognitive enhancement, memory, and performance in medical students. METHODS: A review of four databases (LILACS, PubMed, ScienceDirect, and SciELO, analyzing the title and of all articles published between 1990 and 2012 in English, Portuguese, and Spanish. Selected articles were read in entirety, including in the review those that met the established criteria. RESULTS: The prevalence of use among medical students reached 16%, with no gender difference. Most students began using the drug after entering the university, and the reasons cited to justify it are related to enhancing academic performance. CONCLUSION: There is no evidence in the literature that the use of methylphenidate is beneficial in terms of memory or learning. The drug simply increases wakefulness and alertness, reducing the time of sleep.

  7. Genetic Features of blaNDM-1-Positive Enterobacteriaceae▿

    OpenAIRE

    Poirel, L.; Dortet, L.; Bernabeu, S.; NORDMANN, P.

    2011-01-01

    Genetic features associated with the blaNDM-1 gene were investigated in 6 Escherichia coli, 7 Klebsiella pneumoniae, 1 Citrobacter freundii, 1 Proteus mirabilis, and 1 Providencia stuartii isolate of worldwide origin. Clonal diversity was observed for both E. coli and K. pneumoniae. The blaNDM-1 gene was carried by different plasmid types (IncA/C, IncF, IncL/M, or untypeable) and was likely chromosome borne in two isolates. The blaNDM-1 plasmids coharbored a variety of resistance determinants...

  8. Systematic literature review of hospital medication administration errors in children

    Directory of Open Access Journals (Sweden)

    Ameer A

    2015-11-01

    Full Text Available Ahmed Ameer,1 Soraya Dhillon,1 Mark J Peters,2 Maisoon Ghaleb11Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; 2Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK Objective: Medication administration is the last step in the medication process. It can act as a safety net to prevent unintended harm to patients if detected. However, medication administration errors (MAEs during this process have been documented and thought to be preventable. In pediatric medicine, doses are usually administered based on the child's weight or body surface area. This in turn increases the risk of drug miscalculations and therefore MAEs. The aim of this review is to report MAEs occurring in pediatric inpatients. Methods: Twelve bibliographic databases were searched for studies published between January 2000 and February 2015 using “medication administration errors”, “hospital”, and “children” related terminologies. Handsearching of relevant publications was also carried out. A second reviewer screened articles for eligibility and quality in accordance with the inclusion/exclusion criteria. Key findings: A total of 44 studies were systematically reviewed. MAEs were generally defined as a deviation of dose given from that prescribed; this included omitted doses and administration at the wrong time. Hospital MAEs in children accounted for a mean of 50% of all reported medication error reports (n=12,588. It was also identified in a mean of 29% of doses observed (n=8,894. The most prevalent type of MAEs related to preparation, infusion rate, dose, and time. This review has identified five types of interventions to reduce hospital MAEs in children: barcode medicine administration, electronic prescribing, education, use of smart pumps, and standard concentration. Conclusion: This review has identified a wide variation in the prevalence of hospital MAEs in children. This is attributed to

  9. A Review of Simulators with Haptic Devices for Medical Training.

    Science.gov (United States)

    Escobar-Castillejos, David; Noguez, Julieta; Neri, Luis; Magana, Alejandra; Benes, Bedrich

    2016-04-01

    Medical procedures often involve the use of the tactile sense to manipulate organs or tissues by using special tools. Doctors require extensive preparation in order to perform them successfully; for example, research shows that a minimum of 750 operations are needed to acquire sufficient experience to perform medical procedures correctly. Haptic devices have become an important training alternative and they have been considered to improve medical training because they let users interact with virtual environments by adding the sense of touch to the simulation. Previous articles in the field state that haptic devices enhance the learning of surgeons compared to current training environments used in medical schools (corpses, animals, or synthetic skin and organs). Consequently, virtual environments use haptic devices to improve realism. The goal of this paper is to provide a state of the art review of recent medical simulators that use haptic devices. In particular we focus on stitching, palpation, dental procedures, endoscopy, laparoscopy, and orthopaedics. These simulators are reviewed and compared from the viewpoint of used technology, the number of degrees of freedom, degrees of force feedback, perceived realism, immersion, and feedback provided to the user. In the conclusion, several observations per area and suggestions for future work are provided. PMID:26888655

  10. An international review of tobacco smoking among medical students

    Directory of Open Access Journals (Sweden)

    Smith D

    2007-01-01

    Full Text Available We conducted a systematic international review of tobacco smoking habits among medical students. Particular attention was paid to countries where smoking rates have been historically well-documented in local journals, but were less often included in larger international review articles. The methodology involved a search of relevant medical subject headings, after which the reference lists of journal papers were also examined to find additional publications. A total of 66 manuscripts met the inclusion criteria. The most common countries previously studied included India, the United States, Australia, Japan, Pakistan, Turkey and the United Kingdom. Overall, our review suggests that the prevalence of smoking among medical students varies widely amongst different countries and also between male and female students within the same areas. Consistently low smoking rates were found in Australia and the United States, while generally high rates were reported in Spain and Turkey. Given their important future role as exemplars, more effective measures to help reduce tobacco smoking among medical students are clearly needed worldwide.

  11. Medication safety in home care nursing : a systematic litterature review

    OpenAIRE

    Nwoko, Oluchi Jessy

    2011-01-01

    This bachelor’s thesis is part of the Research and Development (R&D) project “Empowering path” at Laurea University of Applied Sciences, in collaboration with Tapiola pharmacy and Espoo home care. The aim of this project is to explore strategies by which medication safety can be promoted by nurses in home care nursing. The purpose: this systematic review is to discuss how resent literature describes medication safety in home care nursing. It also described methods used to promote safety i...

  12. Health economic analyses in medical nutrition: a systematic literature review

    Directory of Open Access Journals (Sweden)

    Walzer S

    2014-03-01

    Full Text Available Stefan Walzer,1,2 Daniel Droeschel,1,3 Mark Nuijten,4 Hélène Chevrou-Séverac5 1MArS Market Access and Pricing Strategy GmbH, Weil am Rhein, Germany; 2State University Baden-Wuerttemberg, Loerrach, Germany; 3Riedlingen University, SRH FernHochschule, Riedlingen, Germany; 4Ars Accessus Medica BV, Amsterdam, the Netherlands, 5Nestlé Health Science, Vevey, Switzerland Background: Medical nutrition is a specific nutrition category either covering specific dietary needs and/or nutrient deficiency in patients or feeding patients unable to eat normally. Medical nutrition is regulated by a specific bill in Europe and in the US, with specific legislation and guidelines, and is provided to patients with special nutritional needs and indications for nutrition support. Therefore, medical nutrition products are delivered by medical prescription and supervised by health care professionals. Although these products have existed for more than 2 decades, health economic evidence of medical nutrition interventions is scarce. This research assesses the current published health economic evidence for medical nutrition by performing a systematic literature review related to health economic analysis of medical nutrition. Methods: A systematic literature search was done using standard literature databases, including PubMed, the Health Technology Assessment Database, and the National Health Service Economic Evaluation Database. Additionally, a free web-based search was conducted using the same search terms utilized in the systematic database search. The clinical background and basis of the analysis, health economic design, and results were extracted from the papers finally selected. The Drummond checklist was used to validate the quality of health economic modeling studies and the AMSTAR (A Measurement Tool to Assess Systematic Reviews checklist was used for published systematic reviews. Results: Fifty-three papers were identified and obtained via PubMed, or directly

  13. Gendered specialities during medical education: a literature review.

    Science.gov (United States)

    Alers, Margret; van Leerdam, Lotte; Dielissen, Patrick; Lagro-Janssen, Antoine

    2014-06-01

    The careers of male and female physicians indicate gender differences, whereas in medical education a feminization is occurring. Our review aims to specify gender-related speciality preferences during medical education. A literature search on gender differences in medical students' speciality preferences was conducted in PubMed, Eric, Embase and Social Abstracts, and reference lists from January 2000 to June 2013. Study quality was assessed by critical appraisal. Our search yielded 741 hits and included 14, mostly cross-sectional, studies originating from various countries. No cohort studies were found. Throughout medical education, surgery is predominantly preferred by men and gynaecology, paediatrics and general practice by women. Internal medicine was pursued by both genders. The extent of gender-specific speciality preferences seemed related to the male-to-female ratio in the study population. When a population contained more male students gynaecology seemed even more preferred by women, while in a more feminine population, men more highly preferred surgery. Internationally, throughout medical education, gender-related speciality preferences are apparent. The extent might be influenced by the male-to-female ratio of a study population. Further research of the role of gender in career considerations of medical students on the future workforce is necessary. PMID:24980516

  14. Patient safety education for undergraduate medical students: a systematic review

    Directory of Open Access Journals (Sweden)

    Zhang Mingming

    2011-06-01

    Full Text Available Abstract Background To reduce harm caused by health care is a global priority. Medical students should be able to recognize unsafe conditions, systematically report errors and near misses, investigate and improve such systems with a thorough understanding of human fallibility, and disclose errors to patients. Incorporating the knowledge of how to do this into the medical student curriculum is an urgent necessity. This paper aims to systematically review the literature about patient safety education for undergraduate medical students in terms of its content, teaching strategies, faculty availability and resources provided so as to identify evidence on how to promote patient safety in the curriculum for medical schools. This paper includes a perspective from the faculty of a medical school, a major hospital and an Evidence Based Medicine Centre in Sichuan Province, China. Methods We searched MEDLINE, ERIC, Academic Source Premier(ASP, EMBASE and three Chinese Databases (Chinese Biomedical Literature Database, CBM; China National Knowledge Infrastructure, CNKI; Wangfang Data from 1980 to Dec. 2009. The pre-specified form of inclusion and exclusion criteria were developed for literature screening. The quality of included studies was assessed using Darcy Reed and Gemma Flores-Mateo criteria. Two reviewers selected the studies, undertook quality assessment, and data extraction independently. Differing opinions were resolved by consensus or with help from the third person. Results This was a descriptive study of a total of seven studies that met the selection criteria. There were no relevant Chinese studies to be included. Only one study included patient safety education in the medical curriculum and the remaining studies integrated patient safety into clinical rotations or medical clerkships. Seven studies were of a pre and post study design, of which there was only one controlled study. There was considerable variation in relation to contents

  15. Attitudes of medical students to medical leadership and management: a systematic review to inform curriculum development

    Directory of Open Access Journals (Sweden)

    Abbas Mark R

    2011-11-01

    Full Text Available Abstract Background There is a growing acknowledgement that doctors need to develop leadership and management competences to become more actively involved in the planning, delivery and transformation of patient services. We undertook a systematic review of what is known concerning the knowledge, skills and attitudes of medical students regarding leadership and management. Here we report the results pertaining to the attitudes of students to provide evidence to inform curriculum development in this developing field of medical education. Methods We searched major electronic databases and citation indexes within the disciplines of medicine, education, social science and management. We undertook hand searching of major journals, and reference and citation tracking. We accessed websites of UK medical institutions and contacted individuals working within the field. Results 26 studies were included. Most were conducted in the USA, using mainly quantitative methods. We used inductive analysis of the topics addressed by each study to identity five main content areas: Quality Improvement; Managed Care, Use of Resources and Costs; General Leadership and Management; Role of the Doctor, and Patient Safety. Students have positive attitudes to clinical practice guidelines, quality improvement techniques and multidisciplinary teamwork, but mixed attitudes to managed care, cost containment and medical error. Education interventions had variable effects on students' attitudes. Medical students perceive a need for leadership and management education but identified lack of curriculum time and disinterest in some activities as potential barriers to implementation. Conclusions The findings from our review may reflect the relatively little emphasis given to leadership and management in medical curricula. However, students recognise a need to develop leadership and management competences. Although further work needs to be undertaken, using rigorous methods, to identify

  16. Medical students as peer tutors: a systematic review

    OpenAIRE

    Burgess, Annette; Mcgregor, Deborah; Mellis, Craig

    2014-01-01

    Background While Peer Assisted Learning (PAL) has long occurred informally in medical education, in the past ten years, there has been increasing international interest in formally organised PAL, with many benefits for both the students and institutions. We conducted a systematic review of the literature to establish why and how PAL has been implemented, focussing on the recruitment and training process for peer tutors, the benefits for peer tutors, and the competency of peer tutors. Method A...

  17. Introducing Critical Care Forum's ongoing review of medical statistics

    OpenAIRE

    Whitley, Elise; Ball, Jonathon

    2002-01-01

    Statistics is increasingly used in all fields of medicine but is often poorly understood and incorrectly applied. Critical Care is therefore launching a series of articles aimed at providing a simple introduction or refresher to some of the more commonly used statistical tools and ideas. This series does not aim to be an exhaustive review of medical statistics but rather a starting point to inform readers and stimulate more thought and investigation as to the most appropriate statistical meth...

  18. The use of medication in selective mutism: a systematic review.

    Science.gov (United States)

    Manassis, Katharina; Oerbeck, Beate; Overgaard, Kristin Romvig

    2016-06-01

    Despite limited evidence, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are used to reduce symptoms of selective mutism (SM) in children unresponsive to psychosocial interventions. We review existing evidence for the efficacy of these medications, limitations of the literature, and resulting treatment considerations. Bibliographic searches were conducted in Medline, Embase, PsycInfo, Web of Science and Cochrane up to June 2015. Two reviewers independently sought studies of children with SM as primary psychiatric diagnosis, which reported response to medication treatment. Abstracts were limited to those reporting original data. Two reviewers independently assessed the ten papers reporting on >2 subjects regarding study design, key results, and limitations. Heterogeneity of designs mandated a descriptive summary. Symptomatic improvement was found for 66/79 children treated with SSRIs and 4/4 children treated with phenelzine. Only 3/10 studies had unmedicated comparison groups and only two were double-blinded. This review may be affected by publication bias, missed studies, and variability of outcome measures in included studies. Although there is some evidence for symptomatic improvement in SM with medication, especially SSRIs, it is limited by small numbers, lack of comparative trials, lack of consistent measures, and lack of consistent reporting on tolerability. The clinician must weigh this paucity of evidence against the highly debilitating nature of SM, and its adverse effects on the development of those children whose progress with psychosocial interventions is limited or very slow. Studies of optimal dosage and timing of medications in relation to psychosocial treatments are also needed. PMID:26560144

  19. Bedside teaching in medical education: a literature review

    OpenAIRE

    Peters, Max; ten Cate, Olle

    2013-01-01

    Bedside teaching is seen as one of the most important modalities in teaching a variety of skills important for the medical profession, but its use is declining. A literature review was conducted to reveal its strengths, the causes of its decline and future perspectives, the evidence with regard to learning clinical skills and patient/student/teacher satisfaction. PubMed, Embase and the Cochrane library were systematically searched with regard to terms related to bedside teaching. Articles reg...

  20. Presence of blaPER-1 and blaVEB-1 beta-lactamase genes among isolates of Pseudomonas aeruginosa from South West of Iran.

    Science.gov (United States)

    Davodian, Elham; Sadeghifard, Nourkhoda; Ghasemian, Abdolmajid; Noorbakhsh, Samileh

    2016-09-01

    Pseudomonas aeruginosa isolates have acquired resistance to antibiotics such as novel beta-lactams. The aim of this study was to investigate the blaPER-1, blaVEB-1, and blaPSE-1 genes among isolates of P. aeruginosa among intensive care unit (ICU) patients. Sixty-five isolates were collected. The antibiotic susceptibility testing and combined disk tests were performed to detect the isolates producing extended spectrum beta-lactamases (ESBLs) among ceftazidime-resistant isolates. Polymerase chain reaction (PCR) amplification of blaPER-1, blaVEB-1, and blaPSE-1 genes was conducted. Ten (15.3%) isolates were ESBL-positive, of which 40% (n=4) belonged to males and 60% (n=6) were collected from females. Moreover, two and one isolates harbored blaPER-1 and blaVEB-1 genes, respectively. PMID:26944896

  1. Medication errors in the Middle East countries: a systematic review of the literature

    OpenAIRE

    Alsulami, Zayed; Conroy, Sharon; Choonara, Imti

    2013-01-01

    Background Medication errors are a significant global concern and can cause serious medical consequences for patients. Little is known about medication errors in Middle Eastern countries. The objectives of this systematic review were to review studies of the incidence and types of medication errors in Middle Eastern countries and to identify the main contributory factors involved. Methods A systematic review of the literature related to medication errors in Middle Eastern countries was conduc...

  2. Attitudes of medical students to medical leadership and management: a systematic review to inform curriculum development

    OpenAIRE

    Abbas Mark R; Quince Thelma A; Wood Diana F; Benson John A

    2011-01-01

    Abstract Background There is a growing acknowledgement that doctors need to develop leadership and management competences to become more actively involved in the planning, delivery and transformation of patient services. We undertook a systematic review of what is known concerning the knowledge, skills and attitudes of medical students regarding leadership and management. Here we report the results pertaining to the attitudes of students to provide evidence to inform curriculum development in...

  3. 76 FR 31684 - Agency Information Collection (Medical Expense Report) Activity Under OMB Review

    Science.gov (United States)

    2011-06-01

    ... AFFAIRS Agency Information Collection (Medical Expense Report) Activity Under OMB Review AGENCY: Veterans...: Medical Expense Report, VA Form 21-8416. OMB Control Number: 2900-0161. Type of Review: Extension of a... income-based benefits to report medical expenses paid. Unreimbursed medical expenses may be excluded...

  4. Radiation Oncology in Undergraduate Medical Education: A Literature Review

    International Nuclear Information System (INIS)

    Purpose: To review the published literature pertaining to radiation oncology in undergraduate medical education. Methods and Materials: Ovid MEDLINE, Ovid MEDLINE Daily Update and EMBASE databases were searched for the 11-year period of January 1, 1998, through the last week of March 2009. A medical librarian used an extensive list of indexed subject headings and text words. Results: The search returned 640 article references, but only seven contained significant information pertaining to teaching radiation oncology to medical undergraduates. One article described a comprehensive oncology curriculum including recommended radiation oncology teaching objectives and sample student evaluations, two described integrating radiation oncology teaching into a radiology rotation, two described multidisciplinary anatomy-based courses intended to reinforce principles of tumor biology and radiotherapy planning, one described an exercise designed to test clinical reasoning skills within radiation oncology cases, and one described a Web-based curriculum involving oncologic physics. Conclusions: To the authors' knowledge, this is the first review of the literature pertaining to teaching radiation oncology to medical undergraduates, and it demonstrates the paucity of published work in this area of medical education. Teaching radiation oncology should begin early in the undergraduate process, should be mandatory for all students, and should impart knowledge relevant to future general practitioners rather than detailed information relevant only to oncologists. Educators should make use of available model curricula and should integrate radiation oncology teaching into existing curricula or construct stand-alone oncology rotations where the principles of radiation oncology can be conveyed. Assessments of student knowledge and curriculum effectiveness are critical.

  5. Bullying in medically fragile youth: a review of risks, protective factors, and recommendations for medical providers.

    Science.gov (United States)

    Faith, Melissa A; Reed, Gabriela; Heppner, Celia E; Hamill, Lillian C; Tarkenton, Tahnae R; Donewar, Crista W

    2015-05-01

    Bullying is a common child and adolescent phenomenon that has concurrent and long-term implications for victims' psychological, psychosomatic, social, and academic functioning. Youth with chronic illnesses are at increased risk for being bullied, but few studies have evaluated specific risk and protective factors for medically fragile youth. Despite recommendations by the American Academy of Pediatrics and the Society for Adolescent Medicine that pediatric health care providers should contribute to bullying prevention and intervention efforts, researchers also have yet to identify the best ways for providers to intervene with medically fragile youth. In this article, the authors review risk and protective factors for bullying among healthy samples. Then, the authors specifically address the ways in which these risk and protective factors are likely to apply to children with fragile medical conditions, and they provide summaries of extant bullying research for selected examples of medically fragile pediatric populations. Finally, the authors present recommendations for intervening with medically fragile youth and suggest several areas in which additional research is needed. PMID:25923529

  6. "Take ten minutes": a dedicated ten minute medication review reduces polypharmacy in the elderly.

    Science.gov (United States)

    Walsh, E K; Cussen, K

    2010-09-01

    Multiple and inappropriate medications are often the cause for poor health status in the elderly. Medication reviews can improve prescribing. This study aimed to determine if a ten minute medication review by a general practitioner could reduce polypharmacy and inappropriate prescribing in elderly patients. A prospective, randomised study was conducted. Patients over the age of 65 (n = 50) underwent a 10-minute medication review. Inappropriate medications, dosage errors, and discrepancies between prescribed versus actual medication being consumed were recorded. A questionnaire to assess satisfaction was completed following review. The mean number of medications taken by patients was reduced (p < 0.001). A medication was stopped in 35 (70%) patients. Inappropriate medications were detected in 27 (54%) patients and reduced (p < 0.001). Dose errors were detected in 16 (32%). A high level of patient satisfaction was reported. A ten minute medication review reduces polypharmacy, improves prescribing and is associated with high levels of patient satisfaction. PMID:21046863

  7. "Take ten minutes": a dedicated ten minute medication review reduces polypharmacy in the elderly.

    LENUS (Irish Health Repository)

    Walsh, E K

    2010-09-01

    Multiple and inappropriate medications are often the cause for poor health status in the elderly. Medication reviews can improve prescribing. This study aimed to determine if a ten minute medication review by a general practitioner could reduce polypharmacy and inappropriate prescribing in elderly patients. A prospective, randomised study was conducted. Patients over the age of 65 (n = 50) underwent a 10-minute medication review. Inappropriate medications, dosage errors, and discrepancies between prescribed versus actual medication being consumed were recorded. A questionnaire to assess satisfaction was completed following review. The mean number of medications taken by patients was reduced (p < 0.001). A medication was stopped in 35 (70%) patients. Inappropriate medications were detected in 27 (54%) patients and reduced (p < 0.001). Dose errors were detected in 16 (32%). A high level of patient satisfaction was reported. A ten minute medication review reduces polypharmacy, improves prescribing and is associated with high levels of patient satisfaction.

  8. "Take ten minutes": a dedicated ten minute medication review reduces polypharmacy in the elderly.

    LENUS (Irish Health Repository)

    Walsh, E K

    2012-02-01

    Multiple and inappropriate medications are often the cause for poor health status in the elderly. Medication reviews can improve prescribing. This study aimed to determine if a ten minute medication review by a general practitioner could reduce polypharmacy and inappropriate prescribing in elderly patients. A prospective, randomised study was conducted. Patients over the age of 65 (n = 50) underwent a 10-minute medication review. Inappropriate medications, dosage errors, and discrepancies between prescribed versus actual medication being consumed were recorded. A questionnaire to assess satisfaction was completed following review. The mean number of medications taken by patients was reduced (p < 0.001). A medication was stopped in 35 (70%) patients. Inappropriate medications were detected in 27 (54%) patients and reduced (p < 0.001). Dose errors were detected in 16 (32%). A high level of patient satisfaction was reported. A ten minute medication review reduces polypharmacy, improves prescribing and is associated with high levels of patient satisfaction.

  9. Quality of pharmaceutical advertisements in medical journals: a systematic review.

    Directory of Open Access Journals (Sweden)

    Noordin Othman

    Full Text Available BACKGROUND: Journal advertising is one of the main sources of medicines information to doctors. Despite the availability of regulations and controls of drug promotion worldwide, information on medicines provided in journal advertising has been criticized in several studies for being of poor quality. However, no attempt has been made to systematically summarise this body of research. We designed this systematic review to assess all studies that have examined the quality of pharmaceutical advertisements for prescription products in medical and pharmacy journals. METHODS AND FINDINGS: Studies were identified via searching electronic databases, web library, search engine and reviewing citations (1950 - February 2006. Only articles published in English and examined the quality of information included in pharmaceutical advertisements for prescription products in medical or pharmacy journals were included. For each eligible article, a researcher independently extracted the data on the study methodology and outcomes. The data were then reviewed by a second researcher. Any disagreements were resolved by consensus. The data were analysed descriptively. The final analysis included 24 articles. The studies reviewed advertisements from 26 countries. The number of journals surveyed in each study ranged from four to 24 journals. Several outcome measures were examined including references and claims provided in advertisements, availability of product information, adherence to codes or guidelines and presentation of risk results. The majority of studies employed a convenience-sampling method. Brand name, generic name and indications were usually provided. Journal articles were commonly cited to support pharmaceutical claims. Less than 67% of the claims were supported by a systematic review, a meta-analysis or a randomised control trial. Studies that assessed misleading claims had at least one advertisement with a misleading claim. Two studies found that less

  10. Liver transplantation: review of the literature. Part 3: medical complications

    International Nuclear Information System (INIS)

    The first attempted orthotopic liver transplantation, in 1963, involved a child with biliary atresia, who died on the operating table as a result of uncontrollable coagulopathy. Improvements in immunosuppression, surgical technique, medical imaging and postoperative care, as well as more stringent patient selection, have allowed the development of liver transplantation and its universal acceptance as the treatment for a variety of liver diseases. The radiologist plays a major role in the multidisciplinary transplantation team and must be familiar with each stage of orthotopic liver transplantation and its associated complications. In the first article of this series, the authors reviewed the anatomic features and current concepts relevant to orthotopic liver transplantation. In the second article, they discussed the vascular and biliary complications of the operation. This, the third and final article in the series, covers the medical complications. (author)

  11. Medication Review and Patient Outcomes in an Orthopedic Department

    DEFF Research Database (Denmark)

    Lisby, Marianne; Bonnerup, Dorthe Krogsgaard; Brock, Birgitte;

    2015-01-01

    OBJECTIVE: We investigated the health-related effect of systematic medication review performed by a clinical pharmacist and a clinical pharmacologist on nonelective elderly orthopedic patients. METHODS: This is a nonblinded randomized controlled study of 108 patients 65 years or older treated with...... the clinical pharmacologist, and recommendations were delivered directly to the ward physicians. The control was usual medication routine, that is, physicians prescribing admitting orders. The primary outcome was time to the first unplanned contact to a physician after discharge (i.e., general...... practitioner, emergency department visit, or readmission) during 3-month follow-up. Secondary outcomes included other health-related outcomes, for example, length of in-hospital stay, mortality, and quality of life. RESULTS: Time to the first unplanned contact to a physician was 14.9 days (95% confidence...

  12. Medical students-as-teachers: a systematic review of peer-assisted teaching during medical school

    Directory of Open Access Journals (Sweden)

    Yu TC

    2011-06-01

    Full Text Available Tzu-Chieh Yu¹, Nichola C Wilson², Primal P Singh¹, Daniel P Lemanu¹, Susan J Hawken³, Andrew G Hill¹¹South Auckland Clinical School, University of Auckland, Auckland, New Zealand; ²Department of Surgery, University of Auckland, Auckland, New Zealand; ³Department of Psychological Medicine, University of Auckland, Auckland, New ZealandIntroduction: International interest in peer-teaching and peer-assisted learning (PAL during undergraduate medical programs has grown in recent years, reflected both in literature and in practice. There, remains however, a distinct lack of objective clarity and consensus on the true effectiveness of peer-teaching and its short- and long-term impacts on learning outcomes and clinical practice.Objective: To summarize and critically appraise evidence presented on peer-teaching effectiveness and its impact on objective learning outcomes of medical students.Method: A literature search was conducted in four electronic databases. Titles and abstracts were screened and selection was based on strict eligibility criteria after examining full-texts. Two reviewers used a standard review and analysis framework to independently extract data from each study. Discrepancies in opinions were resolved by discussion in consultation with other reviewers. Adapted models of “Kirkpatrick’s Levels of Learning” were used to grade the impact size of study outcomes.Results: From 127 potential titles, 41 were obtained as full-texts, and 19 selected after close examination and group deliberation. Fifteen studies focused on student-learner outcomes and four on student-teacher learning outcomes. Ten studies utilized randomized allocation and the majority of study participants were self-selected volunteers. Written examinations and observed clinical evaluations were common study outcome assessments. Eleven studies provided student-teachers with formal teacher training. Overall, results suggest that peer-teaching, in highly selective

  13. Review of 40-year MD theses in Medical Oncology

    International Nuclear Information System (INIS)

    Background and objective: It is almost 40 years since the foundation of the Medical Oncology (MO) Department. We aimed to appraise the clinical research to fulfill the Medical Doctorate (MD) degree in MO at the National Cancer Institute, Cairo University (NCI, CU). Methods: This review included 62 MD theses containing 66 studies. They were reviewed regarding aims, type of study, clinical trial phase, design and methodology, statistical tests, results, limitations, consent and IRB approval. Theses were grouped into 3 periods: 1970-1989, 1990-1999 and 2000- 2008. Results: Almost 76% of the studies were interventional and 24% were observational. Informed consent and Institutional Review Board approval were mentioned in 18 and 2 studies, respectively. While all studies mentioned the aims, none, clearly mentioned the research question. Outcomes were mainly efficacy followed by safety. Study design was inadequately considered, especially in 70’s–80’s period (p = 0.038). Median sample size and study duration were almost stable through the three periods (p = 0.441, 0.354, respectively). Most of the studies used both descriptive and analytical statistical methods. In a descending order, researched cancers were lymphoma, breast, leukemia, liver, urinary bladder, lung and colorectal. The commonest stages researched were IV and III. The number of studies focused on assessing biomarkers, biomarkers plus drugs/procedures, drugs and procedures are 20, 20, 16 and 6, respectively. Conclusion: With time, research within MD theses in MO increased quantitatively and qualitatively. Improvements were noticeable in documentation of study design.

  14. Evaluation in English-Medium Medical Book Reviews

    Directory of Open Access Journals (Sweden)

    María Ángeles Alcaraz Ariza

    2011-06-01

    Full Text Available The aim of this paper is twofold: 1 to identify the evaluative speech acts, either positive or negative, contained in a corpus of 30 English-written medical book reviews published in The British Medical Journal in the period 2000-2009; 2 to analyze the linguistic-rhetorical strategies used to convey this evaluation. Our main results illustrate that various mitigating strategies are used not only to soften criticism, but also to help maintain social harmony and solidarity with the reviewees. Moreover, negative evaluation is on many occasions voiced at aspects outside the book reviewed, which would mean that apart from showing their expertise in the field tackled, book reviewers also want to discuss certain issues of their concern and to put forward their cultural background.Este trabajo tiene dos objetivos: 1 identificar los actos de habla evaluativos, positivos y negativos, en un corpus de reseñas de 30 libros médicos escritas en inglés y publicadas en el British Medical Journal en el periodo 2000- 2009; 2 analizar las estrategias lingüístico-retóricas utilizadas para transmitir estos actos de habla. Nuestros resultados principales muestran que no sólo se utilizan diversos mecanismos lingüístico-retóricos para atenuar los actos críticos, sino también para ayudar a mantener un clima de armonía social y solidaridad con los autores de los libros reseñados. Además, la evaluación negativa se dirige en numerosas ocasiones a aspectos ajenos a los libros reseñados, lo que implica que aparte de mostrar su competencia en el campo abordado, los reseñadores también desean debatir determinados temas de su interés y hacer gala de su cultural general.

  15. Developing control charts to review and monitor medication errors.

    Science.gov (United States)

    Ciminera, J L; Lease, M P

    1992-03-01

    There is a need to monitor reported medication errors in a hospital setting. Because the quantity of errors vary due to external reporting, quantifying the data is extremely difficult. Typically, these errors are reviewed using classification systems that often have wide variations in the numbers per class per month. The authors recommend the use of control charts to review historical data and to monitor future data. The procedure they have adopted is a modification of schemes using absolute (i.e., positive) values of successive differences to estimate the standard deviation when only single incidence values are available in time rather than sample averages, and when many successive differences may be zero. PMID:10116719

  16. blaCTX-M-1/9/1 Hybrid Genes May Have Been Generated from blaCTX-M-15 on an IncI2 Plasmid

    OpenAIRE

    Liu, Lanping; He, Dandan; Lv, Luchao; Liu, Wuling; Chen, Xiaojie; Zeng, Zhenling; Partridge, Sally R.; Liu, Jian-Hua

    2015-01-01

    Three hybrid CTX-M β-lactamases, CTX-M-64, CTX-M-123, and CTX-M-132, with N and C termini matching CTX-M-1 group enzymes and centers matching CTX-M-9 group enzymes, have been identified. The hybrid gene sequences suggested recombination between blaCTX-M-15 and blaCTX-M-14, the two most common blaCTX-M variants worldwide. However, blaCTX-M-64 and blaCTX-M-123 are found in an ISEcp1-blaCTX-M transposition unit with a 45-bp “spacer,” rather than the 48 bp usually associated with blaCTX-M-15, and...

  17. Medical humanities in healthcare education in Italy: a literature review

    Directory of Open Access Journals (Sweden)

    Laura Fieschi

    2013-03-01

    Full Text Available OBJECTIVE. The introduction of medical humanities (MH in undergraduate medical education in Italy has been an issue of debate since the 90's and few years later it was extended to other healthcare degrees. The aims of this Italian literature review, after considering the international scene, are: to evaluate the extent to which the interest in this subject has gradually developed throughout the country; which professional groups have contributed to the debate; to identify which theoretical constructs led to the introduction of MH in undergraduate medical education; to identify whether a clear and shared definition of MH exists in Italian literature; to verify what kinds of MH experiences have been accomplished in Italy. MATERIALS AND METHODS. A comprehensive literature search was conducted, including electronic databases, bibliographies, manual sorting of articles in paper format, congress proceedings. RESULTS. The analysis of the chosen articles underlines that, however limited, Italian literature does not present a very different picture from the international scene. It emerges that teaching MH is believed to be an important feature in undergraduate education of healthcare professionals who intend to propose a bio-psychological-social approach to care, in spite of the difficulty to measure its short and long term effectiveness. The lack of a multidisciplinary, multi-professional approach is also evident. CONCLUSION. Further research aiming to implement the quantity and quality of MH studies in the curricula of undergraduate healthcare education is desirable.

  18. Misuse of Prescription Opioid Medication among Women: A Scoping Review

    Science.gov (United States)

    Greaves, Lorraine; Poole, Nancy; Schmidt, Rose

    2016-01-01

    Background. National data from Canada and the United States identify women to be at greater risk than men for the misuse of prescription opioid medications. Various sex- and gender-based factors and patient and physician practices may affect women's use and misuse of prescription opioid drugs. Objectives. To explore the particular risks, issues, and treatment considerations for prescription opioid misuse among women who experience chronic noncancer pain and trauma. Methods. A scoping review for articles published between January 1990 and May 2014 was conducted on sex- and gender-based risks and treatment considerations among women who experience chronic noncancer pain and trauma. Results. A total of 57 articles were identified. The present narrative review summarizes the specific risks for the misuse of prescription opioid medication among women who have experienced violence and trauma, Aboriginal women, adolescents and young women, older women, pregnant women, women of a sexual minority, and transwomen. Discussion. The majority of the literature is descriptive, with few studies that evaluate approaches and interventions to respond to the issue of chronic pain, trauma, and misuse of prescription opioids among women, particularly vulnerable subgroups of women. Conclusions. Trauma-informed and women-centred approaches that address women's vulnerabilities and complex needs require further attention.

  19. Physical activity counseling in medical school education: a systematic review

    Directory of Open Access Journals (Sweden)

    Marie L. Dacey

    2014-07-01

    Full Text Available Background: Despite a large evidence base to demonstrate the health benefits of regular physical activity (PA, few physicians incorporate PA counseling into office visits. Inadequate medical training has been cited as a cause for this. This review describes curricular components and assesses the effectiveness of programs that have reported outcomes of PA counseling education in medical schools. Methods: The authors systematically searched MEDLINE, EMBASE, PsychINFO, and ERIC databases for articles published in English from 2000 through 2012 that met PICOS inclusion criteria of medical school programs with PA counseling skill development and evaluation of outcomes. An initial search yielded 1944 citations, and 11 studies representing 10 unique programs met criteria for this review. These studies were described and analyzed for study quality. Strength of evidence for six measured outcomes shared by multiple studies was also evaluated, that is, students’ awareness of benefits of PA, change in students’ attitudes toward PA, change in personal PA behaviors, improvements in PA counseling knowledge and skills, self-efficacy to conduct PA counseling, and change in attitude toward PA counseling. Results: Considerable heterogeneity of teaching methods, duration, and placement within the curriculum was noted. Weak research designs limited an optimal evaluation of effectiveness, that is, few provided pre-/post-intervention assessments, and/or included control comparisons, or met criteria for intervention transparency and control for risk of bias. The programs with the most evidence of improvement indicated positive changes in students’ attitudes toward PA, their PA counseling knowledge and skills, and their self-efficacy to conduct PA counseling. These programs were most likely to follow previous recommendations to include experiential learning, theoretically based frameworks, and students’ personal PA behaviors. Conclusions: Current results provide

  20. Review of hard copy systems for digital medical imaging

    Science.gov (United States)

    Apple, Bernard A.; Tennant, Mark H.; Thomas, Jule W., Jr.

    1996-03-01

    In this paper we review image requirements and the potential use of various printing technologies to record digital diagnostic radiographic information. An analysis of limitations and advantages of alternate imaging systems compared to current laser imager/silver halide film systems will be presented. The future move to digital radiology along with its hard copy requirements will also be discussed. The winning technologies in the market place will be determined by their ability to provide adequate image quality at low cost while meeting productivity, durability, and convenience requirements. The first technology to meet these requirements will have a tremendous advantage in the market place. Medical imaging hard copy is dominated by the use of silver halide media providing monochrome images of diagnostic image quality. As new digital medical imaging modalities have emerged they have opened the door to new hard copy technologies. These new technologies have been born and nurtured outside the medical market by small markets with high image quality requirements or by large markets with lower image quality requirements. The former have tended to provide high cost, high quality solutions and the latter low cost, low quality solutions. Silver halide media still dominates, at least in part, because it provides high image quality at a relatively low cost. Yet, the trend away from wet silver halide is evident. These new hard copy technologies are being tested to determine their applicability to the medical market and are finding niches where they provide value. A clear winner that provides the required image quality at low cost has yet to emerge.

  1. blaCTX-M-I group extended spectrum beta lactamase-producing Salmonella typhi from hospitalized patients in Lagos, Nigeria

    Directory of Open Access Journals (Sweden)

    Akinyemi KO

    2015-05-01

    Full Text Available Kabiru O Akinyemi,1 Bamidele A Iwalokun,2 Olajide O Alafe,1 Sulaiman A Mudashiru,1 Christopher Fakorede,11Department of Microbiology, Lagos State University, Ojo, Lagos, Nigeria; 2Biochemistry and Nutrition Division, Nigerian Institute of Medical Research, Yaba, Lagos, NigeriaPurpose: The global spread of blaCTX-M-I extended-spectrum beta-lactamase (ESBL-producing Salmonella spp. remains a major threat to treatment and control. Evidence of emergence and spread of this marker are lacking in Nigeria. This study investigated blaCTX-M-I ESBL production among Salmonella isolates from hospitalized patients.Methods: Patients (158 total made up of two groups were evaluated. Group A was composed of 135 patients with persistent pyrexia and group B was composed of 23 gastroenteritis patients and their stool samples. Samples were cultured, and isolates were identified and were subjected to antibiotic susceptibility testing by standard methods. Isolates were further screened for ESBL production, blaCTX-M-I genes and transferability by double disk synergy test, plasmid extraction, polymerase chain reaction, and conjugation experiment.Results: Thirty-five (25.9% Salmonella isolates were identified from group A, of which 74.3% were S. typhi, 22.9% were S. paratyphi and two (5.7% were invasive non-typhoidal S. enteritidis. Nine Plasmodium falciparum infections were recorded, four of which were identified as co-infections with typhoidal Salmonella. Only two (8.7% S. enteritidis samples were obtained from group B (P>0.05. A total of 24 isolates were ESBL-positive, eliciting resistance to five to seven antibiotics, and were multiple-drug resistant. ESBL production due to the blaCTX-M-I gene cluster was detected in eleven (45.8% Salmonella isolates. Nine (81.8% of the eleven blaCTX-M-I ESBL producers were S. typhi and two (18.2% isolates were S. enteritidis. Four of nine S. typhi blaCTX-M-I ESBL-producing strains harbored 23 kb self-transmissible plasmid that was co

  2. Quality of published Iranian medical education research studies: a systematic review

    OpenAIRE

    Golnari, Pedram; Sodagari, Faezeh; Baradaran, Hamid Reza

    2014-01-01

    Background: Research in medical education has been paid more attention than before; however the quality of research reporting has not been comprehensively appraised. To evaluate the methodological and reporting quality of Iranian published medical education articles. Methods: Articles describing medical students, residents, fellows or program evaluation were included. Articles related to continuing medical education or faculty development, review articles and reports, and studies considering ...

  3. Interventional tools to improve medication adherence: review of literature

    Directory of Open Access Journals (Sweden)

    Costa E

    2015-09-01

    review the most frequent interventions employed to increase the degree of medication adherence, the measured outcomes, and the improvements achieved, as well as the main limitations of the available studies on adherence, with a particular focus on older persons.Keywords: cognitive impairment, nonadherence, tools, compliance, chronic diseases, elderly

  4. The Occurrence of blaCTX-M, blaSHV, and blaTEM Genes in Extended-Spectrum β-Lactamase-Positive Strains of Klebsiella pneumoniae, Escherichia coli, and Proteus mirabilis in Poland

    OpenAIRE

    Ojdana, Dominika; Sacha, Paweł; Wieczorek, Piotr; Czaban, Sławomir; Michalska, Anna; Jaworowska, Jadwiga; Jurczak, Anna; Poniatowski, Bogusław; Tryniszewska, Elżbieta

    2014-01-01

    Bacteria belonging to the Enterobacteriaceae family that produce extended-spectrum β-lactamase (ESBL) enzymes are important pathogens of infections. Increasing numbers of ESBL-producing bacterial strains exhibiting multidrug resistance have been observed. The aim of the study was to evaluate the prevalence of blaCTX-M, blaSHV, and blaTEM genes among ESBL-producing Klebsiella pneumoniae, Escherichia coli, and Proteus mirabilis strains and to examine susceptibility to antibiotics of tested stra...

  5. Two Multiplex Real-Time PCR Assays to Detect and Differentiate Acinetobacter baumannii and Non- baumannii Acinetobacter spp. Carrying blaNDM, blaOXA-23-Like, blaOXA-40-Like, blaOXA-51-Like, and blaOXA-58-Like Genes.

    Science.gov (United States)

    Yang, Qiu; Rui, Yongyu

    2016-01-01

    Nosocomial infections caused by Acinetobacter spp. resistant to carbapenems are increasingly reported worldwide. Carbapenem-resistant Acinetobacter (CRA) is becoming a serious concern with increasing patient morbidity, mortality, and lengths of hospital stay. Therefore, the rapid detection of CRA is essential for epidemiological surveillance. Polymerase chain reaction (PCR) has been extensively used for the rapid identification of most pathogens. In this study, we have developed two multiplex real-time PCR assays to detect and differentiate A. baumannii and non-A. baumannii Acinetobacter spp, and common carbapenemase genes, including blaNDM, blaOXA-23-like, blaOXA-40-like, blaOXA-51-like, and blaOXA-58-like. We demonstrate the potential utility of these assays for the direct detection of blaNDM-, blaOXA-23-like-, blaOXA-40-like-, blaOXA-51-like-, and blaOXA-58-like-positive CRA in clinical specimens. Primers were specifically designed, and two multiplex real-time PCR assays were developed: multiplex real-time PCR assay1 for the detection of Acinetobacter baumannii 16S-23S rRNA internal transcribed spacer sequence, the Acinetobacter recA gene, and class-B-metalloenzyme-encoding gene blaNDM; and multiplex real-time PCR assay2 to detect class-D-oxacillinase-encoding genes (blaOXA-23-like, blaOXA-40-like, blaOXA-51-like,and blaOXA-58-like). The assays were performed on an ABI Prism 7500 FAST Real-Time PCR System. CRA isolates were used to compare the assays with conventional PCR and sequencing. Known amounts of CRA cells were added to sputum and fecal specimens and used to test the multiplex real-time PCR assays. The results for target and nontarget amplification showed that the multiplex real-time PCR assays were specific, the limit of detection for each target was 10 copies per 20 μL reaction volume, the assays were linear over six log dilutions of the target genes (r2 > 0.99), and the Ct values of the coefficients of variation for intra- and interassay

  6. Two Multiplex Real-Time PCR Assays to Detect and Differentiate Acinetobacter baumannii and Non- baumannii Acinetobacter spp. Carrying blaNDM, blaOXA-23-Like, blaOXA-40-Like, blaOXA-51-Like, and blaOXA-58-Like Genes.

    Directory of Open Access Journals (Sweden)

    Qiu Yang

    Full Text Available Nosocomial infections caused by Acinetobacter spp. resistant to carbapenems are increasingly reported worldwide. Carbapenem-resistant Acinetobacter (CRA is becoming a serious concern with increasing patient morbidity, mortality, and lengths of hospital stay. Therefore, the rapid detection of CRA is essential for epidemiological surveillance. Polymerase chain reaction (PCR has been extensively used for the rapid identification of most pathogens. In this study, we have developed two multiplex real-time PCR assays to detect and differentiate A. baumannii and non-A. baumannii Acinetobacter spp, and common carbapenemase genes, including blaNDM, blaOXA-23-like, blaOXA-40-like, blaOXA-51-like, and blaOXA-58-like. We demonstrate the potential utility of these assays for the direct detection of blaNDM-, blaOXA-23-like-, blaOXA-40-like-, blaOXA-51-like-, and blaOXA-58-like-positive CRA in clinical specimens. Primers were specifically designed, and two multiplex real-time PCR assays were developed: multiplex real-time PCR assay1 for the detection of Acinetobacter baumannii 16S-23S rRNA internal transcribed spacer sequence, the Acinetobacter recA gene, and class-B-metalloenzyme-encoding gene blaNDM; and multiplex real-time PCR assay2 to detect class-D-oxacillinase-encoding genes (blaOXA-23-like, blaOXA-40-like, blaOXA-51-like,and blaOXA-58-like. The assays were performed on an ABI Prism 7500 FAST Real-Time PCR System. CRA isolates were used to compare the assays with conventional PCR and sequencing. Known amounts of CRA cells were added to sputum and fecal specimens and used to test the multiplex real-time PCR assays. The results for target and nontarget amplification showed that the multiplex real-time PCR assays were specific, the limit of detection for each target was 10 copies per 20 μL reaction volume, the assays were linear over six log dilutions of the target genes (r2 > 0.99, and the Ct values of the coefficients of variation for intra- and

  7. Review of image reconstruction techniques in medical transaxial computed tomography

    International Nuclear Information System (INIS)

    After a brief recall about the basic principle of transaxial computed tomography this paper deals with the main image reconstruction techniques usable in different medical fields when projections are pre-processed according to the kind of detected signals. The analytical techniques which are based on the back-projection operation and deconvolution filtering are distinguished from the algebraic techniques which involve an iterative process for computation of the correction coefficients to be applied to the pixel values. For each technique the reconstruction algorithm is described and an illustration of the data processing steps in the case of a single radioactive source is given. The application conditions and related problems are discussed in the field of single photon emission computed tomography. The main deconvolution filters used in analytical techniques are briefly described and this review is completed by a comparison between the characteristics of analytical and algebraic techniques

  8. A two-decade Review of Medical Ethics in Iran

    Directory of Open Access Journals (Sweden)

    F Zahedi

    2009-03-01

    Full Text Available "nThe growing developments in science and technology have raised ethical challenges which should practically be addressed by scientists, regulatory bodies and policy makers. Likewise, challenging issues of medical ethics have also drawn a great deal of academic attention in Iran. In other words, recent decades have been an occasion of considerable development for contemporary bioethics in Iran. At first, the ongoing initiatives to arrange the national and regional research ethics commit­tees and to compile the national strategic plan for medical ethics is worth mentioning. Currently, research ethics committees are actively established in the universities and research centers across the country. Furthermore, the subject of ethics in dif­ferent fields of science, which was followed in a traditional approach previously, is an important object of discussion cur­rently. Much research is now being undertaken in various areas of bioethics nationwide. Consequently, during the period under review, considerable articles and books have been published in the emerging subjects of bioethics. Several educa­tional workshops and courses have been frequently taken place in the universities and research centers. Foundation of aca­demic courses and fellowship in bioethics are also among the recent activities in the realm of medical ethics education in Iran. Likewise, considering several areas of bioethics that need legislation or reconsideration of previous regulations; the authorities, policy-makers, and scientists have carried out some endeavors to prepare appropriate law, codes, and guidelines. This report summarizes the bioethical activities and achievements in different fields of policy-making, organizing, teaching, and putting ethics into practice in our country during two recent decades.

  9. Periorbital hyperpigmentation: review of etiology, medical evaluation, and aesthetic treatment.

    Science.gov (United States)

    Roberts, Wendy E

    2014-04-01

    Periorbital hyperpigmentation (POH) is a common worldwide problem. It is challenging to treat, complex in pathogenesis, and lacking straightforward and repeatable therapeutic options. It may occur in the young and old, however the development of dark circles under the eyes in any age is of great aesthetic concern because it may depict the individual as sad, tired, stressed, and old. While "dark circles" are seen in all skin types, POH is often more commonly seen in skin of color patients worldwide. With a shifting US demographic characterized by growing number of aging patients as well as skin of color patients, we will encounter POH with greater frequency. As forecasted by the US Census, by 2030 1 in 5 Americans will be 65 plus years old and greater than 50% of the population will possess ethnic skin of color. The disparity in the medical community's understanding of POH versus popular demand for treatment is best illustrated when you have only 65 cited articles to date indexed on PubMed line compared to the 150,000,000 results on Google search engine. Most importantly POH may be a final common pathway of dermatitis, allergy, systemic disorders, sleep disturbances, or nutritional deficiences that lends itself to medical, surgical, and cosmeceutical treatments. A complete medical history with ROS and physical examination is encouraged prior to treating the aesthetic component. Sun protection is a cornerstone of therapy. Safety issues are of utmost concern when embarking upon treatments such as chemical peeling, filler injection, and laser therapy as not to worsen the pigmentation. Without intervention, POH usually progresses over time so early intervention and management is encouraged. The objective of this study was to review the current body of knowledge on POH, provide the clinician with a guide to the evaluation and treatment of POH, and to present diverse clinical cases of POH that have responded to different therapies including non-ablative fractional

  10. Characteristics of β-lactamases and their genes (blaA and blaB in Yersinia intermedia and Y. frederiksenii

    Directory of Open Access Journals (Sweden)

    Sharma Sachin

    2007-04-01

    Full Text Available Abstract Background The presence of β-lactamases in Y. enterocolitica has been reported to vary with serovars, biovars and geographical origin of the isolates. An understanding of the β-lactamases in other related species is important for an overall perception of antibiotic resistance in yersiniae. The objective of this work was to study the characteristics of β-lactamases and their genes in strains of Y. intermedia and Y. frederiksenii, isolated from clinical and non-clinical sources in India. Results The enzymes, Bla-A (a constitutive class A penicillinase and Bla-B (an inducible class C cephalosporinase were found to be present in all the clinical and non-clinical strains of Y. intermedia and Y. frederiksenii by double disc diffusion method. The results showed differential expression of Bla-A as indicated by presence/absence of synergy whereas expression of Bla-B was quite consistent. The presence of these enzymes was also reflected in the high minimum inhibitory concentrations, MIC50 (126–1024 mg/L and MIC90 (256–1024 mg/L of β-lactam antibiotics against these species. Restriction fragment length polymorphism (RFLP revealed heterogeneity in both blaA and blaB genes of Y. intermedia and Y. frederiksenii. The blaA gene of Y. intermedia shared significant sequence identity (87–96% with blaA of Y. enterocolitica biovars 1A, 1B and 4. The sequence identity of blaA of Y. frederiksenii with these biovars was 77–79%. The sequence identity of blaB gene of Y. intermedia and Y. frederiksenii was more (85% with that of Y. enterocolitica biovars 1A, 1B and 2 compared to other species viz., Y. bercovieri, Y. aldovae and Y. ruckeri. Isoelectric focusing data further revealed that both Y. intermedia and Y. frederiksenii produced Bla-A (pI 8.7 and "Bla-B like" (pI 5.5–7.1 enzymes. Conclusion Both Y. intermedia and Y. frederiksenii showed presence of blaA and blaB genes and unequivocal expression of the two β-lactamases. Limited heterogeneity

  11. Dissemination of Pseudomonas aeruginosa producing blaIMP-1 and blaVIM-1 in Qazvin and Alborz educational hospitals, Iran

    Directory of Open Access Journals (Sweden)

    Amir Peymani

    2016-01-01

    Full Text Available Background and Objectives: Pseudomonas aeruginosa is a frequent opportunistic pathogen in health care associated infections that is highly resistant to the majority of β-lactams. The aims of this study were to access the antimicrobial susceptibility pattern of P. aeruginosa isolated from educational hospitals of Qazvin and Alborz provinces, to determine the prevalence of metallo-β-lactamase (MBL among carbapenem non-susceptible isolates by combined disk (CD method, and to detect the blaIMP, blaVIM, blaSIM, blaGIM, blaSPM and blaNDM-1-MBL genes.Materials and Methods: In this cross-sectional study, 300 P. aeruginosa isolates were collected from different clinical specimens in two provinces of Qazvin and Alborz hospitals, Iran. After identification of isolates by standard laboratory methods, antimicrobial susceptibility was done against 17 antibiotics according to clinical and laboratory standards institute (CLSI guideline. CD method was carried out for detection of MBLs and the presence of blaIMP, blaVIM, blaSIM, blaGIM, blaNDM-1 and blaSPM-genes was further assessed by PCR and sequencing methods.Results: In this study, 107 (35.66% isolates were non-susceptible to imipenem and/or meropenem among those 56 (52.3% isolates were metallo-β-lactamase producer. Twenty-four of 56 (42.85% MBL-positive isolates were confirmed to be positive for MBL-encoding genes in which 14 (25% and 10 (17.85% isolates carried blaIMP-1 and blaVIM-1 genes either alone or in combination. Three (5.35% isolates carried blaIMP and blaVIM genes, simultaneously.Conclusion: Considering the moderate prevalence and clinical importance of MBL-producing isolates, rapid identification and use of appropriate infection control (IC measures are necessary to prevent further spread of infections by these resistant organisms.Keywords: Pseudomonas aeruginosa, Antibiotic resistance, Metallo-β-lactamase

  12. Detection of blaIMP4 and blaNDM1 harboring Klebsiella pneumoniae isolates in a university hospital in Malaysia

    Directory of Open Access Journals (Sweden)

    Nurul Izzati Hamzan

    2015-03-01

    Full Text Available Background: Antibiotic resistance among Enterobacteriaceae posts a great challenge to the health care service. The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP is attracting significant attention due to its rapid and global dissemination. The infection is associated with significant morbidity and mortality, thus creating challenges for infection control and managing teams to curb the infection. In Southeast Asia, there have been limited reports and subsequent research regarding CRKP infections. Thus, the study was conducted to characterize CRKP that has been isolated in our setting. Methods: A total of 321 K. pneumoniae were included in the study. Each isolate went through an identification process using an automated identification system. Phenotypic characterization was determined using disk diffusion, modified Hodge test, Epsilometer test, and inhibitor combined disk test. Further detection of carbapenemase genes was carried out using polymerase chain reaction and confirmed by gene sequence analysis. Results: All together, 13 isolates (4.05% were CRKP and the majority of them were resistant to tested antibiotics except colistin and tigercycline. Among seven different carbapenemase genes studied (bla KPC, bla IMP, bla SME, bla NDM, bla IMI, bla VIM, and bla OXA, only two, bla IMP4 (1.87% and bla NDM1 (2.18%, were detected in our setting. Conclusion: Evidence suggests that the prevalence of CRKP in our setting is low, and knowledge of Carbapenem-resistant Enterobacteriaceae and CRKP has improved and become available among clinicians.

  13. Epidemic Plasmid Carrying bla CTX-M-15 in Klebsiella penumoniae in China

    OpenAIRE

    Zhuo, Chao; Li, Xiao-Qiang; Zong, Zhi-yong; Zhong, Nan-shan

    2013-01-01

    Objective To investigate the local epidemiology of Klebsiella penumoniae carrying bla CTX-M-15 in southern China and to characterize the genetic environment of bla CTX-M-15. Methods PCR and DNA sequencing were used to detect and characterize the genetic contexts of bla CTX-M-15. The clonal relatedness of isolates carrying bla CTX-M-15 was determined by pulse-field gel electrophoresis. Conjugative plasmids carrying bla CTX-M-15 were obtained by mating and were further subject to restriction an...

  14. Preventing infection from reusable medical equipment: a systematic review

    Directory of Open Access Journals (Sweden)

    Hart Tony

    2002-03-01

    Full Text Available Abstract Background In 2000, the World Health Organization (WHO had eight sets of conflicting recommendations for decontaminating medical equipment. We conducted a systematic review of observational studies to assist WHO in reconciling the various guidelines. This paper summarises the methods developed and illustrates the results for three procedures – alcohol, bleach and povidone iodine. Methods We developed a Medline search strategy and applied inclusion criteria specifying the decontamination procedures of interest and an outcome of microbial destruction for a set of marker organisms. We developed protocols to assess the quality of studies and categorised them according to the reliability of the methods used. Through an iterative process we identified best practice for the decontamination methods and key additional factors required to ensure their effectiveness. We identified 88 published papers for inclusion, describing 135 separate studies of decontamination. Results For disinfection with alcohol, best practice was identified from 23 studies as an exposure to 70–80% ethanol or isopropanol for at least 5 minutes. Bleach was effective for sterilization at a concentration of 5000 ppm for 5 minutes and for disinfection at 1000 ppm for 10 minutes (33 studies. Povidone iodine was only partially effective for disinfection at a concentration of 1% for 15 minutes (15 studies. Conclusions Our findings provide an evidence base for WHO guidelines on decontaminating medical equipment. The results support the recommended use of bleach and show that alcohol could be used more widely than current guidelines suggest, provided best practice is followed. The effectiveness of povidone iodine is uncertain.

  15. Factors associated with dropout in medical education: a literature review

    DEFF Research Database (Denmark)

    O'Neill, Lotte Dyhrberg; Wallstedt, Birgitta; Eika, Berit;

    2011-01-01

    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....

  16. Risks to emergency medical responders at terrorist incidents: a narrative review of the medical literature.

    Science.gov (United States)

    Thompson, Julian; Rehn, Marius; Lossius, Hans Morten; Lockey, David

    2014-01-01

    As the threat of international terrorism rises, there is an increasing requirement to provide evidence-based information and training for the emergency personnel who will respond to terrorist incidents. Current major incident training advises that emergency responders prioritize their own personal safety above that of the 'scene and survivors'. However, there is limited information available on the nature of these threats and how they may be accurately evaluated. This study reviews the published medical literature to identify the hazards experienced by emergency responders who have attended previous terrorist incidents. A PubMed literature search identified 10,894 articles on the subject of 'terrorism', and there was a dramatic increase in publications after the 9/11 attacks in 2001. There is heterogeneity in the focus and quality of this literature, and 307 articles addressing the subject of scene safety were assessed for information regarding the threats encountered at terrorist incidents. These articles demonstrate that emergency responders have been exposed to both direct terrorist threats and environmental scene hazards, including airborne particles, structural collapse, fire, and psychological stress. The emphasis of training and preparedness for terrorist incidents has been primarily on the direct threats, but the published literature suggests that the dominant causes of mortality and morbidity in responders after such incidents are the indirect environmental hazards. If the medical response to terrorist incidents is to be based on evidence rather than anecdote, analysis of the current literature should be incorporated into major incident training, and consistent collection of key data from future incidents is required. PMID:25323086

  17. Systematic literature review of hospital medication administration errors in children

    OpenAIRE

    Ameer A; Dhillon S; Peters MJ; Ghaleb M

    2015-01-01

    Ahmed Ameer,1 Soraya Dhillon,1 Mark J Peters,2 Maisoon Ghaleb11Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; 2Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK Objective: Medication administration is the last step in the medication process. It can act as a safety net to prevent unintended harm to patients if detected. However, medication administration errors (MAEs) during this process have been documented and t...

  18. Pharmacist-led medication review in an acute admissions unit

    DEFF Research Database (Denmark)

    Hansen, Trine Graabæk; Bonnerup, Dorthe Krogsgaard; Kjeldsen, Lene Juel; Rossing, Charlotte; Pottegård, Anton

    2015-01-01

    data, (2) collection of information about the patient's medical treatment, (3) patient interview, (4) critical examination of the patient's medications and (5) recommendations for the hospital physician.Conclusions We have provided a detailed description of a procedure for pharmacist-led medication...

  19. 75 FR 57045 - Parallel Review of Medical Products

    Science.gov (United States)

    2010-09-17

    ... diagnostics generally occur in a serial manner. First, a new medical product is submitted to FDA, which... of Medical Products AGENCIES: Centers for Medicare and Medicaid Services; Food and Drug... overlapping evaluations of premarket, FDA-regulated medical products when the product sponsor and...

  20. Medical and dental management of Alagille syndrome: A review

    Science.gov (United States)

    Berniczei-Royko, Adam; Chałas, Renata; Mitura, Iwona; Nagy, Katalin; Prussak, Elżbieta

    2014-01-01

    Alagille syndrome is a rare, autosomal, complex, dominant disorder associated with dysfunction of the liver, heart, skeleton, and eyes, as well as characteristic facial appearance. It is associated with the defect in component of the Notch signalling pathway. Here, we review the main features of Alagille syndrome with special focus on oro-facial manifestations like prominent forehead, moderate hypertelorism with deep-set eyes, a saddle or straight nose with a flattened, bulbous tip, and large ears. The article is based on the most recent and significant literature available from the Medline database. Contrary to healthy children, patients with Alagille syndrome have many problems, depending on several factors like the severity of cholestasis and scarring in the liver, heart or lung problems, presence of infections, or other problems related to poor nutrition that can manifest in their oral cavity in the dental and periodontal tissues, as well as oral mucosa. From the dentist’s view, the most important elements are careful observation, accurate diagnosis, and planned management of such patients, especially during the patient’s formative years, to prevent complications. Aggressive preventive oral care and consultations with medical specialists before any invasive procedure are obligatory. All this can improve quality of life in patients with Alagille syndrome. PMID:24658020

  1. Medication Abortion within a Student Health Care Clinic: A Review of the First 46 Consecutive Cases

    Science.gov (United States)

    Godfrey, Emily M.; Bordoloi, Anita; Moorthie, Mydhili; Pela, Emily

    2012-01-01

    Objective: Medication abortion with mifepristone and misoprostol has been available in the United States since 2000. The authors reviewed the first 46 medication abortion cases conducted at a university-based student health care clinic to determine the safety and feasibility of medication abortion in this type of clinical setting. Participants:…

  2. Description of a practice model for pharmacist medication review in a general practice setting

    DEFF Research Database (Denmark)

    Brandt, Mette; Hallas, Jesper; Hansen, Trine Graabæk;

    2014-01-01

    and clinical or laboratory data. The medication review focuses on the diagnoses of the patient instead of the individual drugs. Patient interviews are not part of the model. The model was tested in a pilot study by conducting medical reviews on 50 polypharmacy patients (i.e. receiving 7 or more drugs...

  3. A Review of the Design Process for Implantable Orthopedic Medical Devices

    OpenAIRE

    Aitchison, G.A; Hukins, D. W. L.; Parry, J.J; Shepherd, D.E.T; Trotman, S.G

    2009-01-01

    The design process for medical devices is highly regulated to ensure the safety of patients. This paper will present a review of the design process for implantable orthopedic medical devices. It will cover the main stages of feasibility, design reviews, design, design verification, manufacture, design validation, design transfer and design changes.

  4. The use of Facebook in medical education – A literature review

    OpenAIRE

    Pander, Tanja; Pinilla, Severin; Dimitriadis, Konstantinos; Fischer, Martin R

    2014-01-01

    [english] Background: The vogue of social media has changed interpersonal communication as well as learning and teaching opportunities in medical education. The most popular social media tool is Facebook. Its features provide potentially useful support for the education of medical students but it also means that some new challenges will have to be faced. Aims: This review aimed to find out how Facebook has been integrated into medical education. A systematical review of the current literature...

  5. Technology-assisted education in graduate medical education: a review of the literature

    OpenAIRE

    Jwayyed, Sharhabeel; Stiffler, Kirk A; Wilber, Scott T; Southern, Alison; Weigand, John; Bare, Rudd; Gerson, Lowell W.

    2011-01-01

    Studies on computer-aided instruction and web-based learning have left many questions unanswered about the most effective use of technology-assisted education in graduate medical education. Objective We conducted a review of the current medical literature to report the techniques, methods, frequency and effectiveness of technology-assisted education in graduate medical education. Methods A structured review of MEDLINE articles dealing with "Computer-Assisted Instruction," "Internet or World W...

  6. Rapid and Simultaneous Detection of Genes Encoding Klebsiella pneumoniae Carbapenemase (blaKPC) and New Delhi Metallo-β-Lactamase (blaNDM) in Gram-Negative Bacilli

    OpenAIRE

    Cunningham, Scott A.; Noorie, Tabassum; Meunier, Daniele; Woodford, Neil; Patel, Robin

    2013-01-01

    We present a duplex, real-time PCR assay for detection of Klebsiella pneumoniae carbapenemase (blaKPC) and New Delhi metallo-β-lactamase (blaNDM) genes. Accuracy was assessed with 158 Gram-negative bacillary isolates, including 134 carbapenemase producers. The assay had 100% sensitivity and specificity compared with reference methods and a turnaround time of 90 min.

  7. Prevalence of self-medication for skin diseases: a systematic review *

    OpenAIRE

    Corrêa-Fissmer, Mariane; Mendonça, Mariana Gaspar; Martins, Anesio Henrique; Galato, Dayani

    2014-01-01

    Self-medication is the selection and use of drugs without medical prescription, to treat diseases or for symptomatic relief. This article is a systematic review on self-medication in skin diseases. A search was conducted on Virtual Health Library and PubMed databases using predetermined descriptors. Two researchers performed the article selection process independently, with the degree of inter-observer agreement measured by the kappa index. The prevalence of self-medication ranged from 6.0 to...

  8. What do we know about Canadian involvement in medical tourism? A scoping review

    OpenAIRE

    Snyder, J.; Crooks, Valorie; Johnston, R.; Kingsbury, R.

    2011-01-01

    Background: Medical tourism, the intentional pursuit of elective medical treatments in foreign countries, is a rapidly growing global industry. Canadians are among those crossing international borders to seek out privately purchased medical care. Given Canada’s universally accessible, single-payer domestic health care system, important implications emerge from Canadians’ private engagement in medical tourism. Methods: A scoping review was conducted of the popular, academic, and business li...

  9. Medication reconciliation and prescribing reviews by pharmacy technicians in a geriatric ward

    OpenAIRE

    Buck, Thomas Croft; Gronkjaer, Louise Smed; Duckert, Marie-Louise; Rosholm, Jens-Ulrik; Aagaard, Lise

    2013-01-01

    Objective: Incomplete medication histories obtained on hospital admission are responsible for more than 25% of prescribing errors. This study aimed to evaluate whether pharmacy technicians can assist hospital physicians’ in obtaining medication histories by performing medication reconciliation and prescribing reviews. A secondary aim was to evaluate whether the interventions made by pharmacy technicians could reduce the time spent by the nurses on administration of medications to the patients...

  10. Checklists in Neurosurgery to Decrease Preventable Medical Errors: A Review.

    Science.gov (United States)

    Enchev, Yavor

    2015-10-01

    Neurosurgery represents a zero tolerance environment for medical errors, especially preventable ones like all types of wrong site surgery, complications due to the incorrect positioning of patients for neurosurgical interventions and complications due to failure of the devices required for the specific procedure. Following the excellent and encouraging results of the safety checklists in intensive care medicine and in other surgical areas, the checklist was naturally introduced in neurosurgery. To date, the reported world experience with neurosurgical checklists is limited to 15 series with fewer than 20,000 cases in various neurosurgical areas. The purpose of this review was to study the reported neurosurgical checklists according to the following parameters: year of publication; country of origin; area of neurosurgery; type of neurosurgical procedure-elective or emergency; person in charge of the checklist completion; participants involved in completion; whether they prevented incorrect site surgery; whether they prevented complications due to incorrect positioning of the patients for neurosurgical interventions; whether they prevented complications due to failure of the devices required for the specific procedure; their specific aims; educational preparation and training; the time needed for checklist completion; study duration and phases; number of cases included; barriers to implementation; efforts to implementation; team appreciation; and safety outcomes. Based on this analysis, it could be concluded that neurosurgical checklists represent an efficient, reliable, cost-effective and time-saving tool for increasing patient safety and elevating the neurosurgeons' self-confidence. Every neurosurgical department must develop its own neurosurgical checklist or adopt and modify an existing one according to its specific features and needs in an attempt to establish or develop its safety culture. The world, continental, regional and national neurosurgical societies

  11. Increasing secondary bacterial infections with Enterobacteriaceae harboring blaCTX-M-15 and blaCMY-6 in patients with bronchogenic carcinoma:an emerging point of concern

    Institute of Scientific and Technical Information of China (English)

    Mohammed Shahid; Abida Malik; Rakesh Bhargava

    2011-01-01

    Objective: To look for secondary bacterial infections in bronchogenic carcinoma (BCA) with resistant organisms harboring bla genes considering the paucity of relevant studies. Methods:A total of 137 confirmed cases of BCA and 34 healthy volunteers were studied for the occurrence and prevalence of blaCTX-M and and blaAmpC harboring-enterobacteriaceae. A subset of these patients (n=69) was previously reported for the secondary infection with the Aspergillus species. Bronchoalveolar lavages (BAL) were subjected for bacterial and fungal cultures and the bacterial isolates were screened by multiplex PCRs for the presence of blaCTX-M and blaAmpC. The isolates were also screened for the association of insertion sequence (IS26) by PCR and characterized by RAPD for any clonal relatedness. Results: A total of 143 bacterial isolates were obtained from 137 BAL specimens of BCA patients. The Enterobacteriaceae-isolates were multidrug-resistant showing concomitant resistance to fluoroquinolones and aminoglycosides. Both blaCTX-M and blaAmpC of CIT family were detected in 77.4% and 27.4% isolates, respectively. Sequencing revealed the presence of blaCTX-M-15 and blaCMY-6. Twenty one percent of the isolates were simultaneously harboring blaampC and blaCTX-M-15. IS26 PCR and RAPD typing revealed the presence of diverse bacterial population but no predominant clone was identified. The present study also suggests strong association of aspergillosis with lung cancer and further strengthens the potential use of non-validated serological tests suggested earlier. Conclusions: We emphasize that all patients of bronchogenic carcinoma should also be screened for secondary bacterial infections, along with secondary fungal infections, so as to introduce early and specific antimicrobial therapy and to prevent unwanted deaths.

  12. Spread of Enterobacter cloacae carrying blaNDM-1, blaCTX-M-15, blaSHV-12 and plasmid-mediated quinolone resistance genes in a surgical intensive care unit in Croatia.

    Science.gov (United States)

    Petrosillo, N; Vranić-Ladavac, M; Feudi, C; Villa, L; Fortini, D; Barišić, N; Bedenić, B; Ladavac, R; D'Arezzo, S; Andrašević, A Tambić; Capone, A

    2016-03-01

    The objective of this study was to describe a hospital cluster of NDM-1-producing Enterobacter cloacae infections observed in the surgical intensive care unit (ICU) of a tertiary-care hospital at Pula, Croatia. NDM-1-producing E. cloacae strains isolated from clinical samples were screened by PCR for the presence of carbapenemases. Genetic relatedness of NDM-1-producing E. cloacae strains was determined by multilocus sequence typing (MLST). During the period October 2013 to April 2014, four patients, with overlapping hospital stay in the surgical ICU, developed severe infections caused by E. cloacae demonstrated to produce carbapenemases. According to MLST, all strains belonged to ST133 and were positive by PCR for the blaNDM-1 carbapenemase gene, for blaCTX-M-15 and blaSHV-12 extended-spectrum β-lactamase (ESBL) genes, and for blaTEM-1 and blaOXA-1 narrow-spectrum β-lactamase genes. They were negative for other carbapenemases genes including blaOXA-48, blaVIM and blaKPC as well as for AmpC and the armA and rmtB aminoglycoside resistance genes. All strains were positive for the HI2 replicon, suggesting that an IncHI2 plasmid is likely the plasmid carrying the blaNDM-1 gene. Infection control measures were implemented after the first case although they were not effective in avoiding spread of this organism to other patients in the surgical ICU. In conclusion, the evolving epidemiology of NDM-producing micro-organisms and the interspecies diffusion of this resistance mechanism to emerging pathogens such as E. cloacae necessitate the setting up of strong and urgent joint measures to control the spread of NDM carbapenemase especially in the ICU setting. PMID:27436392

  13. Factors associated with dropping out of medical school: a literature review

    DEFF Research Database (Denmark)

    O'Neill, Lotte Dyhrberg

    2010-01-01

    of Aarhus; Jan Hartvigsen, PhD, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark.   Title: Factors associated with dropping out of medical school: a literature review.      Background: Considerable resources are spent on medical school selection and the...... competition for places is usually fierce. Dropping out must therefore be the worst possible performance outcome in medical education. What do we know about factors associated with dropping out of medical school? Summary of work: A systematic critical literature review of the international peer......-reviewed research literature on medical education is ongoing. Inclusion criteria are: Study population=medical students, outcome=dropout, follow up period=minimum 1 year, study designs=cohort/case-control/experimental. An experienced research librarian performed a primary search of the databases PubMed, ERIC, Psyc...

  14. Personality and Medical Specialty Choice: A Literature Review and Integration.

    Science.gov (United States)

    Borges, Nicole J.; Savickas, Mark L.

    2002-01-01

    Synthesizes studies categorized by medical specialties and using the following instruments into the Five Factor Model of personality: Adjective Check List, California Psychological Inventory, 16 Personality Factor Questionnaire, and Myers-Briggs Type Indicator. Suggests a loose association between personalty factors and medical specialties and…

  15. Podcasts from the journal Medical Education. Personality factors and medical training: a review of the literature

    OpenAIRE

    Doherty, Eva M; Eva, Kevin

    2011-01-01

    It has been acknowledged that certain personality characteristics influence both medical students’ and doctors’ performance. With regard to medical students, studies have been concerned with the role of personality, and performance indicators such as academic results and clinical competence. Eva Doherty (Director of human factors and patient safety, National Surgical Training Centre, The Royal College of Surgeons in Ireland, Dublin, Ireland) speaks to Kevin Eva, Editor in Chief of Medical Edu...

  16. What attracts medical students towards psychiatry? A review of factors before and during medical school.

    Science.gov (United States)

    Farooq, Kitty; Lydall, Gregory J; Bhugra, Dinesh

    2013-08-01

    Potential psychiatrists decide on their careers before, during or after medical school. This article summarises the literature focusing on the first two groups. Pre-medical school factors associated with choosing psychiatry include gender, academic aptitude, ethnicity and migration, exposure to mental illness, economic considerations and medical school route and selection. Factors involved in influencing career choice at medical school level include attitudes towards psychiatry, teaching methods, quality and length of clinical exposure, electives and enrichment activities, and personality factors. Considering these factors may improve recruitment to psychiatry and address shortages in the speciality. PMID:24032490

  17. Review of existing issues, ethics and practices in general medical research and in radiation protection research

    International Nuclear Information System (INIS)

    A literature review was carried out in relation to general medical research and radiation protection research. A large number of documents were found concerning the subject of ethics in general medical research. For radiation protection research, the number of documents and the information available is very limited. A review of practices in 13 European countries concerning general medical research and radiation protection research was carried out by sending a questionnaire to each country. It was found that all countries reviewed were well regulated for general medical research. For research that involves ionising radiation, the UK and Ireland are by far the most regulated countries. For other countries, there does not seem to be much information available. From the literature review and the review of practices, a number of existing ethical issues were identified and exposed, and a number of conclusions were drawn. (authors)

  18. Transcriptional Analysis of the blaCTX-M-2 Gene in Salmonella enterica Serovar Infantis

    OpenAIRE

    Di Conza, José A.; Gutkind, Gabriel O.; Mollerach, Marta E.; Ayala, Juan A.

    2005-01-01

    Transcriptional organization of blaCTX-M-2 present in a multiresistance plasmid of Salmonella enterica serovar Infantis suggests the presence of more than one promoter involved in the expression of the β-lactamase gene. At least two blaCTX-M-2-specific mRNAs (near to 1 kb and 5 kb) were evidenced. Two +1 signals were detected at −22 bp and −59 bp of blaCTX-M-2 defining two putative promoters.

  19. Predictors of Self-Medication Behavior: A Systematic Review

    OpenAIRE

    Abdolreza Shaghaghi; Marzieh Asadi; Hamid Allahverdipour

    2014-01-01

    Abstract Background Self-medication with over the counter (OTC) and non OTC drugs may provoke serious consequences for users and societies. Recognition of its predictors therefore, is pivotal in plans to hinder the aggregating behavior. This study aimed to identify possibly all predictors of self-medication and the range of its prevalence among different populations. Methods Medline, Amed, Scopus, Medlib, SID, Pub Med, Science Direct, and super searcher of Google Scholar were scrutinized usin...

  20. The need for general medical services: a literature review

    OpenAIRE

    Roy Carr-Hill

    1999-01-01

    General Medical Services (GMS) are provided mainly through Family Practices, on a demand led basis: that is, there is no cash limit expect for certain specified selected services such as Practice Nurses etc. Nevertheless, since 1948, the Medical Practices Committee (MPC) have influenced the delivery of GMS through a system of allowances for areas designated as under-doctored; and, of course, there are deprivation payments (mostly in urban areas) and the rural practice allowance. However, ther...

  1. Ethylene oxide sterilization of medical devices: a review

    OpenAIRE

    Mendes, Gisela C. C.; Brandão, Teresa R. S.; Cristina L.M. Silva

    2007-01-01

    Ethylene oxide (EO) is a well-known sterilizing agent. However, only recently has its use significantly emerged, based on its range of applications in the field of new medical device development and sterilization. This paper describes the progress in terms of EO sterilization and concludes that it remains a promising field to explore and develop. The EO action mechanism and toxicity are analyzed, and a critical analysis is made on how it is possible to use EO sterilization for medical devices...

  2. Noncompliance to medication in psychiatric patients : a literature review

    OpenAIRE

    Mibei, Felix

    2013-01-01

    One in four people globally will be affected by mental disorders at some point in their life. Currently approximately 450 million people worldwide suffer from this conditions. The aim of this project is to produce evidence based knowledge for nursing students and practicing nurses in the specialty of mental health about the reasons of noncompliance to medication in psychiatric patients. What are the main reasons for noncompliance to medication in psychiatric patients?. Methods, this...

  3. Investigation of diversity of plasmids carrying the blaTEM-52 gene

    DEFF Research Database (Denmark)

    Bielak, Eliza Maria; Bergenholtz, Rikke D.; Jørgensen, Mikael Skaanning; Sørensen, Søren J.; Hansen, Lars H.; Hasman, Henrik

    2011-01-01

    OBJECTIVES: To investigate the diversity of plasmids that carry blaTEM-52 genes among Escherichia coli and Salmonella enterica originating from animals, meat products and humans. METHODS: A collection of 22 blaTEM-52-encoding plasmids was characterized by restriction fragment length polymorphism...... demonstrated dissemination of blaTEM-52 in Denmark (imported meat from Germany), France, Belgium and the Netherlands from 2000 to 2006 by mainly two different plasmids, one encoding blaTEM-52b (IncX1A, 45 kb) and the other blaTEM-52c (IncI1, 80 kb). In addition, blaTEM-52b was also found to be located on...... various other plasmids belonging to IncA/C and IncL/M, while blaTEM-52c was found on IncN-like as well as on IncR plasmids. In the majority of cases (n = 21) the blaTEM-52 gene was located on a Tn3 transposon. Seven out of 10 blaTEM-52 plasmids tested in conjugation experiments were shown to be capable of...

  4. Peer review and refereeing in medicine and medical sciences

    OpenAIRE

    Ajao Oluwole

    1997-01-01

    Every academic scientist will come into contact with peer review process either as a reviewer of others work, or as an author whose work is being reviewed by others, or as an applicant for research grant. Historically, peer review process came at various times to various journals for a variety of reasons in haphazard manner. Many forms of criticisms have been made against the process of peer review, and some critics do not believe that the process prevents the publication of flawed articles a...

  5. Complete sequencing of an IncX3 plasmid carrying blaNDM-5 allele reveals an early stage in the dissemination of the blaNDM gene

    Directory of Open Access Journals (Sweden)

    M Krishnaraju

    2015-01-01

    Full Text Available Purpose: The aim of the present study was to perform molecular characterisation of the blaNDM plasmids and to understand the mechanism of its spread among pathogenic bacteria. Materials and Methods: Seventy-six non-repetitive carbapenem-resistant isolates which were collected during Nov 2011 to April 2013 from four hospitals in Chennai were analyzed for the presence of the blaNDM gene by PCR. Further, the genetic context of the blaNDM gene was analyzed by PCR specific to ISAba125 and bleMBL gene. One of the blaNDM plasmid was completely sequenced in the Illumina HiSeq platform. Results: Twenty-three isolates consisting of 8 Escherichia coli, 8 Klebsiella pneumoniae, 3 Klebsiella oxytoca, 3 Acinetobacter baumanii and 1 Pseudomonas aeruginosa were found to carry the blaNDM gene. In 18 isolates the blaNDM gene was associated with a bleMBL gene and the ISAba125 element. The complete sequencing of pNDM-MGR194 revealed an IncX3 replication type plasmid, with a length of 46,253 bp, an average GC content of 47% and 59 putative ORFs. The iteron region contained the blaNDM5 gene and the bleMBL , trpF and dsbC genes downstream and an IS5 inserted within the ISAba125 element upstream. Conclusion: This is the first report where the blaNDM gene insertion in a plasmid is not accompanied by other resistance gene determinants. These observations suggest that the IncX3 plasmid pNDM-MGR194 is an early stage in the dissemination of the blaNDM .

  6. blaCTX-M,blaTEM, andblaSHV inEnterobacteriaceae from North-Indian tertiary hospital:high occurrence of combination genes

    Institute of Scientific and Technical Information of China (English)

    Mohammed Shahid; Anuradha Singh; Farrukh Sobia; Mohammad Rashid; Abida Malik; Indu Shukla; Haris Manzoor Khan

    2011-01-01

    Objective:To delineate the frequency of occurrence ofblaCTX-M,blaTEM, andblaSHV in Enterobacteriaceae from North-Indian tertiary hospital.Methods: A random collection of a subset of45Escherichia coli (E. coli) and28Klebsiella pneumoniae (K. pneumoniae) that was resistant to a third generation cephalosporin and obtained during2007-2008 was selected for detailed screening forblaCTX-M,blaTEM, andblaSHV by monoplexPCRs. The isolates demonstrating the presence of blaCTX-M alleles were characterized for the specificCTX-M-genogroup by using a multiplexPCR.Results:Resistance to cefoperazone, ceftazidime, ceftriaxone, cefotaxime, cefoxitin and piperacillin was 100% each inK. pneumoniae isolates, whereas these resistance-rates forE. coli isolates were93.1%, 83.8%, 91.9%, 93.6%, 97.3% and97.1%, respectively. Concomitant resistance to aminoglycosides, quinolones and aztreonam was also noticed. Presence of any of the bla genes (blaCTX-M,blaTEM, andblaSHV) was noticed in a total of28 (38.4%) isolates of the73isolates studied. Many isolates demonstrated occurrence of these genes in various combinations.blaCTX-M,blaTEM, andblaSHV were noticed in 28.8%,10.9% and13.7% isolates, respectively. MultiplexPCR inblaCTX-Mharboring isolates demonstrated the presence ofCTX-M-Genogroup-1 and sequencing for the specificCTX-M-type revealed presence ofCTX-M-15 type. RAPD typing showed wide diversity in isolates.Conclusions:This is amongst the premier report describing the simultaneous occurrence ofblaTEM,blaSHV, andblaampC in IndianEnterobacteriaceae and that wider dissemination of these genes, as demonstrated by diversity of isolates, raises concern and emphasizes a need for extensive search for the presence of these gene pools in Indian subcontinent.

  7. A systematic guide for peer reviewers for a medical journal.

    Science.gov (United States)

    Garfield, Joseph M; Kaye, Alan David; Kolinsky, Daniel C; Urman, Richard D

    2015-01-01

    Performing a peer review of an article under consideration for publication requires not only an understanding of the subject matter, but also a systematic approach that includes screening for conflicts of interest; determining whether the manuscript is within or outside the reviewer's area of expertise; properly classifying the manuscript; and writing a detailed, organized review. Although some journals may provide guidelines for the reviewers, the guidelines usually are not detailed and do not take into consideration the variability in reviewer experience. This article is meant to serve as a guideline for peer reviewers and provide concrete information on how to write a comprehensive, unbiased review that will serve both the author and the journal well. PMID:26062311

  8. Medication reconciliation and prescribing reviews by pharmacy technicians in a geriatric ward

    DEFF Research Database (Denmark)

    Buck, Thomas Croft; Gronkjaer, Louise Smed; Duckert, Marie-Louise;

    2013-01-01

    OBJECTIVE: Incomplete medication histories obtained on hospital admission are responsible for more than 25% of prescribing errors. This study aimed to evaluate whether pharmacy technicians can assist hospital physicians' in obtaining medication histories by performing medication reconciliation...... and prescribing reviews. A secondary aim was to evaluate whether the interventions made by pharmacy technicians could reduce the time spent by the nurses on administration of medications to the patients. METHODS: This observational study was conducted over a 7 week period in the geriatric ward at Odense...... University Hospital, Denmark. Two pharmacy technicians conducted medication reconciliation and prescribing reviews at the time of patients' admission to the ward. The reviews were conducted according to standard operating procedures developed by a clinical pharmacist and approved by the Head of the Geriatric...

  9. ERISA preemption. Colleton Regional Hospital v. MRS Medical Review Systems Inc.

    Science.gov (United States)

    1997-01-01

    ERISA preempts state law claims brought by hospitals against medical utilization review firm including claims of tortious interference with contracts, defamation, unfair trade practices, bad faith refusal to pay claims and improper claims practices. PMID:10184694

  10. Evaluating the effectiveness of clinical medical librarian programs: a systematic review of the literature*

    OpenAIRE

    Wagner, Kay Cimpl; Byrd, Gary D.

    2004-01-01

    Objective: This study was undertaken to determine if a systematic review of the evidence from thirty years of literature evaluating clinical medical librarian (CML) programs could help clarify the effectiveness of this outreach service model.

  11. Comprehensive Medical Management of Rosacea: An Interim Study Report and Literature Review

    OpenAIRE

    Del Rosso, James Q.; Baum, Eric W.

    2008-01-01

    Rosacea is a common inflammatory facial dermatosis seen in adults that exhibits considerable variety in clinical presentation. Multiple medical therapeutic options are available including topical and oral treatments. Optimal medical management of rosacea includes assessment of subtype and disease severity and use of appropriate skin care to reduce epidermal barrier dysfunction. This article provides an overall discussion of the medical management of rosacea and reviews interim results from a ...

  12. Perceptions of preparedness for the first medical clerkship: a systematic review and synthesis

    OpenAIRE

    Surmon, Laura; Bialocerkowski, Andrea; Hu, Wendy

    2016-01-01

    Background The transition from university-based to clerkship-based education can be challenging. Medical schools have introduced strategies to ease the transition, but there has been no systematic review synthesizing the evidence on the perceptions of preparedness of medical students for their first clerkship to support these interventions. This study therefore aimed to (1) identify and synthesize the published evidence on medical students’ perceptions of preparedness for their first clerkshi...

  13. Medication adherence: a review of pharmacy education, research, practice and policy in Finland

    OpenAIRE

    Bell JS; Enlund H; Vainio K

    2010-01-01

    Aims: To describe pharmacy education, research, practice and policy related to medication adherence in Finland since the year 2000.Methods: The three universities that provide pharmacy education (Åbo Akademi, University of Eastern Finland, and University of Helsinki) completed a structured pro-forma questionnaire regarding education related to medication adherence. A MEDLINE and EMBASE literature search was performed to identify English language peer-reviewed research that reported medication...

  14. A Systematic Literature Review: Workplace Violence Against Emergency Medical Services Personnel

    OpenAIRE

    Pourshaikhian; Abolghasem Gorji; Aryankhesal; Khorasani-Zavareh; Barati

    2016-01-01

    Context In spite of the high prevalence and consequences of much workplace violence against emergency medical services personnel, this phenomenon has been given insufficient attention. A systematic review can aid the development of guidelines to reduce violence. Objectives The research question addressed by this paper is, “What are the characteristics and findings of studies on workplace violence against emergency medical services...

  15. 78 FR 50136 - Notice of Information Collection Under Emergency Review: Medical History and Examination for...

    Science.gov (United States)

    2013-08-16

    ... of Information Collection Under Emergency Review: Medical History and Examination for Foreign Service... submit comments by any of the following methods: Web: Persons with access to the Internet may use the... of Information Collection: Medical History and Examination for Foreign Service. OMB Control...

  16. Prevention of Medical Events During Air Travel: A Narrative Review.

    Science.gov (United States)

    Naouri, Diane; Lapostolle, Frederic; Rondet, Claire; Ganansia, Olivier; Pateron, Dominique; Yordanov, Youri

    2016-09-01

    Prior to traveling, and when seeking medical pretravel advice, patients consult their personal physicians. Inflight medical issues are estimated to occur up to 350 times per day worldwide (1/14,000-40,000 passengers). Specific characteristics of the air cabin environment are associated with hypoxia and the expansion of trapped gases into body cavities, which can lead to harm. The most frequent medical events during air travel include abdominal pain; ear, nose, and throat pathologies; psychiatric disorders; and life-threatening events such as acute respiratory failure or cardiac arrest. Physicians need to be aware of the management of these conditions in this unusual setting. Chronic respiratory and cardiovascular diseases are common and are at increased risk of acute exacerbation. Physicians must be trained in these conditions and inform their patients about their prevention. PMID:27267286

  17. Utilisation of helicopter emergency medical services in the early medical response to major incidents: a systematic literature review

    Science.gov (United States)

    Johnsen, Anne Siri; Fattah, Sabina; Sollid, Stephen J M; Rehn, Marius

    2016-01-01

    Objective This systematic review identifies, describes and appraises the literature describing the utilisation of helicopter emergency medical services (HEMS) in the early medical response to major incidents. Setting Early prehospital phase of a major incident. Design Systematic literature review performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Web of Science, PsycINFO, Scopus, Cinahl, Bibsys Ask, Norart, Svemed and UpToDate were searched using phrases that combined HEMS and ‘major incidents’ to identify when and how HEMS was utilised. The identified studies were subjected to data extraction and appraisal. Results The database search identified 4948 articles. Based on the title and abstract, the full text of 96 articles was obtained; of these, 37 articles were included in the review, and an additional five were identified by searching the reference lists of the 37 articles. HEMS was used to transport medical and rescue personnel to the incident and to transport patients to the hospital, especially when the infrastructure was damaged. Insufficient air traffic control, weather conditions, inadequate landing sites and failing communication were described as challenging in some incidents. Conclusions HEMS was used mainly for patient treatment and to transport patients, personnel and equipment in the early medical management of major incidents, but the optimal utilisation of this specialised resource remains unclear. This review identified operational areas with improvement potential. A lack of systematic indexing, heterogeneous data reporting and weak methodological design, complicated the identification and comparison of incidents, and more systematic reporting is needed. Trial registration number CRD42013004473. PMID:26861938

  18. Recruiting for health, medical or psychosocial research using Facebook: Systematic review

    OpenAIRE

    Louise Thornton; Batterham, Philip J; Daniel B. Fassnacht; Frances Kay-Lambkin; Calear, Alison L; Sally Hunt

    2016-01-01

    Recruiting participants is a challenge for many health, medical and psychosocial research projects. One tool more frequently being used to improve recruitment is the social networking website Facebook. A systematic review was conducted to identify studies that have used Facebook to recruit participants of all ages, to any psychosocial, health or medical research. 110 unique studies that used Facebook as a recruitment source were included in the review. The majority of studies used a cross-sec...

  19. Temporal reasoning with medical data--a review with emphasis on medical natural language processing.

    Science.gov (United States)

    Zhou, Li; Hripcsak, George

    2007-04-01

    Temporal information is crucial in electronic medical records and biomedical information systems. Processing temporal information in medical narrative data is a very challenging area. It lies at the intersection of temporal representation and reasoning (TRR) in artificial intelligence and medical natural language processing (MLP). Some fundamental concepts and important issues in relation to TRR have previously been discussed, mainly in the context of processing structured data in biomedical informatics; however, it is important that these concepts be re-examined in the context of processing narrative data using MLP. Theoretical and methodological TRR studies in biomedical informatics can be classified into three main categories: category 1 applies theories and models from temporal reasoning in AI; category 2 defines frameworks that meet needs from clinical applications; category 3 resolves issues such as temporal granularity and uncertainty. Currently, most MLP systems are not designed with a formal representation of time, and their ability to reason about temporal relations among medical events is limited. Previous work in processing time with clinical narrative data includes processing time in clinical reports, modeling textual temporal expressions in clinical databases, processing time in clinical guidelines, and building time standards for data exchange and integration. In addition to common problems in MLP, there are challenges specific to TRR in medical text, which occur at each level of linguistic structure and analysis. Despite advances in temporal reasoning in biomedical informatics, processing time in medical text deserves more attention. Besides the need for more research in temporal granularity, fuzzy time, temporal contradiction, intermittent events and uncertainty, broad areas for future research include enhancing functions of current MLP systems on processing temporal information, incorporating medical knowledge into temporal reasoning systems

  20. Strategic Review of Medical Training and Career Structures Report on Medical Career Structures and Pathways following completion of Specialist Training

    OpenAIRE

    Department of Health

    2014-01-01

    The Minister for Health decided, in July 2013, to establish a Working Group, chaired by Professor Brian MacCraith, President of DCU, to carry out a strategic review of medical training and career structure. The Working Group will examine and make high-level recommendations relating to training and career pathways for doctors with a view to: From January-April 2014, the Working Group prioritised work on career structures and pathways following completion of specialist training in order to r...

  1. A review of ion sources for medical accelerators (invited)

    Energy Technology Data Exchange (ETDEWEB)

    Muramatsu, M.; Kitagawa, A. [National Institute of Radiological Sciences (NIRS), 4-9-1 Anagawa, Inage, Chiba 263-8555 (Japan)

    2012-02-15

    There are two major medical applications of ion accelerators. One is a production of short-lived isotopes for radionuclide imaging with positron emission tomography and single photon emission computer tomography. Generally, a combination of a source for negative ions (usually H- and/or D-) and a cyclotron is used; this system is well established and distributed over the world. Other important medical application is charged-particle radiotherapy, where the accelerated ion beam itself is being used for patient treatment. Two distinctly different methods are being applied: either with protons or with heavy-ions (mostly carbon ions). Proton radiotherapy for deep-seated tumors has become widespread since the 1990s. The energy and intensity are typically over 200 MeV and several 10{sup 10} pps, respectively. Cyclotrons as well as synchrotrons are utilized. The ion source for the cyclotron is generally similar to the type for production of radioisotopes. For a synchrotron, one applies a positive ion source in combination with an injector linac. Carbon ion radiotherapy awakens a worldwide interest. About 6000 cancer patients have already been treated with carbon beams from the Heavy Ion Medical Accelerator in Chiba at the National Institute of Radiological Sciences in Japan. These clinical results have clearly verified the advantages of carbon ions. Heidelberg Ion Therapy Center and Gunma University Heavy Ion Medical Center have been successfully launched. Several new facilities are under commissioning or construction. The beam energy is adjusted to the depth of tumors. It is usually between 140 and 430 MeV/u. Although the beam intensity depends on the irradiation method, it is typically several 10{sup 8} or 10{sup 9} pps. Synchrotrons are only utilized for carbon ion radiotherapy. An ECR ion source supplies multi-charged carbon ions for this requirement. Some other medical applications with ion beams attract developer's interests. For example, the several types of

  2. A review of ion sources for medical accelerators (invited).

    Science.gov (United States)

    Muramatsu, M; Kitagawa, A

    2012-02-01

    There are two major medical applications of ion accelerators. One is a production of short-lived isotopes for radionuclide imaging with positron emission tomography and single photon emission computer tomography. Generally, a combination of a source for negative ions (usually H- and/or D-) and a cyclotron is used; this system is well established and distributed over the world. Other important medical application is charged-particle radiotherapy, where the accelerated ion beam itself is being used for patient treatment. Two distinctly different methods are being applied: either with protons or with heavy-ions (mostly carbon ions). Proton radiotherapy for deep-seated tumors has become widespread since the 1990s. The energy and intensity are typically over 200 MeV and several 10(10) pps, respectively. Cyclotrons as well as synchrotrons are utilized. The ion source for the cyclotron is generally similar to the type for production of radioisotopes. For a synchrotron, one applies a positive ion source in combination with an injector linac. Carbon ion radiotherapy awakens a worldwide interest. About 6000 cancer patients have already been treated with carbon beams from the Heavy Ion Medical Accelerator in Chiba at the National Institute of Radiological Sciences in Japan. These clinical results have clearly verified the advantages of carbon ions. Heidelberg Ion Therapy Center and Gunma University Heavy Ion Medical Center have been successfully launched. Several new facilities are under commissioning or construction. The beam energy is adjusted to the depth of tumors. It is usually between 140 and 430 MeV∕u. Although the beam intensity depends on the irradiation method, it is typically several 10(8) or 10(9) pps. Synchrotrons are only utilized for carbon ion radiotherapy. An ECR ion source supplies multi-charged carbon ions for this requirement. Some other medical applications with ion beams attract developer's interests. For example, the several types of accelerators are

  3. ISEcp1B-Mediated Transposition of blaCTX-M in Escherichia coli

    OpenAIRE

    Poirel, Laurent; Lartigue, Marie-Frédérique; Decousser, Jean-Winoc; Nordmann, Patrice

    2005-01-01

    Several expanded-spectrum β-lactamase blaCTX-M genes are associated with ISEcp1-like elements in Enterobacteriaceae. We found that ISEcp1B was able to mobilize the adjacent blaCTX-M-19 gene by a transpositional mechanism in Escherichia coli by recognizing a variety of DNA sequences as right inverted repeats.

  4. ISEcp1B-Mediated Transposition of blaCTX-M in Escherichia coli

    Science.gov (United States)

    Poirel, Laurent; Lartigue, Marie-Frédérique; Decousser, Jean-Winoc; Nordmann, Patrice

    2005-01-01

    Several expanded-spectrum β-lactamase blaCTX-M genes are associated with ISEcp1-like elements in Enterobacteriaceae. We found that ISEcp1B was able to mobilize the adjacent blaCTX-M-19 gene by a transpositional mechanism in Escherichia coli by recognizing a variety of DNA sequences as right inverted repeats. PMID:15616333

  5. Is video review of patient encounters an effective tool for medical student learning? A review of the literature

    OpenAIRE

    Hammoud MM; Morgan HK; Edwards ME; Lyon JA; White C.

    2012-01-01

    Maya M Hammoud1, Helen K Morgan1, Mary E Edwards2, Jennifer A Lyon2, Casey White31Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA; 2Health Sciences Center Libraries, University of Florida, Gainesville, FL, USA; 3Graduate Medical Education, Faculty Affairs and Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USAPurpose: To determine if video review of student performance during patient encounters is an ...

  6. MEDICATION ADHERENCE IN ELDERLY WITH POLYPHARMACY LIVING AT HOME: A SYSTEMATIC REVIEW OF EXISTING STUDIES

    Science.gov (United States)

    Zelko, Erika; Klemenc-Ketis, Zalika; Tusek-Bunc, Ksenija

    2016-01-01

    Background: We wanted to systematically review the available evidence to evaluate the drug adherence in elderly with polypharmacy living at home. Methods: We performed a literature search using MEDLINE, ISI Web of Science, ProQuest, EMBASE, SCOPUS, Springer Link, Sage Journals and CINAHL. We used the following terms: Medication Adherence, Medication Compliance, Polypharmacy, and Elderly. The search was limited to English-language articles. We included only clinical trials, systematic reviews, meta-analysis and cross-sectional studies. Results: A total of seven articles were included in this systematic review after applying the search strategy. Six studies dealt with the prevalence of medication adherence and its correlates in patients aged 65 years or more with polypharmacy. Two studies dealt with the effect of various interventions on medication adherence in patients aged 65 years or more with polypharmacy. Conclusion: The available literature on the polypharmacy and drug adherence in elderly living at home is scarce and further studies are needed.

  7. Brief review: dangers of the electronic medical record

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2015-04-01

    Full Text Available EMRs represent a potential boon to patient care and providers, but to date that potential has been unfulfilled. Data suggest that in some instances EMRs may even produce adverse outcomes. This result probably has occurred because lack of provider input and familiarity with EMRs resulting in the medical records becoming less a tool for patient care and more of a tool for documentation and reimbursement.

  8. Health economic analyses in medical nutrition: a systematic literature review

    OpenAIRE

    Walzer, Stefan

    2014-01-01

    Stefan Walzer,1,2 Daniel Droeschel,1,3 Mark Nuijten,4 Hélène Chevrou-Séverac5 1MArS Market Access and Pricing Strategy GmbH, Weil am Rhein, Germany; 2State University Baden-Wuerttemberg, Loerrach, Germany; 3Riedlingen University, SRH FernHochschule, Riedlingen, Germany; 4Ars Accessus Medica BV, Amsterdam, the Netherlands, 5Nestlé Health Science, Vevey, Switzerland Background: Medical nutrition is a specific nutrition category either covering specif...

  9. Interventional tools to improve medication adherence: review of literature

    OpenAIRE

    Costa E; Giardini A; Savin M.; Menditto E; Lehane EA; Laosa O; Pecorelli S; Monaco A.; Marengoni A

    2015-01-01

    Elísio Costa,1 Anna Giardini,2 Magda Savin,3 Enrica Menditto,4 Elaine Lehane,5 Olga Laosa,6 Sergio Pecorelli,7,8 Alessandro Monaco,7 Alessandra Marengoni9On behalf of the A1 Action group “Prescription and Adherence to Medical Plans”, European Innovation Partnership on Active and Healthy Ageing1UCIBIO, REQUIMTE, Faculty of Pharmacy, University of Porto, Porto, Portugal; 2Psychology Unit, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Montescano (PV), Pavia, Ita...

  10. Interventional tools to improve medication adherence: review of literature

    OpenAIRE

    Costa, Elisio

    2015-01-01

    Elísio Costa,1 Anna Giardini,2 Magda Savin,3 Enrica Menditto,4 Elaine Lehane,5 Olga Laosa,6 Sergio Pecorelli,7,8 Alessandro Monaco,7 Alessandra Marengoni9On behalf of the A1 Action group “Prescription and Adherence to Medical Plans”, European Innovation Partnership on Active and Healthy Ageing1UCIBIO, REQUIMTE, Faculty of Pharmacy, University of Porto, Porto, Portugal; 2Psychology Unit, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Montescano (PV)...

  11. A review of RSICC software for medical and health physics

    International Nuclear Information System (INIS)

    RSICC (Radiation Safety Information Computational Center) collects, organizes, evaluates and disseminates technical information (software and nuclear data) involving the transport of neutral and charged particle radiation, and shielding and protection from the radiation associated with: nuclear weapons and materials, fission and fusion reactors, outer space applications, accelerators, medical facilities, and nuclear waste management. The Center provides in-depth coverage of radiation transport topics. An RSICC software package consists of an abstract, source code, sample problem input, sample problem output, documentation, and an executable program.The paper is a synopsis of various computer code and nuclear data packages, maintained, tested and distributed by RSICC,used for medical and health physics dosimetry applications. The codes are classified into 5 categories: 1) radiation transport, shielding, and supporting codes for radiation therapy (12 codes); 2) codes devoted to medical X-ray calculations (6 codes); 3) codes for internal and external dose calculations (4 codes); 4) data collections and supporting codes useful in nuclear medicine (3 codes) and 5) codes and data collections dealing with the microdosimetry of radiation therapy. (A.C.)

  12. Drug-related problems identified in medication reviews by Australian pharmacists

    DEFF Research Database (Denmark)

    Stafford, Andrew C; Tenni, Peter C; Peterson, Gregory M;

    2009-01-01

    OBJECTIVE: In Australia, accredited pharmacists perform medication reviews for patients to identify and resolve drug-related problems. We analysed the drug-related problems identified in reviews for both home-dwelling and residential care-facility patients. The objective of this study was to exam...

  13. Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes

    DEFF Research Database (Denmark)

    Hansen, Trine Graabæk; Kjeldsen, Lene Juel

    2013-01-01

    outcomes vary among studies. Hence, there is a need for compiling the evidence within this area. The aim of this systematic MiniReview was to identify, assess and summarize the literature investigating the effect of pharmacist-led medication reviews in hospitalized patients. Five databases (MEDLINE, EMBASE...

  14. Comparative Analysis of IncHI2 Plasmids Carrying blaCTX-M-2 or blaCTX-M-9 from Escherichia coli and Salmonella enterica Strains Isolated from Poultry and Humans▿

    OpenAIRE

    Fernández, Aurora García; Cloeckaert, Axel; Bertini, Alessia; Praud, Karine; Doublet, Benoît; Weill, François-Xavier; Carattoli, Alessandra

    2007-01-01

    Salmonella enterica blaCTX-M-2 and blaCTX-M-9 plasmid backbones from isolates from Belgium and France were analyzed. The blaCTX-M-2-plasmids from both human and poultry isolates were related to the IncHI2 pAPEC-O1-R plasmid, previously identified in the United States in avian Escherichia coli strains; the blaCTX-M-9 plasmids were closely related to the IncHI2 R478 plasmid.

  15. Standardised assessment of patients' capacity to manage medications: a systematic review of published instruments

    Directory of Open Access Journals (Sweden)

    Elliott Rohan A

    2009-07-01

    Full Text Available Abstract Background Older people are commonly prescribed complex multi-drug regimens while also experiencing declines in the cognitive and physical abilities required for medication management, leading to increased risk of medication errors and need for assisted living. The purpose of this study was to review published instruments designed to assess patients' capacity to self-administer medications. Methods Searches of Medline, EMBASE, CINAHL, PsycINFO, International Pharmaceutical Abstracts, Health and Psychosocial Instruments, Google, and reference lists of identified publications were conducted to identify English-language articles describing development and validation of instruments designed to assess patients' capacity to self-administer medications. Methodological quality of validation studies was rated independently against published criteria by two reviewers and reliability and validity data were reviewed. Results Thirty-two instruments were identified, of which 14 met pre-defined inclusion criteria. Instruments fell into two categories: those that used patients' own medications as the basis for assessment and those that used a simulated medication regimen. The quality of validation studies was generally low to moderate and few instruments were subjected to reliability testing. Most instruments had some evidence of construct validity, through associations with tests of cognitive function, health literacy, activities of daily living or measures of medication management or adherence. Only one instrument had sensitivity and specificity data with respect to prediction of medication-related outcomes such as adherence to therapy. Only three instruments had validity data from more than one independent research group. Conclusion A number of performance-based instruments exist to assess patients' capacity to manage their own medications. These may be useful for identifying physical and cognitive barriers to successful medication management, but

  16. 78 FR 5558 - Medical Review Board Public Meeting

    Science.gov (United States)

    2013-01-25

    ... held at the Hilton Alexandria Old Town, 1767 King Street, Alexandria, VA 22314 in Salon BC on the main floor. The Hilton Alexandria Old Town is located across the street from the King Street Metro station... Federal Register (70 FR 57642, October 3, 2005). The MRB is charged initially with the review of...

  17. 76 FR 27375 - Medical Review Board Public Meeting

    Science.gov (United States)

    2011-05-11

    ..., business, labor union, etc.). You may review the U.S. Department of Transportation's complete Privacy Act... Street, Alexandria, VA 22314. You may submit comments identified by DOT Docket Management System (DMS.... Mail: Docket Management Facility; U.S. Department of Transportation, 1200 New Jersey Avenue, SE.,...

  18. Educational strategies aimed at improving student nurse's medication calculation skills: a review of the research literature.

    Science.gov (United States)

    Stolic, Snezana

    2014-09-01

    Medication administration is an important and essential nursing function with the potential for dangerous consequences if errors occur. Not only must nurses understand the use and outcomes of administering medications they must be able to calculate correct dosages. Medication administration and dosage calculation education occurs across the undergraduate program for student nurses. Research highlights inconsistencies in the approaches used by academics to enhance the student nurse's medication calculation abilities. The aim of this integrative review was to examine the literature available on effective education strategies for undergraduate student nurses on medication dosage calculations. A literature search of five health care databases: Sciencedirect, Cinahl, Pubmed, Proquest, Medline to identify journal articles between 1990 and 2012 was conducted. Research articles on medication calculation educational strategies were considered for inclusion in this review. The search yielded 266 papers of which 20 meet the inclusion criteria. A total of 5206 student nurse were included in the final review. The review revealed educational strategies fell into four types of strategies; traditional pedagogy, technology, psychomotor skills and blended learning. The results suggested student nurses showed some benefit from the different strategies; however more improvements could be made. More rigorous research into this area is needed. PMID:25001180

  19. Adult learning theories and medical education : a review

    OpenAIRE

    Abela, Jurgen C.

    2009-01-01

    Adult learning theories describe ways in which adults assimilate knowledge, skills and attitudes. One popular theory is andragogy. This is analysed in detail in this review. The importance of extrinsic motivation and reflective practice in adult learning is highlighted, particularly since andragogy fails to address adequately these issues. Transformative Learning is put forward as an alternative concept. Using the three recognised domains of knowledge, skills and attitudes, ways of applying t...

  20. A Review of Wireless Body Area Networks for Medical Applications

    OpenAIRE

    2010-01-01

    Recent advances in Micro-Electro-Mechanical Systems (MEMS) technology, integrated circuits, and wireless communication have allowed the realization of Wireless Body Area Networks (WBANs). WBANs promise unobtrusive ambulatory health monitoring for a long period of time and provide real-time updates of the patient's status to the physician. They are widely used for ubiquitous healthcare, entertainment, and military applications. This paper reviews the key aspects of WBANs for numerous applicati...

  1. Quality of Pharmaceutical Advertisements in Medical Journals: A Systematic Review

    OpenAIRE

    Othman, Noordin; Vitry, Agnes; Roughead, Elizabeth E.

    2009-01-01

    Background Journal advertising is one of the main sources of medicines information to doctors. Despite the availability of regulations and controls of drug promotion worldwide, information on medicines provided in journal advertising has been criticized in several studies for being of poor quality. However, no attempt has been made to systematically summarise this body of research. We designed this systematic review to assess all studies that have examined the quality of pharmaceutical advert...

  2. Isotopes in medical diagnosis. New techniques reviewed at Vienna symposium

    International Nuclear Information System (INIS)

    The medical uses of radioisotopes cover diagnosis and therapy as well as clinical research. There is specialized equipment not only detects the radiations from a radioactive substance inside the body, but also produces a two-dimensional visual image of the size and functional condition of tissue that absorbs this substance. This is known as medical radioisotope scanning, aimed at determining the distribution of a radioisotope within an organ which specifically concentrates a radioisotope. Methods of scanning are exceedingly complex, and although a variety of equipment is now available for the automatic determination of the distribution of a radioisotope in an organ, experience of their use is still limited. To facilitate an adequate exchange of views and a pooling of experience in this field, the International Atomic Energy Agency and the World Health Organization recently arranged a seminar to discuss the techniques and results of scanning. Topics discussed included problems of collimation, sensitivity patterns of various collimating systems, optimum isotope concentrations, essential requirements for obtaining satisfactory visualization by a scanner, basic principles of scintillation counting, a the scintillation camera, isotope scanning for studies on liver disorders and liver tumours, radiogold used for liver scanning, scanning the liver and pancreas with the help of positron-emitting isotopes, measuring the distribution of radioisotopes in deep lying tissues by detection of 'bremsstrahlen', 'profile counting', brain tumour scanning with the usage of radioarsenic or radioiodine-labelled albumen, different aspects of thyroid scanning, value and methods of scanning in thyroid cancer as well as scanning procedures in non-cancerous thyroid disease. During the discussions Dr. Keroe (IAEA) demonstrated a new electronic device, the use of which results in a substantial increase of contrast and resolution of the recordings of a scanning machine, and which is the first

  3. Review Article: Medical, surgical and radiological management of perianal Crohn's fistulas

    OpenAIRE

    Tozer, Phil; Burling, David; Gupta, Arun; Phillips, Robin K.; Hart, Ailsa

    2010-01-01

    Abstract Background Crohn?s anal fistulas are common and cause considerable morbidity. Their management is often difficult; medical and surgical treatments rarely lead to true healing with frequent recurrence and complications. Aim In this review, we examine medical treatments previously and currently used, surgical techniques and the important role of optimal imaging. Methods We conducted a literature search in the Pub Med database using Crohn?s, Anal Fistula, ...

  4. The relationship between academic assessment and psychological distress among medical students: a systematic review

    OpenAIRE

    Lyndon, Mataroria P.; Strom, Joanna M.; Alyami, Hussain M.; Yu, Tzu-Chieh; Wilson, Nichola C; Singh, Primal P; Lemanu, Daniel P; Yielder, Jill; Hill, Andrew G.

    2014-01-01

    A systematic review was conducted to determine the relationship between academic assessment and medical student psychological distress with the aim of informing assessment practices. A systematic literature search of six electronic databases (Medline, Medline IN PROCESS, PubMed, EMBASE, Psychinfo, ERIC) from 1991 to May 2014 was completed. Articles focusing on academic assessment and its relation to stress or anxiety of medical students were included. From 3,986 potential titles, 82 full-text...

  5. The impact of a supplementary medication review and counselling service within the oncology outpatient setting

    OpenAIRE

    Read, H.; Ladds, S; Rhodes, B.; Brown, D.; Portlock, J.

    2007-01-01

    The impact on the care of breast cancer patients, of a pharmacy technician-led medication review and counselling clinic, provided in an outpatient setting, was investigated using a controlled randomised study. Compared to the controls, clinic patients showed a significantly improved level of understanding of their chemotherapy support medication (95% CI for difference in mean knowledge rating scores=2.165–2.826, P

  6. Evaluation in medical education: A topical review of target parameters, data collection tools and confounding factors

    OpenAIRE

    Schiekirka, Sarah; Feufel, Markus A.; Herrmann-Lingen, Christoph; Raupach, Tobias

    2015-01-01

    Background and objective: Evaluation is an integral part of education in German medical schools. According to the quality standards set by the German Society for Evaluation, evaluation tools must provide an accurate and fair appraisal of teaching quality. Thus, data collection tools must be highly reliable and valid. This review summarises the current literature on evaluation of medical education with regard to the possible dimensions of teaching quality, the psychometric properties of survey...

  7. The use of Facebook in medical education – A literature review

    Directory of Open Access Journals (Sweden)

    Pander, Tanja

    2014-08-01

    Full Text Available [english] Background: The vogue of social media has changed interpersonal communication as well as learning and teaching opportunities in medical education. The most popular social media tool is Facebook. Its features provide potentially useful support for the education of medical students but it also means that some new challenges will have to be faced. Aims: This review aimed to find out how Facebook has been integrated into medical education. A systematical review of the current literature and grade of evidence is provided, research gaps are identified, links to prior reviews are drawn and implications for the future are discussed.Method: The authors searched six databases. Inclusion criteria were defined and the authors independently reviewed the search results. The key information of the articles included was methodically abstracted and coded, synthesized and discussed in the categories study design, study participants’phase of medical education and study content.Results: 16 articles met all inclusion criteria. 45-96% of health care professionals in all phases of their medical education have a Facebook profile. Most studies focused on Facebook and digital professionalism. Unprofessional behavior and privacy violations occurred in 0.02% to 16%. In terms of learning and teaching environment, Facebook is well accepted by medical students. It is used to prepare for exams, share online material, discuss clinical cases, organize face-to-face sessions and exchange information on clerkships. A few educational materials to teach Facebook professionalism were positively evaluated. There seems to be no conclusive evidence as to whether medical students benefit from Facebook as a learning environment on higher competence levels.Discussion: Facebook influences a myriad of aspects of health care professionals, particularly at undergraduate and graduate level in medical education. Despite an increasing number of interventions, there is a lack of

  8. Telephone-based motivational interviewing for medication adherence: a systematic review

    OpenAIRE

    Teeter, Benjamin S; Kavookjian, Jan

    2014-01-01

    Adherence to prescribed medications continues to be a problem in the treatment of chronic disease. Motivational interviewing (MI) has been shown to be successful for eliciting patients’ motivations to change their medication-taking behaviors. Due to the constraints of the US healthcare system, patients do not always have in-person access to providers. Because of this, there is increasing use of non-traditional healthcare delivery methods such as telephonic counseling. A systematic review was ...

  9. The Role of Prospective Memory in Medication Adherence: A Review of an Emerging Literature

    OpenAIRE

    Zogg, Jennifer B.; Woods, Steven Paul; Sauceda, John A.; Wiebe, John S.; Simoni, Jane M.

    2011-01-01

    Although neurocognitive impairment is an established risk factor for medication non-adherence, standard neurocognitive tests developed for clinical purposes may not fully capture the complexities of non-adherence behavior or effectively inform theory-driven interventions. Prospective memory, an innovative cognitive construct describing one’s ability to remember to do something at a later time, is an understudied factor in the detection and remediation of medication non-adherence. This review ...

  10. Understanding medical symptoms: a conceptual review and analysis.

    Science.gov (United States)

    Malterud, Kirsti; Guassora, Ann Dorrit; Graungaard, Anette Hauskov; Reventlow, Susanne

    2015-12-01

    The aim of this article is to present a conceptual review and analysis of symptom understanding. Subjective bodily sensations occur abundantly in the normal population and dialogues about symptoms take place in a broad range of contexts, not only in the doctor's office. Our review of symptom understanding proceeds from an initial subliminal awareness by way of attribution of meaning and subsequent management, with and without professional involvement. We introduce theoretical perspectives from phenomenology, semiotics, social interactionism, and discourse analysis. Drew Leder's phenomenological perspectives deal with how symptom perception occurs when any kind of altered balance brings forward a bodily attention. Corporeality is brought to explicit awareness and perceived as sensations. Jesper Hoffmeyer's biosemiotic perspectives provide access to how signs are interpreted to attribute meaning to the bodily messages. Symptom management is then determined by the meaning of a symptom. Dorte E. Gannik's concept "situational disease" explains how situations can be reviewed not just in terms of their potential to produce signs or symptoms, but also in terms of their capacity to contain symptoms. Disease is a social and relational phenomenon of containment, and regulating the situation where the symptoms originate implies adjusting containment. Discourse analysis, as presented by Jonathan Potter and Margaret Wetherell, provides a tool to notice the subtle ways in which language orders perceptions and how language constructs social interaction. Symptoms are situated in culture and context, and trends in modern everyday life modify symptom understanding continuously. Our analysis suggests that a symptom can only be understood by attention to the social context in which the symptom emerges and the dialogue through which it is negotiated. PMID:26597868

  11. Nursing administration of medication via enteral tubes in adults: a systematic review.

    Science.gov (United States)

    Phillips, Nicole M; Nay, Rhonda

    2007-09-01

    Background  Enteral tubes are frequently inserted as part of medical treatment in a wide range of patient situations. Patients with an enteral tube are cared for by nurses in a variety of settings, including general and specialised acute care areas, aged care facilities and at home. Regardless of the setting, nurses have the primary responsibility for administering medication through enteral tubes. Medication administration via an enteral tube is a reasonably common nursing intervention that entails a number of skills, including preparing the medication, verifying the tube position, flushing the tube and assessing for potential complications. If medications are not given effectively through an enteral tube, harmful consequences may result leading to increased morbidity, for example, tube occlusion, diarrhoea and aspiration pneumonia. There are resultant costs for the health-care system related to possible increased length of stay and increased use of equipment. Presently what is considered to be best practice to give medications through enteral tubes is unknown. Objectives  The objective of this systematic review was to determine the best available evidence on which nursing interventions are effective in minimising the complications associated with the administration of medications via enteral tubes in adults. Nursing interventions and considerations related to medication administration included form of medication, verifying tube placement before administration, methods used to give medication, methods used to flush tubes, maintenance of tube patency and specific practices to prevent possible complications related to the administration of enteral medications. Search strategy  The following databases were searched for literature reported in English only: CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO. There was no date restriction applied. In addition, the reference lists of all included

  12. Virtual slides in peer reviewed, open access medical publication

    Directory of Open Access Journals (Sweden)

    Kayser Klaus

    2011-12-01

    Full Text Available Abstract Background Application of virtual slides (VS, the digitalization of complete glass slides, is in its infancy to be implemented in routine diagnostic surgical pathology and to issues that are related to tissue-based diagnosis, such as education and scientific publication. Approach Electronic publication in Pathology offers new features of scientific communication in pathology that cannot be obtained by conventional paper based journals. Most of these features are based upon completely open or partly directed interaction between the reader and the system that distributes the article. One of these interactions can be applied to microscopic images allowing the reader to navigate and magnify the presented images. VS and interactive Virtual Microscopy (VM are a tool to increase the scientific value of microscopic images. Technology and Performance The open access journal Diagnostic Pathology http://www.diagnosticpathology.org has existed for about five years. It is a peer reviewed journal that publishes all types of scientific contributions, including original scientific work, case reports and review articles. In addition to digitized still images the authors of appropriate articles are requested to submit the underlying glass slides to an institution (DiagnomX.eu, and Leica.com for digitalization and documentation. The images are stored in a separate image data bank which is adequately linked to the article. The normal review process is not involved. Both processes (peer review and VS acquisition are performed contemporaneously in order to minimize a potential publication delay. VS are not provided with a DOI index (digital object identifier. The first articles that include VS were published in March 2011. Results and Perspectives Several logistic constraints had to be overcome until the first articles including VS could be published. Step by step an automated acquisition and distribution system had to be implemented to the corresponding

  13. Dosing antiretroviral medication when crossing time zones: a review.

    Science.gov (United States)

    Lewis, Joseph M; Volny-Anne, Alain; Waitt, Catriona; Boffito, Marta; Khoo, Saye

    2016-01-01

    International tourism continues to increase worldwide, and people living with HIV and their clinicians are increasingly confronted with the problem of how to dose antiretroviral therapy during transmeridian air travel across time zones. No guidance on this topic currently exists. This review is a response to requests from patient groups for clear, practical and evidence-based guidance for travelling on antiretroviral therapy; we present currently available data on the pharmacokinetic forgiveness and toxicity of various antiretroviral regimens, and synthesize this data to provide guidelines on how to safely dose antiretrovirals when travelling across time zones. PMID:26684823

  14. A Review of Medication Use as an Indicator of Human Health Impact in Environmentally Stressed Areas.

    Science.gov (United States)

    Hollingworth, Samantha A; Kim, Diane Dabok; Jagals, Paul

    2016-01-01

    We reviewed from literature the feasibility of medication use as an indicator of health outcomes in environmentally stressed areas, especially where a paucity of typical epidemiological and other risk-based data are encountered. The majority of studies reported were about medication use as an indicator of adverse respiratory effects from air pollution in developed countries. Studies to a lesser extent pointed to medication use as indicator of health outcomes associated with other environmental health stressors such as water, noise pollution, and habitat conditions. The relationship between environmental stressors and medication use strongly suggests that medication use could be used to measure the impact of environmental stressors that otherwise could not be measured by epidemiological or other impact assessment studies, typically in settings where morbidity and mortality data might not be not accessible. PMID:27325069

  15. Is video review of patient encounters an effective tool for medical student learning? A review of the literature

    Directory of Open Access Journals (Sweden)

    Hammoud MM

    2012-03-01

    Full Text Available Maya M Hammoud1, Helen K Morgan1, Mary E Edwards2, Jennifer A Lyon2, Casey White31Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA; 2Health Sciences Center Libraries, University of Florida, Gainesville, FL, USA; 3Graduate Medical Education, Faculty Affairs and Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USAPurpose: To determine if video review of student performance during patient encounters is an effective tool for medical student learning.Methods: Multiple bibliographic databases that include medical, general health care, education, psychology, and behavioral science literature were searched for the following terms: medical students, medical education, undergraduate medical education, education, self-assessment, self-evaluation, self-appraisal, feedback, videotape, video recording, televised, and DVD. The authors examined all abstracts resulting from this search and reviewed the full text of the relevant articles as well as additional articles identified in the reference lists of the relevant articles. Studies were classified by year of student (preclinical or clinical and study design (controlled or non-controlled.Results: A total of 67 articles met the final search criteria and were fully reviewed. Most studies were non-controlled and performed in the clinical years. Although the studies were quite variable in quality, design, and outcomes, in general video recording of performance and subsequent review by students with expert feedback had positive outcomes in improving feedback and ultimate performance. Video review with self-assessment alone was not found to be generally effective, but when linked with expert feedback it was superior to traditional feedback alone.Conclusion: There are many methods for integrating effective use of video-captured performance into a program of learning. We recommend combining student self-assessment with feedback

  16. A Review of Wireless Body Area Networks for Medical Applications

    CERN Document Server

    Ullah, Sana; Ullah, Niamat; Saleem, Shahnaz; Higgins, Henry; Kwak, Kyung Sup; 10.4236/ijcns.2009.28093

    2010-01-01

    Recent advances in Micro-Electro-Mechanical Systems (MEMS) technology, integrated circuits, and wire-less communication have allowed the realization of Wireless Body Area Networks (WBANs). WBANs promise unobtrusive ambulatory health monitoring for a long period of time, and provide real-time updates of the patients status to the physician. They are widely used for ubiquitous healthcare, entertainment, and military applications. This paper reviews the key aspects of WBANs for numerous applications. We present a WBAN infrastructure that provides solutions to on-demand, emergency, and normal traffic. We further discuss in-body antenna design and low-power MAC protocol for a WBAN. In addition, we briefly outline some of the WBAN applications with examples. Our discussion realizes a need for new power-efficient solutions towards in-body and on-body sensor networks.

  17. Rapid Detection of blaKPC Carbapenemase Genes by Real-Time PCR▿

    OpenAIRE

    Hindiyeh, Musa; Smollen, Gill; Grossman, Zehava; Ram, Daniela; Davidson, Yehudit; Mileguir, Fernando; Vax, Marina; Ben David, Debbie; Tal, Ilana; Rahav, Galia; Shamiss, Ari; Mendelson, Ella; Keller, Nathan

    2008-01-01

    Carbapenem resistance among Enterobacteriaceae is an emerging problem worldwide. Klebsiella pneumoniae carbapenemase (blaKPC) enzymes are among the most common β-lactamases described. In this study, we report the development and validation of a real-time PCR (q-PCR) assay for the detection of blaKPC genes using TaqMan chemistry. The q-PCR amplification of blaKPC DNA was linear over 7 log dilutions (r2 = 0.999; slope, 3.54), and the amplification efficiency was 91.6%. The q-PCR detection limit...

  18. Prevalence and Cause of Self-Medication in Iran: A Systematic Review and Meta-Analysis Article

    OpenAIRE

    Azami-Aghdash, Saber; Mohseni, Mohammad; Etemadi, Manal; ROYANI, Sanaz; MOOSAVI, Ahmad; Majid NAKHAEE

    2015-01-01

    Background: Nowadays self-medication is one of the most common public health issues in many countries, as well as in Iran. According to need to epidemiological information about self-medication, the aim of this study was to systematic review and meta-analysis of prevalence and cause of self-medication in community setting of Iran.Methods: Required data were collected searching following key words: medication, self-medication, over-the-counter, non-prescription, prevalence, epidemiology, etiol...

  19. Discharge diagnoses versus medical record review in the identification of community-acquired sepsis

    OpenAIRE

    Henry E. Wang; Addis, Dylan R; Donnelly, John P.; Shapiro, Nathan I.; Griffin, Russell L.; Safford, Monika M.; Baddley, John W.

    2015-01-01

    Introduction We evaluated the accuracy of hospital discharge diagnoses in the identification of community-acquired sepsis and severe sepsis. Methods We reviewed 379 serious infection hospitalizations from 2003 to 2012 from the national population-based reasons for geographic and racial differences in stroke (REGARDS) cohort. Through manual review of medical records, we defined criterion-standard community-acquired sepsis events as the presence of a serious infection on hospital presentation w...

  20. Review of cases of nosocomial Lassa fever in Nigeria: the high price of poor medical practice.

    OpenAIRE

    Fisher-Hoch, S P; Tomori, O.; Nasidi, A; Perez-Oronoz, G. I.; Fakile, Y.; Hutwagner, L.; McCormick, J. B.

    1995-01-01

    OBJECTIVE--To investigate two hospital outbreaks of Lassa fever in southern central Nigeria. SETTING--Hospitals and clinics in urban and rural areas of Imo State, Nigeria. DESIGN--Medical records were reviewed in hospitals and clinics in both areas. Patients with presumed and laboratory confirmed Lassa fever were identified and contracts traced. Hospital staff, patients, and local residents were questioned, records were carefully reviewed, and serum samples were taken. Serum samples were assa...

  1. Do calculation errors by nurses cause medication errors in clinical practice? A literature review.

    Science.gov (United States)

    Wright, Kerri

    2010-01-01

    This review aims to examine the literature available to ascertain whether medication errors in clinical practice are the result of nurses' miscalculating drug dosages. The research studies highlighting poor calculation skills of nurses and student nurses have been tested using written drug calculation tests in formal classroom settings [Kapborg, I., 1994. Calculation and administration of drug dosage by Swedish nurses, student nurses and physicians. International Journal for Quality in Health Care 6(4): 389 -395; Hutton, M., 1998. Nursing Mathematics: the importance of application Nursing Standard 13(11): 35-38; Weeks, K., Lynne, P., Torrance, C., 2000. Written drug dosage errors made by students: the threat to clinical effectiveness and the need for a new approach. Clinical Effectiveness in Nursing 4, 20-29]; Wright, K., 2004. Investigation to find strategies to improve student nurses' maths skills. British Journal Nursing 13(21) 1280-1287; Wright, K., 2005. An exploration into the most effective way to teach drug calculation skills to nursing students. Nurse Education Today 25, 430-436], but there have been no reviews of the literature on medication errors in practice that specifically look to see whether the medication errors are caused by nurses' poor calculation skills. The databases Medline, CINAHL, British Nursing Index (BNI), Journal of American Medical Association (JAMA) and Archives and Cochrane reviews were searched for research studies or systematic reviews which reported on the incidence or causes of drug errors in clinical practice. In total 33 articles met the criteria for this review. There were no studies that examined nurses' drug calculation errors in practice. As a result studies and systematic reviews that investigated the types and causes of drug errors were examined to establish whether miscalculations by nurses were the causes of errors. The review found insufficient evidence to suggest that medication errors are caused by nurses' poor

  2. Medication reviews led by community pharmacists in Switzerland: a qualitative survey to evaluate barriers and facilitators

    Directory of Open Access Journals (Sweden)

    Niquille A

    2010-03-01

    Full Text Available Objective: 1 To evaluate the participation rate and identify the practical barriers to implementing a community pharmacist-led medication review service in francophone Switzerland and, 2 To assess the effectiveness of external support.Methods: A qualitative survey was undertaken to identify barriers to patient inclusion and medication review delivery in daily practice among all contactable independent pharmacists working in francophone Switzerland (n=78 who were members of a virtual chain (pharmacieplus, regardless of their participation in a simultaneous cross-sectional study. This study analyzed the dissemination of a medication review service including a prescription and drug utilization review with access to clinical data, a patient interview and a pharmaceutical report to the physicians. In addition, we observed an exploratory and external coaching for pharmacists that we launched seven months after the beginning of the cross-sectional study. Results: Poor motivation on the part of pharmacists and difficulties communicating with physicians and patients were the primary obstacles identified. Lack of time and lack of self-confidence in administering the medication review process were the most commonly perceived practical barriers to the implementation of the new service. The main facilitators to overcome these issues may be well-planned workflow organization techniques, strengthened by an adequate remuneration scheme and a comprehensive and practice-based training course that includes skill-building in pharmacotherapy and communication. External support may partially compensate for a weak organizational framework.Conclusions: To facilitate the implementation of a medication review service, a strong local networking with physicians, an effective workflow management and a practice- and communications-focused training for pharmacists and their teams seem key elements required. External support can be useful to help some pharmacists improve their

  3. Confounding factors in using upward feedback to assess the quality of medical training: a systematic review

    Directory of Open Access Journals (Sweden)

    Anli Yue Zhou Zhou

    2014-08-01

    Full Text Available Purpose: Upward feedback is becoming more widely used in medical training as a means of quality control. Multiple biases exist, thus the accuracy of upward feedback is debatable. This study aims to identify factors that could influence upward feedback, especially in medical training. Methods: A systematic review using a structured search strategy was performed. Thirty-five databases were searched. Results were reviewed and relevant abstracts were shortlisted. All studies in English, both medical and non-medical literature, were included. A simple pro-forma was used initially to identify the pertinent areas of upward feedback, so that a focused pro-forma could be designed for data extraction. Results: A total of 204 articles were reviewed. Most studies on upward feedback bias were evaluative studies and only covered Kirkpatrick level 1-reaction. Most studies evaluated trainers or training, were used for formative purposes and presented quantitative data. Accountability and confidentiality were the most common overt biases, whereas method of feedback was the most commonly implied bias within articles. Conclusion: Although different types of bias do exist, upward feedback does have a role in evaluating medical training. Accountability and confidentiality were the most common biases. Further research is required to evaluate which types of bias are associated with specific survey characteristics and which are potentially modifiable.

  4. Liposuction for chronic medical diseases and noncosmetic conditions: review of the literature

    Directory of Open Access Journals (Sweden)

    Hamdy Abuelhassan El-Khatib

    2015-03-01

    Full Text Available The purpose of this systematic literature review was to evaluate the safety of liposuction techniques and to identify the cosmetic and noncosmetic application of liposuction. Liposuction can be used to improve the quality-of-life in patients with disabling medical conditions in addition to its use for cosmetic rejuvenation. An online search of the Cochrane Library, MEDLINE, Embase, and SciELO were conducted. Forty-seven original articles reported from 1982 to February 2014 were included in this review. The articles reported on the use as well as the limitations of liposuction for treatment of noncosmetic and disabling medical conditions. The criteria used for selection of articles were: large sample size and originality. The case reports were excluded. There was a broad agreement about the applicability and the efficacy of the liposuction for treatment of these chronic medical conditions, such as multiple systemic lipomatosis, dercum's disease, chronic lymphedema, and axillary hyperhidrosis. Literatures review confirmed that Liposuction technique has provided significant and stable cure for these chronic medical conditions. Liposuction is the most frequent esthetic procedure for adipose tissue reduction and treatment of lipedema worldwide. Apart from esthetic indications, liposuction can also be used to treat chronic medical diseases and noncosmetic conditions.

  5. A scoping review of studies comparing the medication event monitoring system (MEMS) with alternative methods for measuring medication adherence.

    Science.gov (United States)

    El Alili, Mohamed; Vrijens, Bernard; Demonceau, Jenny; Evers, Silvia M; Hiligsmann, Mickael

    2016-07-01

    Different methods are available for measuring medication adherence. In this paper, we conducted a scoping review to identify and summarize evidence of all studies comparing the Medication Event Monitoring System (MEMS) with alternative methods for measuring medication adherence. A literature search was performed using the open database www.iAdherence.org that includes all original studies reporting findings from the MEMS. Papers comparing methods for measuring adherence to solid oral formulations were included. Data was extracted using a standardized extraction table. A total of 117 articles fulfilled the inclusion criteria, including 251 comparisons. Most frequent comparisons were against self-report (n = 119) and pill count (n = 59). Similar outcome measures were used in 210 comparisons (84%), among which 78 used dichotomous variables (adherent or not) and 132 used continuous measures (adherence expressed as percentage). Furthermore, 32% of all comparisons did not estimate adherence over the same coverage period and 44% of all comparisons did not use a statistical method or used a suboptimal one. Only eighty-seven (35%) comparisons had similar coverage periods, similar outcome measures and optimal statistical methods. Compared to MEMS, median adherence was grossly overestimated by 17% using self-report, by 8% using pill count and by 6% using rating. In conclusion, among all comparisons of MEMS versus alternative methods for measuring adherence, only a few used adequate comparisons in terms of outcome measures, coverage periods and statistical method. Researchers should therefore use stronger methodological frameworks when comparing measurement methods and be aware that non-electronic measures could lead to overestimation of medication adherence. PMID:27005306

  6. Misuse of stimulant medication among college students: a comprehensive review and meta-analysis.

    Science.gov (United States)

    Benson, Kari; Flory, Kate; Humphreys, Kathryn L; Lee, Steve S

    2015-03-01

    The misuse of stimulant medication among college students is a prevalent and growing problem. The purpose of this review and meta-analysis is to summarize the current research on rates and demographic and psychosocial correlates of stimulant medication misuse among college students, to provide methodological guidance and other ideas for future research, and to provide some preliminary suggestions for preventing and reducing misuse on college campuses. Random-effects meta-analysis found that the rate of stimulant medication misuse among college students was estimated at 17 % (95 % CI [0.13, 0.23], p disorder, problems associated with alcohol use, and marijuana use. A qualitative review of the literature also revealed that Greek organization membership, academic performance, and other substance use were associated with misuse. Students are misusing primarily for academic reasons, and the most common source for obtaining stimulant medication is peers with prescriptions. Interpretation of findings is complicated by the lack of a standard misuse definition as well as validated tools for measuring stimulant misuse. The relation between stimulant medication misuse and extra curricular participation, academic outcomes, depression, and eating disorders requires further investigation, as do the reasons why students divert or misuse and whether policies on college campuses contribute to the high rates of misuse among students. Future research should also work to develop and implement effective prevention strategies for reducing the diversion and misuse of stimulant medication on college campuses. PMID:25575768

  7. Medications and glucose-6-phosphate dehydrogenase deficiency: an evidence-based review.

    Science.gov (United States)

    Youngster, Ilan; Arcavi, Lidia; Schechmaster, Renata; Akayzen, Yulia; Popliski, Hen; Shimonov, Janna; Beig, Svetlana; Berkovitch, Matitiahu

    2010-09-01

    Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzyme defect and one of the most common genetic disorders worldwide, with an estimated 400 million people worldwide carrying a mutation in the G6PD gene that causes deficiency of the enzyme. Although drug-induced haemolysis is considered the most common adverse clinical consequence of G6PD deficiency, significant confusion exists regarding which drugs can cause haemolytic anaemia in patients with G6PD deficiency. In the absence of consensus among physicians, patients are subject to conflicting advice, causing uncertainty and distress. In the current review we aimed, by thorough search of the medical literature, to collect evidence on which to base decisions either to prohibit or allow the use of various medications in patients with G6PD deficiency. A literature search was conducted during May 2009 for studies and case reports on medication use and G6PD deficiency using the following sources: MEDLINE (1966-May 2009), PubMed (1950-May 2009), the Cochrane database of systematic reviews (2009), and major pharmacology, internal medicine, haematology and paediatric textbooks. After assessing the literature, we divided medications into one of three groups: medications that should be avoided in individuals with G6PD deficiency, medications that were considered unsafe by at least one source, but according to our review can probably be given safely in normal therapeutic dosages to individuals with G6PD deficiency as evidence does not contravene their use, and medications where no evidence at all was found to contravene their use in G6PD-deficient patients. It is reasonable to conclude that, over time, many compounds have been wrongly cited as causing haemolysis because they were administered to patients experiencing an infection-related haemolytic episode. We found solid evidence to prohibit only seven currently used medications: dapsone, methylthioninium chloride (methylene blue), nitrofurantoin

  8. Medication overuse headache: a critical review of end points in recent follow-up studies

    DEFF Research Database (Denmark)

    Hagen, Knut; Jensen, Rigmor; Bøe, Magne Geir; Stovner, Lars Jacob

    2010-01-01

    No guidelines for performing and presenting the results of studies on patients with medication overuse headache (MOH) exist. The aim of this study was to review long-term outcome measures in follow-up studies published in 2006 or later. We included MOH studies with >6 months duration presenting a...

  9. Attention to gender in communication skills assessment instruments in medical education: a review.

    NARCIS (Netherlands)

    Dielissen, P.W.; Bottema, B.J.A.M.; Verdonk, P.; Lagro-Janssen, T.

    2011-01-01

    CONTEXT: Gender is increasingly regarded as an important factor in doctor-patient communication education. This review aims to assess if and how gender is addressed by current assessment instruments for communication skills in medical education. METHODS: In 2009 at Radboud University Nijmegen Medica

  10. Medical Signbank as a Model for Sign Language Planning? A Review of Community Engagement

    Science.gov (United States)

    Napier, Jemina; Major, George; Ferrara, Lindsay; Johnston, Trevor

    2015-01-01

    This paper reviews a sign language planning project conducted in Australia with deaf Auslan users. The Medical Signbank project utilised a cooperative language planning process to engage with the Deaf community and sign language interpreters to develop an online interactive resource of health-related signs, in order to address a gap in the health…

  11. Novel variant (bla(VIM-4)) of the metallo-beta-lactamase gene bla(VIM-1) in a clinical strain of Pseudomonas aeruginosa.

    Science.gov (United States)

    Pournaras, Spyros; Tsakris, Athanassios; Maniati, Maria; Tzouvelekis, Leonidas S; Maniatis, Antonios N

    2002-12-01

    A Pseudomonas aeruginosa isolate highly resistant to carbapenems was collected from a patient with postsurgical cerebrospinal infection in Greece. The isolate carried a class 1 integron that contained as a sole cassette the gene bla(VIM-4), a novel variant of bla(VIM-1), with one nucleotide difference resulting in a Ser-to-Arg change at amino acid position 175 of the VIM-1 enzyme. This is the first detection of a VIM-1 variant after its appearance in Italy. PMID:12435718

  12. The establishment of a duplex real-time PCR assay for rapid and simultaneous detection of bla NDM and bla KPC genes in bacteria

    OpenAIRE

    Zheng, Fen; Sun, Jingjing; Cheng, Cancan; Rui, Yongyu

    2013-01-01

    The latest threat of multidrug-resistant Gram-negative bacteria corresponds to the emergence of carbapenemase New Delhi metallo-β-lactamase (NDM) and Klebsiella pneumoniae carbapenemase (KPC) producers. Rapid molecular detection is essential to limit their spread. In this study, a duplex real-time polymerase chain reaction (PCR) that was specific for the detection of bla NDM and blaKPC with the same limit of detection of ten plasmid copies was developed. The assay was linear over eight log di...

  13. A Review on Usage and Effectiveness of e-Learning in Medical Education.

    Science.gov (United States)

    Park, Joo Hyun; Son, Ji Young; Yoo, Nam Jin; Kim, Sun

    2010-06-01

    E-learning is recently considered as a critical strategy to improve the effectiveness and efficiency of education. Although the use of e-learning has been growing rapidly in medical education, there are not sufficient data applying e-learning and evidence of the effectiveness. The purpose of the study is to review the recent literatures on applying e-learning in medical education settings and to identify usage types and educational effectiveness appeared in the research. The results demonstrated the types applying e-learning in medical education were categorized into the blended learning, online education, and virtual learning environment. The educational effectiveness of e-learning were the improvements of knowledge, clinical skill, attitude, and satisfaction. The study suggested the recommendations based on the results in order to apply e-learning effectively to medical education. PMID:25813808

  14. Three-Dimensional Printing and Medical Imaging: A Review of the Methods and Applications.

    Science.gov (United States)

    Marro, Alessandro; Bandukwala, Taha; Mak, Walter

    2016-01-01

    The purpose of this article is to review recent innovations on the process and application of 3-dimensional (3D) printed objects from medical imaging data. Data for 3D printed medical models can be obtained from computed tomography, magnetic resonance imaging, and ultrasound using the Data Imaging and Communications in Medicine (DICOM) software. The data images are processed using segmentation and mesh generation tools and converted to a standard tessellation language (STL) file for printing. 3D printing technologies include stereolithography, selective laser sintering, inkjet, and fused-deposition modeling . 3D printed models have been used for preoperative planning of complex surgeries, the creation of custom prosthesis, and in the education and training of physicians. The application of medical imaging and 3D printers has been successful in providing solutions to many complex medical problems. As technology advances, its applications continue to grow in the future. PMID:26298798

  15. Effect of nurse-led medication reviews in psychiatric patients - an interventional study

    DEFF Research Database (Denmark)

    Sørensen, Ann Lykkegaard; Nielsen, Lars Peter; Poulsen, Birgitte Klindt;

    2013-01-01

    nurses are the health professionals spending most time directly with the patient and very few studies investigate nurses’ role and potential in improving the appropriateness of medication. Therefore, the main objective of this study is to investigate the effect of educating nurses in general pharmacology...... wards. The study will contribute with information regarding the effect of pharmacological training of nurses and possibly improve medication safety for psychiatric patients. Results from this study could serve as evidence, when hospital management makes decisions on how to accede the need for medication......OBJECTIVES: There is an increasing demand for medication reviews to improve the quality of prescribing for patients with chronic illness such as psychiatric patients. Traditionally, this has been undertaken by physicians. Pharmacists have also proven to be a resource in this field but registered...

  16. Effect of nurse-led medication reviews in psychiatric patients - an interventional study

    DEFF Research Database (Denmark)

    Sørensen, Ann Lykkegaard; Mainz, Jan; Poulsen, Birgitte Klindt;

    nurses are the health professionals spending most time directly with the patient and very few studies investigate nurses’ role and potential in improving the appropriateness of medication. Therefore, the main objective of this study is to investigate the effect of educating nurses in general pharmacology...... wards. The study will contribute with information regarding the effect of pharmacological training of nurses and possibly improve medication safety for psychiatric patients. Results from this study could serve as evidence, when hospital management makes decisions on how to accede the need for medication......OBJECTIVES: There is an increasing demand for medication reviews to improve the quality of prescribing for patients with chronic illness such as psychiatric patients. Traditionally, this has been undertaken by physicians. Pharmacists have also proven to be a resource in this field but registered...

  17. Hypertension and medical expenditure in the Japanese population:Review of prospective studies

    Institute of Scientific and Technical Information of China (English)

    Koshi; Nakamura; Tomonori; Okamura; Katsuyuki; Miura; Akira; Okayama

    2014-01-01

    Hypertension is a major determinant of health and is likely to have an effect on medical economics.The economic burden due to hypertension may be attributable not only to antihypertensive medication but also to the very expensive procedures required for cases of cardiovascular disease that occur more frequently in hypertensive compared with normotensive individuals.The objective of this article was to review articles published on prospective cohort studies that measured medical expenditure attributable to hypertension in community-dwelling populations in Japan.Many medical services in these populations are provided under the medical insurance system that requires the enrolment of all Japanese residents.Personal medical expenditure attributable to hypertension increases with worsening severity of the condition.Medical expenditure was increased further in cases of hypertensive patients who have another concomitant cardiovascular risk factor.In particular,hypertension,especially moderate-to-severe untreated hypertension,increases the risk of long-term hospitalization resulting in considerably higher medical expenditure,compared with non-hospitalized cases.Therefore,assuming that the use of antihypertensive medication is essential for hypertensive patients to prevent serious vascular diseases,a cost-effective highrisk strategy needs to be considered to reduce both ill-health and the economic burden due to hypertension.However,from a population perspective,medical expenditure attributable to hypertension comes mainly from pre-to-mild hypertension.Therefore,there is also a need to consider a population strategy that aims to shift the entire population to lower levels of blood pressure.

  18. Multicenter Evaluation of a New DNA Microarray for Rapid Detection of Clinically Relevant bla Genes from ? -Lactam-Resistant Gram-Negative Bacteria

    OpenAIRE

    Bogaerts, P.; Hujer, A.M.; Naas, T.; de Castro, R. R.; A. Endimiani; Nordmann, P.; Glupczynski, Y.; Bonomo, R.A.

    2011-01-01

    A new commercial low-density microarray which identifies common extended-spectrum β-lactamase plasmid-mediated cephalosporinase genes, as well as carbapenemase (blaKPC and blaNDM) genes, was evaluated. We tested 207 clinical and reference/collection isolates of the Enterobacteriaceae possessing different bla genes. Overall, the sensitivity and specificity of the microarray were 100% for the detection of the plasmid-mediated blaAmpC, blaKPC, and blaNDM genes using bla gene sequencing as the re...

  19. Multilocus Sequence Types of Carbapenem-Resistant Pseudomonas aeruginosa in Singapore Carrying Metallo-β-Lactamase Genes, Including the Novel blaIMP-26 Gene▿

    OpenAIRE

    Koh, Tse Hsien; Khoo, Cheng Teng; Tan, Thuan Tong; Mohamed Arshad, Mohamed Amir Bin; Ang, Li Ping; Lau, Lee Jin; Hsu, Li-Yang; Ooi, Eng Eong

    2010-01-01

    Nine imipenem-resistant Pseudomonas aeruginosa isolates were found to contain a variety of metallo-β-lactamase genes, including blaIMP-1, blaIMP-7, blaVIM-2, blaVIM-6, and the novel blaIMP-26. Multilocus sequence typing showed a diversity of sequence types. Comparison with isolates from an earlier study showed that the epidemic clones from 2000 have not become established.

  20. Global health competencies and approaches in medical education: a literature review

    Directory of Open Access Journals (Sweden)

    Hulme Jennifer

    2010-12-01

    Full Text Available Abstract Background Physicians today are increasingly faced with healthcare challenges that require an understanding of global health trends and practices, yet little is known about what constitutes appropriate global health training. Methods A literature review was undertaken to identify competencies and educational approaches for teaching global health in medical schools. Results Using a pre-defined search strategy, 32 articles were identified; 11 articles describing 15 global health competencies for undergraduate medical training were found. The most frequently mentioned competencies included an understanding of: the global burden of disease, travel medicine, healthcare disparities between countries, immigrant health, primary care within diverse cultural settings and skills to better interface with different populations, cultures and healthcare systems. However, no consensus on global health competencies for medical students was apparent. Didactics and experiential learning were the most common educational methods used, mentioned in 12 and 13 articles respectively. Of the 11 articles discussing competencies, 8 linked competencies directly to educational approaches. Conclusions This review highlights the imperative to document global health educational competencies and approaches used in medical schools and the need to facilitate greater consensus amongst medical educators on appropriate global health training for future physicians.

  1. The potential for misuse and abuse of medications in ADHD: a review.

    Science.gov (United States)

    Clemow, David B; Walker, Daniel J

    2014-09-01

    This article reviews the literature concerning attention-deficit/hyperactivity disorder (ADHD) medication misuse, abuse, dependence, diversion, and malingering. The review covers nonmedical use (NMU) of both stimulant (methylphenidate and amphetamine) and nonstimulant (α-adrenergic agonists and atomoxetine) prescription medications, and provides a discussion on the relevance for ADHD treatment today. The neural basis for ADHD medication mechanisms of action (increased norepinephrine and dopamine signaling) and their neurobiochemical relationship to the abuse potential is explored. Regionally-specific, stimulant-induced elevations in brain dopamine appear to be integral to both efficacy in ADHD and potential for abuse. In addition to the prevalence of misuse and diversion, additional topics discussed include the potential safety concerns associated with NMU of prescription ADHD medications and the cost to payers of prescription drug diversion (eg, increased emergency department visits associated with misuse). The evidence describing the difficulty in detecting malingering for the purpose of illicit access to ADHD medications for subsequent misuse or diversion is also summarized. Moreover, the effect of ADHD medications in patients with comorbid substance use disorder and the controversial potential linkage of stimulant prescription use with subsequent substance use disorder are explored. Overall, the data suggest that ADHD medication misuse and diversion are common health care problems for stimulant medications, with the prevalence believed to be approximately 5% to 10% of high school students and 5% to 35% of college students, depending on the study. Stimulant effectiveness and speed of action are deemed desirable to enhance attention and focus performance for activities like studying, but stimulants are also misused recreationally. Conversely, the data suggest a lack of abuse potential and lack of actual medication misuse for the nonstimulant medications

  2. World Workshop on Oral Medicine VI: a systematic review of medication-induced salivary gland dysfunction.

    Science.gov (United States)

    Villa, A; Wolff, A; Narayana, N; Dawes, C; Aframian, D J; Lynge Pedersen, A M; Vissink, A; Aliko, A; Sia, Y W; Joshi, R K; McGowan, R; Jensen, S B; Kerr, A R; Ekström, J; Proctor, G

    2016-07-01

    The aim of this paper was to perform a systematic review of the pathogenesis of medication-induced salivary gland dysfunction (MISGD). Review of the identified papers was based on the standards regarding the methodology for systematic reviews set forth by the World Workshop on Oral Medicine IV and the PRISMA statement. Eligible papers were assessed for both the degree and strength of relevance to the pathogenesis of MISGD as well as on the appropriateness of the study design and sample size. A total of 99 papers were retained for the final analysis. MISGD in human studies was generally reported as xerostomia (the sensation of oral dryness) without measurements of salivary secretion rate. Medications may act on the central nervous system (CNS) and/or at the neuroglandular junction on muscarinic, α-and β-adrenergic receptors and certain peptidergic receptors. The types of medications that were most commonly implicated for inducing salivary gland dysfunction were those acting on the nervous, cardiovascular, genitourinary, musculoskeletal, respiratory, and alimentary systems. Although many medications may affect the salivary flow rate and composition, most of the studies considered only xerostomia. Thus, further human studies are necessary to improve our understanding of the association between MISGD and the underlying pathophysiology. PMID:26602059

  3. Applying Established Guidelines to Team-Based Learning Programs in Medical Schools: A Systematic Review

    Science.gov (United States)

    McGregor, Deborah M.; Mellis, Craig M.

    2014-01-01

    Purpose Team-based learning (TBL), a structured form of small-group learning, has gained popularity in medical education in recent years. A growing number of medical schools have adopted TBL in a variety of combinations and permutations across a diversity of settings, learners, and content areas. The authors conducted this systematic review to establish the extent, design, and practice of TBL programs within medical schools to inform curriculum planners and education designers. Method The authors searched the MEDLINE, PubMed, Web of Knowledge, and ERIC databases for articles on TBL in undergraduate medical education published between 2002 and 2012. They selected and reviewed articles that included original research on TBL programs and assessed the articles according to the seven core TBL design elements (team formation, readiness assurance, immediate feedback, sequencing of in-class problem solving, the four S’s [significant problem, same problem, specific choice, and simultaneous reporting], incentive structure, and peer review) described in established guidelines. Results The authors identified 20 articles that satisfied the inclusion criteria. They found significant variability across the articles in terms of the application of the seven core design elements and the depth with which they were described. The majority of the articles, however, reported that TBL provided a positive learning experience for students. Conclusions In the future, faculty should adhere to a standardized TBL framework to better understand the impact and relative merits of each feature of their program. PMID:24556770

  4. General practitioners' views of pharmacists' current and potential contributions to medication review and prescribing in New Zealand

    OpenAIRE

    Hatah E; Braund R; Duffull SB; Tordoff J

    2013-01-01

    INTRODUCTION: Internationally, non-medical practitioners are increasingly involved in tasks traditionally undertaken by general practitioners (GPs), such as medication review and prescribing. This study aims to evaluate GPs' perceptions of pharmacists' contributions to those services. METHODS: Semi-structured interviews were carried out in two localities with GPs whose patients had and had not undergone a pharmacist-led adherence support Medication Use Review (MUR). GPs were asked their opini...

  5. Eating disorders: a review of the literature with emphasis on medical complications and clinical nutrition.

    Science.gov (United States)

    Patrick, Lyn

    2002-06-01

    Eating disorders, including anorexia nervosa, bulimia nervosa, binge-eating disorder, and atypical eating disorder (eating disorder not otherwise specified or NOS), are estimated to occur in 5-10 million young and adult women and one million males in the United States. The etiology of eating disorders is complex and appears to include predisposing genetic factors and serotonin dysregulation, as well as psychological factors that include a history of trauma and childhood sexual abuse. Both anorexia nervosa and bulimia nervosa are medical conditions complicated by multiple neuroendocrine dysfunctions, nutritional deficiencies, and psychiatric diagnoses. Medical complications, specific nutritional deficiencies, and research involving the therapeutic use of inositol and zinc are reviewed. PMID:12126461

  6. Author Role in Online Submission and Peer Review Systems of Iranian Medical Journals

    Directory of Open Access Journals (Sweden)

    Fereydoun Azadeh

    2015-10-01

    Full Text Available Since the late 1990s, different web-based submission and peer review systems have emerged, and significant numbers of journals have shifted from their old paper-based systems to the web-based ones. Exploring the main features of these online systems might lead to better understand this flow. This study was performed to examine the features and capabilities of online submissions and peer review systems, with focus on the  author role,  which have been currently using by Iranian, approved medical and biomedical journals. This descriptive study was conducted during 2011-2012. The population of the study was peer review systems of approved medical and biomedical journals by Ministry of Health and Medical Education, Iran. In  this term, 199 journals were identified. Data were gathered by a standardized, researcher made checklist. The data were analyzed using SPSS 18 and Microsoft Excel 2007. 27 out of199 journals were using no systems. 21 out of 199 were using 12 systems with inaccessible information or unknown status (which were removed from this study, and 151 journals were using 6 systems which were examined in this study. Evaluated systems were more than 80% in compliance with the research checklist. Due to rapid changes in information technology and information systems` designs, it is required for such systems to be constantly evaluated. It is of high value to investigate new demands of beneficiary groups like authors and researchers, editorial boards, and reviewers in this regard.

  7. International medical migration: a critical conceptual review of the global movements of doctors and nurses.

    Science.gov (United States)

    Bradby, Hannah

    2014-11-01

    This paper critically appraises the discourse around international medical migration at the turn of the 21st century. A critical narrative review of a range of English-language sources, including grey literature, books and research reports, traces the development and spread of specific causative models. The attribution of causative relations between the movement of skilled medical workers, the provision of health care and population health outcomes illustrates how the global reach of biomedicine has to be understood in the context of local conditions. The need to understand migration as an aspect of uneven global development, rather than a delimited issue of manpower services management, is illustrated with reference to debates about 'brain drain' of Africa's health-care professionals, task-shifting and the crisis in health-care human resources. The widespread presumed cause of shortages of skilled health-care staff in sub-Saharan Africa was overdetermined by a compelling narrative of rich countries stealing poor countries' trained health-care professionals. This narrative promotes medical professional interests and ignores historical patterns of underinvestment in health-care systems and structures. Sociological theories of medicalization suggest that the international marketization of medical recruitment is a key site where the uneven global development of capital is at work. A radical reconfiguration of medical staffing along the lines of 'task-shifting' in rich and poor countries' health-care systems alike offers one means of thinking about global equity in access to quality care. PMID:24677336

  8. Improving medical students' knowledge of genetic disease: a review of current and emerging pedagogical practices

    Directory of Open Access Journals (Sweden)

    Wolyniak MJ

    2015-10-01

    Full Text Available Michael J Wolyniak,1 Lynne T Bemis,2 Amy J Prunuske2 1Department of Biology, Hampden-Sydney College, Hampden-Sydney, VA, 2Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, MN, USA Abstract: Genetics is an essential subject to be mastered by health professional students of all types. However, technological advances in genomics and recent pedagogical research have changed the way in which many medical training programs teach genetics to their students. These advances favor a more experience-based education focused primarily on developing student's critical thinking skills. In this review, we examine the current state of genetics education at both the preclinical and clinical levels and the ways in which medical and pedagogical research have guided reforms to current and emerging teaching practices in genetics. We discover exciting trends taking place in which genetics is integrated with other scientific disciplines both horizontally and vertically across medical curricula to emphasize training in scientific critical thinking skills among students via the evaluation of clinical evidence and consultation of online databases. These trends will produce future health professionals with the skills and confidence necessary to embrace the new tools of medical practice that have emerged from scientific advances in genetics, genomics, and bioinformatics. Keywords: genetics education, medical genetics, pedagogical practice, active learning, problem-based learning

  9. A pilot survey of junior doctors’ attitudes and awareness around medication review: time to change our educational approach?

    OpenAIRE

    Jubraj, Barry; Marvin, Vanessa; Poots, Alan J.; Patel, Shreena; Bovill, Iñaki; Barnett, Nina; Issen, Laurel; Bell, Derek

    2015-01-01

    Objectives Our aim was to explore junior doctors’ attitudes and awareness around concepts related to medication review, in order to find ways to change the culture for reviewing, altering and stopping inappropriate or unnecessary medicines. Having already demonstrated the value of team working with senior doctors and pharmacists and the use of a medication review tool, we are now looking to engage first year clinicians and undergraduates in the process. Method An online survey about medicatio...

  10. A pilot survey of junior doctors’ attitudes and awareness around medication review:Time to change our educational approach?

    OpenAIRE

    Jubraj, Barry; Marvin, Vanessa; Poots, Alan J.; Patel, Shreena; Bovill, Iñaki; Barnett, Nina; Issen, Laurel; Bell, Derek

    2015-01-01

    Objectives Our aim was to explore junior doctors' attitudes and awareness around concepts related to medication review, in order to find ways to change the culture for reviewing, altering and stopping inappropriate or unnecessary medicines. Having already demonstrated the value of team working with senior doctors and pharmacists and the use of a medication review tool, we are now looking to engage first year clinicians and undergraduates in the process. Method An online survey about medicatio...

  11. A pilot survey of junior doctors’ attitudes and awareness around medication review: time to change our educational approach?

    OpenAIRE

    Jubraj, Barry; Marvin, Vanessa; Poots, Alan J; Patel, Shreena; Bovill, Iñaki; Barnett, Nina; Issen, Laurel; Bell, Derek

    2015-01-01

    Objectives Our aim was to explore junior doctors' attitudes and awareness around concepts related to medication review, in order to find ways to change the culture for reviewing, altering and stopping inappropriate or unnecessary medicines. Having already demonstrated the value of team working with senior doctors and pharmacists and the use of a medication review tool, we are now looking to engage first year clinicians and undergraduates in the process. Method An online survey about medicatio...

  12. The outcomes of recent patient safety education interventions for trainee physicians and medical students: a systematic review

    OpenAIRE

    Kirkman, Matthew A.; Sevdalis, Nick; Arora, Sonal; Baker, Paul; Vincent, Charles; Ahmed, Maria

    2015-01-01

    Objective To systematically review the latest evidence for patient safety education for physicians in training and medical students, updating, extending and improving on a previous systematic review on this topic. Design A systematic review. Data sources Embase, Ovid Medline and PsycINFO databases. Study selection Studies including an evaluation of patient safety training interventions delivered to trainees/residents and medical students published between January 2009 and May 2014. Data extra...

  13. A Brief Historical Review of Specific Religious Denominations: How History Influences Current Medical-Religious Partnerships.

    Science.gov (United States)

    Galiatsatos, Panagis; Lehmijoki-Gardner, Maiju; Daniel Hale, W

    2016-04-01

    Improving health care in the twenty-first century will require new and creative approaches, with special attention given to health literacy and patient engagement since these two variables play a significant role in chronic health issues and their management. In order to better improve these key variables, strong partnerships between patients, their communities, and medical institutions must be developed. One way of facilitating these relationships is through medical-religious partnerships. Religious leaders are in regular contact with people who need education about and support with health issues. However, identifying the most effective way to approach specific congregations can pose a challenge to healthcare providers and institutions. In this paper, we provide a brief historical review of certain religious traditions and how their history plays a role in current medical-religious partnerships. PMID:26345681

  14. Antecedents of the people and organizational aspects of medical informatics: review of the literature.

    Science.gov (United States)

    Lorenzi, N M; Riley, R T; Blyth, A J; Southon, G; Dixon, B J

    1997-01-01

    People and organizational issues are critical in both implementing medical informatics systems and in dealing with the altered organizations that new systems often create. The people and organizational issues area--like medical informatics itself--is a blend of many disciplines. The academic disciplines of psychology, sociology, social psychology, social anthropology, organizational behavior and organizational development, management, and cognitive sciences are rich with research with significant potential to ease the introduction and on-going use of information technology in today's complex health systems. These academic areas contribute research data and core information for better understanding of such issues as the importance of and processes for creating future direction; managing a complex change process; effective strategies for involving individuals and groups in the informatics effort; and effectively managing the altered organization. This article reviews the behavioral and business referent disciplines that can potentially contribute to improved implementations and on-going management of change in the medical informatics arena. PMID:9067874

  15. Author Role in Online Submission and Peer Review Systems of Iranian Medical Journals

    OpenAIRE

    Fereydoun Azadeh; Alireza Hemmati; Javad Ghazi-Mir-Saeed; Tania Azadi

    2015-01-01

    Since the late 1990s, different web-based submission and peer review systems have emerged, and significant numbers of journals have shifted from their old paper-based systems to the web-based ones. Exploring the main features of these online systems might lead to better understand this flow. This study was performed to examine the features and capabilities of online submissions and peer review systems, with focus on the  author role,  which have been currently using by Iranian, approved medic...

  16. Incidence of blaNDM-1 gene in Escherichia coli isolates at a tertiary care referral hospital in Northeast India

    Directory of Open Access Journals (Sweden)

    A Bora

    2013-01-01

    Full Text Available Purpose: Increasing reports on New Delhi metallo-β-lactamase-1 (NDM-1 producing Escherichia coli constitute a serious threat to global health since it is found to be highly resistant to most of the currently available antibiotics including carbapenems. This study has been performed to find out the incidence blaNDM-1 in E. coli isolates recovered from the various clinical samples at a tertiary care referral hospital in Northeast India. Materials and Methods: A total of 270 non-duplicated E. coli isolates were recovered from the various clinical samples at a tertiary care referral hospital in Northeast India. All isolates with reduced susceptibility to meropenem or ertapenem (diameter of zones of inhibition, ≤21 mm were further phenotypically confirmed for carbapenemase production by modified Hodge test. All screened isolates were also subjected to the polymerase chain reaction detection of blaNDM-1 gene and additional bla genes coding for transmission electron microscopy, SHV, CTX-M, and AmpC. Results: Out of 270 E. coli isolates, 14 were screened for carbapenemase production on the basis of their reduced susceptibility to meropenem or ertapenem. All screened isolates were found to be positive for blaNDM-1 . Each of the blaNDM-1 possessing isolate was also positive for two or more additional bla genes, such as blaTEM , blaCTX-M and blaAmpC . Phylogenetic analysis showed very less variation in blaNDM-1 gene with respect to blaNDM-1 possessing E. coli isolates from other parts of India and abroad. Conclusions: Our findings highlight the incidence of blaNDM-1 in E. coli isolates with a reduced susceptibility to meropenem or ertapenem.

  17. Dominance of blaCTX-M within an Australian Extended-Spectrum β-Lactamase Gene Pool▿

    OpenAIRE

    Zong, Zhiyong; Partridge, Sally R.; Thomas, Lee; Iredell, Jonathan R.

    2008-01-01

    blaCTX-M genes, particularly blaCTX-M-15, are the dominant extended-spectrum β-lactamase (ESBL) genes among clinical isolates of Escherichia coli and Klebsiella pneumoniae in Sydney, Australia, where we also found one example of blaCTX-M-62, encoding a novel enzyme conferring ceftazidime resistance. ESBL genes were present in diverse community isolates and in a variety of associated conjugative plasmids.

  18. The predictive value of psychological assessment of candidates for gastric bypass: A medical chart review

    OpenAIRE

    Nathalie Aubert; Isabelle Lyon-Pagès; Isabelle Carrard; Michel Suter; Friedrich Stiefel; Vittorio Giusti

    2010-01-01

    Background and Objectives: Guidelines for bariatric surgery demand a psychological evaluation of applicants. The aim of this study was to evaluate if the presence of "psychological risk factors" predicts postoperative weight loss after gastric bypass. Methods: Medical records of obese women who underwent bariatric surgery between 2000 and 2004 were reviewed. Psychological assessment consisted of a one-hour semi-structured interview, summarized in a written report. Anthropometric assessment at...

  19. The predictive value of psychological assessment of candidates for gastric bypass: A medical chart review

    OpenAIRE

    Nathalie Aubert; Isabelle Lyon-Pagès; Isabelle Carrard; Michel Suter; Friedrich Stiefel; Vittorio Giusti

    2010-01-01

    Background and Objectives: Guidelines for bariatric surgery demand a psychological evaluation of applicants. The aim of this study was to evaluate if the presence of "psychological risk factors" predicts postoperative weight loss after gastric bypass. Methods: Medical records of obese women who underwent bariatric surgery between 2000 and 2004 were reviewed. Psychological assessment consisted of a one-hour semi-structured interview, summarized in a written report. Anthropometric assessment...

  20. Liposuction for chronic medical diseases and noncosmetic conditions: review of the literature

    OpenAIRE

    Hamdy Abuelhassan El-Khatib

    2015-01-01

    The purpose of this systematic literature review was to evaluate the safety of liposuction techniques and to identify the cosmetic and noncosmetic application of liposuction. Liposuction can be used to improve the quality-of-life in patients with disabling medical conditions in addition to its use for cosmetic rejuvenation. An online search of the Cochrane Library, MEDLINE, Embase, and SciELO were conducted. Forty-seven original articles reported from 1982 to February 2014 were included in th...

  1. The incidence of adverse events in Swedish hospitals: a retrospective medical record review study

    OpenAIRE

    Soop, Michael; Fryksmark, Ulla; Köster, Max; Haglund, Bengt

    2009-01-01

    Objectives To estimate the incidence, nature and consequences of adverse events and preventable adverse events in Swedish hospitals. Design A three-stage structured retrospective medical record review based on the use of 18 screening criteria. Setting Twenty-eight Swedish hospitals. Population A representative sample (n = 1967) of the 1.2 million Swedish hospital admissions between October 2003 and September 2004. Main Outcome Measures Proportion of admissions with adverse events, the proport...

  2. Economics of medically unexplained symptoms: a systematic review of the literature

    OpenAIRE

    Konnopka, Alexander; Schäfert, Rainer; Heinrich, Sven; Kaufmann, Claudia; Luppa, Melanie; Herzog, Wolfgang; König, Hans-Helmut

    2012-01-01

    Objective: To review cost-of-illness studies (COI) and economic evaluations (EE) conducted for medically unexplained symptoms and to analyze their methods and results. Methods: We searched the databases PubMed, PsycINFO and National Health Service Economic Evaluations Database of the University of York. Cost data were inflated to 2006 using country-specific gross domestic product inflators and converted to 2006 USD purchasing power parities. Results: We identified 5 COI and 8 EE, of which 6 w...

  3. The Impact of Social Media on Medical Professionalism: A Systematic Qualitative Review of Challenges and Opportunities

    OpenAIRE

    Gholami-Kordkheili, Fatemeh; Wild, Verina; Strech, Daniel

    2013-01-01

    Background: The rising impact of social media on the private and working lives of health care professionals has made researchers and health care institutions study and rethink the concept and content of medical professionalism in the digital age. In the last decade, several specific policies, original research studies, and comments have been published on the responsible use of social media by health care professionals. However, there is no systematic literature review that analyzes the full s...

  4. Review of Cost-Effectiveness Analysis of Medical Treatment For Myocardial Infarction

    OpenAIRE

    Yanmei Liu; Koustuv Dalal

    2011-01-01

    Objectives: Myocardial infarction (MI) is a leading cause of death in both the industrialized and developing countries globally. The economic evaluation of MI is undertaken to rationale the allocation of scarce healthcare resource. The objective is to review cost-effectiveness analysis of MI with medications. Methods: We searched PubMed using the key words: "cost effectiveness analysis" and "myocardial infarction". After applying the selection criteria, eight articles were selected for th...

  5. A review of immediacy and implications for provider–patient relationships to support medication management

    Science.gov (United States)

    Bartlett Ellis, Rebecca J; Carmon, Anna F; Pike, Caitlin

    2016-01-01

    Objectives This review is intended to 1) describe the construct of immediacy by analyzing how immediacy is used in social relational research and 2) discuss how immediacy behaviors can be incorporated into patient–provider interventions aimed at supporting patients’ medication management. Methods A literature search was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, OVID, PubMed, and Education Resource Information Center (ERIC) EBSCO with the keyword “immediacy”. The literature was reviewed and used to describe historical conceptualizations, identify attributes, examine boundaries, and identify antecedents and consequences of immediacy. Results In total, 149 articles were reviewed, and six attributes of immediacy were identified. Immediacy is 1) reciprocal in nature and 2) reflected in the communicator’s attitude toward the receiver and the message, 3) conveys approachability, 4) respectfulness, 5) and connectedness between communicators, and 6) promotes receiver engagement. Immediacy is associated with affective learning, cognitive learning, greater recall, enhanced relationships, satisfaction, motivation, sharing, and perceptions of mutual value in social relationships. Conclusion Immediacy should be further investigated as an intervention component of patient–provider relationships and shared decision making in medication management. Practice implications In behavioral interventions involving relational interactions between interveners and participants, such as in medication management, the effects of communication behaviors and immediacy during intervention delivery should be investigated as an intervention component. PMID:26792985

  6. First report of the blaOXA-58 gene in a clinical isolate of Acinetobacter baumannii in Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Deuseli Quaresma de Figueiredo

    2011-05-01

    Full Text Available Carbapenemase production is an important mechanism of carbapenem resistance among nonfermentative Gram-negative isolates. This study aimed to report the detection of blaOXA-58 gene in multiresistant clinical isolates of Acinetobacter baumannii recovered from inpatients in a public hospital. Polymerase chain reaction tests were performed to detect the blaOXA-23-like, blaOXA-24-like, blaOXA-58-like and blaOXA-51-like genes. The blaOXA-58 and blaOXA-23 genes were detected in one and three isolates, respectively. Sequencing of the blaOXA-58-like amplicon revealed 100% identity with the A. baumannii blaOXA-58 gene listed in the GenBank database. This is the first report of an OXA-58-producing A. baumannii isolate in Rio de Janeiro, Brazil.

  7. Stereoscopic displays in medical domains: a review of perception and performance effects

    Science.gov (United States)

    van Beurden, Maurice H. P. H.; van Hoey, Gert; Hatzakis, Haralambos; Ijsselsteijn, Wijnand A.

    2009-02-01

    In this paper we review empirical studies that investigate performance effects of stereoscopic displays for medical applications. We focus on four distinct application areas: diagnosis, pre-operative planning, minimally invasive surgery (MIS) and training/teaching. For diagnosis, stereoscopic displays can augment the understanding of complex spatial structures and increase the detection of abnormalities. Stereoscopic viewing of medical data has proven to increase the detection rate in breast imaging. A stereoscopic presentation of noisy and transparent images in 3D ultrasound results in better visualization of the internal structures, however more empirical studies are needed to confirm the clinical relevance. For MRI and CT, where images are frequently rendered in 3D perspective, the added value of binocular depth has not yet been convincingly demonstrated. For MIS, stereoscopic displays can decrease surgery time and increase accuracy of surgical procedures. Performance of surgical procedures is similar when high resolution 2D displays are compared with lower resolution stereoscopic displays, indicating an image quality improvement for stereoscopic displays. Training and surgical planning already use computer simulations in 2D, however more research is needed to the benefit of stereoscopic displays in those applications. Overall there is a clear need for more empirical evidence that quantifies the added value of stereoscopic displays in medical domains, such that the medical community will have ample basis to invest in stereoscopic displays in all or some of the described medical applications.

  8. Medical students' exposure to and attitudes about the pharmaceutical industry: a systematic review.

    Directory of Open Access Journals (Sweden)

    Kirsten E Austad

    2011-05-01

    Full Text Available BACKGROUND: The relationship between health professionals and the pharmaceutical industry has become a source of controversy. Physicians' attitudes towards the industry can form early in their careers, but little is known about this key stage of development. METHODS AND FINDINGS: We performed a systematic review reported according to PRISMA guidelines to determine the frequency and nature of medical students' exposure to the drug industry, as well as students' attitudes concerning pharmaceutical policy issues. We searched MEDLINE, EMBASE, Web of Science, and ERIC from the earliest available dates through May 2010, as well as bibliographies of selected studies. We sought original studies that reported quantitative or qualitative data about medical students' exposure to pharmaceutical marketing, their attitudes about marketing practices, relationships with industry, and related pharmaceutical policy issues. Studies were separated, where possible, into those that addressed preclinical versus clinical training, and were quality rated using a standard methodology. Thirty-two studies met inclusion criteria. We found that 40%-100% of medical students reported interacting with the pharmaceutical industry. A substantial proportion of students (13%-69% were reported as believing that gifts from industry influence prescribing. Eight studies reported a correlation between frequency of contact and favorable attitudes toward industry interactions. Students were more approving of gifts to physicians or medical students than to government officials. Certain attitudes appeared to change during medical school, though a time trend was not performed; for example, clinical students (53%-71% were more likely than preclinical students (29%-62% to report that promotional information helps educate about new drugs. CONCLUSIONS: Undergraduate medical education provides substantial contact with pharmaceutical marketing, and the extent of such contact is associated with

  9. Peer review in medical journals: Beyond quality of reports towards transparency and public scrutiny of the process.

    Science.gov (United States)

    Vercellini, Paolo; Buggio, Laura; Viganò, Paola; Somigliana, Edgardo

    2016-06-01

    Published medical research influences health care providers and policy makers, guides patient management, and is based on the peer review process. Peer review should prevent publication of unreliable data and improve study reporting, but there is little evidence that these aims are fully achieved. In the blinded systems, authors and readers do not know the reviewers' identity. Moreover, the reviewers' reports are not made available to readers. Anonymous peer review poses an ethical imbalance toward authors, who are judged by masked referees, and to the medical community and society at large, in case patients suffer the consequences of acceptance of flawed manuscripts or erroneous rejection of important findings. Some general medical journals have adopted an open process, require reviewers to sign their reports, and links online pre-publication histories to accepted articles. This system increases editors' and reviewers' accountability and allows public scrutiny, consenting readers understand on which basis were decisions taken and by whom. Moreover, this gives credit to reviewers for their apparently thankless job, as online availability of signed and scored reports may contribute to researchers' academic curricula. However, the transition from the blind to the open system could pose problems to journals. Reviewers may be more difficult to find, and publishers or medical societies could resist changes that may affect editorial costs and journals' revenues. Nonetheless, also considering the risk of competing interests in the medical field, general and major specialty journals could consider testing the effects of open review on manuscripts regarding studies that may influence clinical practice. PMID:27129625

  10. Factor Analysis Methods and Validity Evidence: A Systematic Review of Instrument Development across the Continuum of Medical Education

    Science.gov (United States)

    Wetzel, Angela Payne

    2011-01-01

    Previous systematic reviews indicate a lack of reporting of reliability and validity evidence in subsets of the medical education literature. Psychology and general education reviews of factor analysis also indicate gaps between current and best practices; yet, a comprehensive review of exploratory factor analysis in instrument development across…

  11. BlaSTorage: a fast package to parse, manage and store BLAST results

    Directory of Open Access Journals (Sweden)

    Orsini Massimiliano

    2013-01-01

    Full Text Available Abstract Background Large-scale sequence studies requiring BLAST-based analysis produce huge amounts of data to be parsed. BLAST parsers are available, but they are often missing some important features, such as keeping all information from the raw BLAST output, allowing direct access to single results, and performing logical operations over them. Findings We implemented BlaSTorage, a Python package that parses multi BLAST results and returns them in a purpose-built object-database format. Unlike other BLAST parsers, BlaSTorage retains and stores all parts of BLAST results, including alignments, without loss of information; a complete API allows access to all the data components. Conclusions BlaSTorage shows comparable speed of more basic parser written in compiled languages as C++ and can be easily integrated into web applications or software pipelines.

  12. Effect of book reviewing workshop on awareness of, aptitude for and attitude toward book reviews in faculty members of faculty of management and medical information

    OpenAIRE

    Najafi, Nayere Sadat Soleimanzade; Ashrafi-rizi, Hasan; Yarmohammadian, Mohammad Hossein; Shahrzadi, Leila; Hasanzade, Akbar

    2014-01-01

    Introduction: Works evaluation and critique is one of the most important phases in scientific production cycle. Reviewers need some aptitude about rules and principles of writing good review. Considering the important role of books for storage and transferring the scientific findings, book reviewing is vital to scientific progress. Despite this fact, investigation of Isfahan University of Medical Science's journal, demonstrated the number of published book reviews to be very small. This study...

  13. Klebsiella pneumoniae carrying blaNDM-1 gene in orthopedic practice

    Directory of Open Access Journals (Sweden)

    Varsha Gupta

    2014-01-01

    Full Text Available Emergence and spread of carbapenemases in Enterobacteriaceae is a cause of concern worldwide, the latest threat being New Delhi metallo-β-lactamase (NDM-1. This report is of an orthopedic case with fracture femur managed with internal fixation and bone grafting, who subsequently developed secondary infection with Klebsiella pneumoniae harboring blaNDM-1 gene. Minimum inhibitory concentration (MIC of imipenem was ≥8 μg/ml by E-test, suggestive of carbapenemase production. Phenotypic and further genotypic detection confirmed the presence of blaNDM-1 gene. The isolate remained susceptible only to tigecycline, colistin, and polymyxin B.

  14. Blaženje podnebnih sprememb z uporabo geoinženiringa

    OpenAIRE

    Horvat, Sanja

    2015-01-01

    V diplomski nalogi se osredotočamo na vrednotenje dveh znanosti, znanosti o podnebnih spremembah in znanosti o geoinženiringu, katerega osnovni namen je blaženje podnebnih sprememb. Diplomska naloga je razdeljena na dva dela. V prvem delu podrobneje razglabljamo o znanosti in politiki podnebnih sprememb ter njihovem orodju (o t.i. klimatskih modelih), s katerim operiramo in napovedujemo razvoj podnebnih sprememb, na podlagi katerih se sprejemajo radikalne družbenopolitične odločitve za blažen...

  15. Goslar Blaž Demšar: prispevek za zgodovino slovenskega glasbilarstva:

    OpenAIRE

    Pokorn, Danilo

    1999-01-01

    The article is didiceted to Blaž Demšar (1903-1981), the best Slovene violin maker. He was the first in Slovenia who elevated violin making to the level of artistry and also archieved international recognition with his instruments Prispevek je posvečen Blažu Demšarju (1903-1981), najboljšemu slovenskemu goslarju. Goslarstvo je kot prvi na Slovenskem povzdignil na reven umetniškega oblikovanja in s svojimi instrumenti dosegel priznanje tudi v tujini

  16. Improving medical students' knowledge of genetic disease: a review of current and emerging pedagogical practices.

    Science.gov (United States)

    Wolyniak, Michael J; Bemis, Lynne T; Prunuske, Amy J

    2015-01-01

    Genetics is an essential subject to be mastered by health professional students of all types. However, technological advances in genomics and recent pedagogical research have changed the way in which many medical training programs teach genetics to their students. These advances favor a more experience-based education focused primarily on developing student's critical thinking skills. In this review, we examine the current state of genetics education at both the preclinical and clinical levels and the ways in which medical and pedagogical research have guided reforms to current and emerging teaching practices in genetics. We discover exciting trends taking place in which genetics is integrated with other scientific disciplines both horizontally and vertically across medical curricula to emphasize training in scientific critical thinking skills among students via the evaluation of clinical evidence and consultation of online databases. These trends will produce future health professionals with the skills and confidence necessary to embrace the new tools of medical practice that have emerged from scientific advances in genetics, genomics, and bioinformatics. PMID:26604852

  17. Rural Residence and Prescription Medication Use by Community-Dwelling Older Adults: A Review of the Literature

    Science.gov (United States)

    Grymonpre, Ruby E.; Hawranik, Pamela G.

    2008-01-01

    Context: Due to various barriers to health care access in the rural setting, there is concern that rural older adults might have lower access to prescribed medications than their urban counterparts. Purpose: To review published research reports to determine prevalence and mean medication use in rural, noninstitutionalized older adults and assess…

  18. A review of the use of handheld computers in medical nutrition.

    Science.gov (United States)

    Holubar, Stefan; Harvey-Banchik, Lillian

    2007-08-01

    Handheld computers, or personal digital assistants (PDAs), have been used to assist clinicians in medical nutrition since the early 1980s. The term PDA was originally applied to programmable calculators; over time, the capabilities of these devices were expanded to allow for the use of more complicated programs such as databases, spreadsheets, and electronic books. Slowly, the device evolved into what is more commonly thought of as a PDA, that is, a device such as a PalmOS (PalmSource, Inc, Tokyo, Japan) or PocketPC (Microsoft, Redmond, WA) unit. We present a review of the literature about the use of PDAs in medical nutrition, followed by a discussion of the different types of PDAs and mobile technologies that are commercially available. This is followed by a discussion of software applications that are currently available for use by nutrition clinicians, focusing on freeware applications. Finally, future technologies and applications are discussed. PMID:17644697

  19. Internet-based medical education: a realist review of what works, for whom and in what circumstances

    OpenAIRE

    Greenhalgh Trisha; Wong Geoff; Pawson Ray

    2010-01-01

    Abstract Background Educational courses for doctors and medical students are increasingly offered via the Internet. Despite much research, course developers remain unsure about what (if anything) to offer online and how. Prospective learners lack evidence-based guidance on how to choose between the options on offer. We aimed to produce theory driven criteria to guide the development and evaluation of Internet-based medical courses. Methods Realist review - a qualitative systematic review meth...

  20. Interpractice audit of diagnosis and management of hypertension in primary care: educational intervention and review of medical records.

    OpenAIRE

    Mashru, M.; Lant, A.

    1997-01-01

    OBJECTIVE: To determine whether peer review medical audit in a primary care setting changes clinical behaviour in relation to the management of hypertension. DESIGN: Review of medical records in general practices to identify hypertensive patients followed up by assessment of the pre-educational and post-educational management of interventions. SETTING: Six general practices in north west London picked at random within defined criteria of geography and size. SUBJECTS: 740 hypertensive patients...

  1. Medication reviews in primary care in Sweden: importance of clinical pharmacists' recommendations on drug-related problems.

    Science.gov (United States)

    Modig, Sara; Holmdahl, Lydia; Bondesson, Åsa

    2016-02-01

    Background One way of preventing and solving drug-related problems in frail elderly is to perform team-based medication reviews. Objective To evaluate the quality of the clinical pharmacy service to primary care using structured medication reviews, focusing on the clinical significance of the recommendations made by clinical pharmacists. Setting A random sample of 150 patients (out of 1541) who received structured team based medication reviews. The patients lived at a geriatric nursing home or were ≥65 years and lived in ordinary housing with medication-related community help. Method Based on information on symptoms, kidney function, blood pressure, diagnoses and the medication list, a pharmacist identified possible drug-related problems and supplied recommendations for the general practitioner to act on. Two independent physicians retrospectively ranked the clinical significance of the recommendations according to Hatoum, with rankings ranging between 1 (adverse significance) and 6 (extremely significant). Main outcome measure The clinical significance of the recommendations. Results In total 349 drug-related problems were identified, leading to recommendations. The vast majority of the recommendations (96 %) were judged to have significance 3 or higher and more than the half were judged to have significance 4 or higher. Conclusion The high proportion of clinically significant recommendations provided by pharmacists when performing team-based medication reviews suggest that these clinical pharmacy services have potential to increase prescribing quality. As such, the medication reviews have the potential for contributing to a better and safer drug therapy for elderly patients. PMID:26582483

  2. Nontrauma helicopter emergency medical services transport: annotated review of selected outcomes-related literature.

    Science.gov (United States)

    Thomas, Stephen H; Cheema, Farah; Cumming, Melissa; Wedel, Suzanne K; Thomson, David

    2002-01-01

    While helicopter emergency medical services (HEMS) has its roots in military transport of wounded soldiers, rotor-wing transport is also used for a wide variety of nontrauma indications. Despite this common use of HEMS for noninjured patients, a Medline search found little systematic review of the literature pertinent to HEMS use for nontrauma. With HEMS utilization subject to appropriately increased scrutiny, those seeking to research HEMS utility in noninjured patients could benefit from existence of a collection of the topical literature. This paper aims to provide such a review, in the form of an annotated bibliography of Index Medicus journal studies assessing potential medical risks and benefits of HEMS transport for noninjured patients. The paper's goal is to provide a useful resource for those interested in pursuing more focused review of various sectors of the nontrauma HEMS literature. As such, the main objective of the article summaries is to provide a brief outline of study design and results; there is also limited editorial comment included after each summary. PMID:11962576

  3. A review of medical robotics for minimally invasive soft tissue surgery.

    Science.gov (United States)

    Dogangil, G; Davies, B L; Rodriguez y Baena, F

    2010-01-01

    This paper provides an overview of recent trends and developments in medical robotics for minimally invasive soft tissue surgery, with a view to highlight some of the issues posed and solutions proposed in the literature. The paper includes a thorough review of the literature, which focuses on soft tissue surgical robots developed and published in the last five years (between 2004 and 2008) in indexed journals and conference proceedings. Only surgical systems were considered; imaging and diagnostic devices were excluded from the review. The systems included in this paper are classified according to the following surgical specialties: neurosurgery; eye surgery and ear, nose, and throat (ENT); general, thoracic, and cardiac surgery; gastrointestinal and colorectal surgery; and urologic surgery. The systems are also cross-classified according to their engineering design and robotics technology, which is included in tabular form at the end of the paper. The review concludes with an overview of the field, along with some statistical considerations about the size, geographical spread, and impact of medical robotics for soft tissue surgery today. PMID:20718269

  4. Recruiting for health, medical or psychosocial research using Facebook: Systematic review

    Directory of Open Access Journals (Sweden)

    Louise Thornton

    2016-05-01

    Full Text Available Recruiting participants is a challenge for many health, medical and psychosocial research projects. One tool more frequently being used to improve recruitment is the social networking website Facebook. A systematic review was conducted to identify studies that have used Facebook to recruit participants of all ages, to any psychosocial, health or medical research. 110 unique studies that used Facebook as a recruitment source were included in the review. The majority of studies used a cross-sectional design (80% and addressed a physical health or disease issue (57%. Half (49% of the included studies reported specific details of the Facebook recruitment process. Researchers paid between $1.36 and $110 per completing participants (Mean = $17.48, SD = $23.06. Among studies that examined the representativeness of their sample, the majority concluded (86% their Facebook-recruited samples were similarly representative of samples recruited via traditional methods. These results indicate that Facebook is an effective and cost-efficient recruitment method. Researchers should consider their target group, advertisement wording, offering incentives and no-cost methods of recruitment when considering Facebook as a recruitment source. It is hoped this review will assist researchers to make decisions regarding the use of Facebook as a recruitment tool in future research.

  5. Complete Genome Sequence of a Klebsiella pneumoniae Strain Carrying blaNDM-1 on a Multidrug Resistance Plasmid

    Science.gov (United States)

    Lau, Anna F.; Palmore, Tara N.; Frank, Karen M.; Segre, Julia A.

    2016-01-01

    Here, we report the genome sequence of a blaNDM-1-positive Klebsiella pneumoniae AATZP isolate cultured from a perirectal surveillance swab collected upon admission of a patient to the NIH Clinical Center in 2014. Genome sequencing of this isolate revealed three plasmids, including one carrying the blaNDM-1 gene encoding resistance to carbapenems. PMID:27417839

  6. Content analysis of oncology-related pharmaceutical advertising in a peer-reviewed medical journal.

    Directory of Open Access Journals (Sweden)

    Kan Yonemori

    Full Text Available BACKGROUND: The oncology market represents one of the largest pharmaceutical markets in any medical field, and printed advertising in medical journals is an important channel by which pharmaceutical companies communicate with healthcare professionals. The aim of the present study was to analyze the volume and content of and trends and changes in oncology-related advertising intended for healthcare professionals in a peer-reviewed medical journal. Information that could be included in advertisements to promote drug development and improve treatment strategies for cancer patients is discussed on the basis of the results of the analysis. METHODS/PRINCIPAL FINDINGS: Overall, 6,720 advertisements covering 13,039 pages in a leading oncology medical journal published (by the American Society of Clinical Oncology between January 2005 and December 2009 were analyzed. The advertisements targeting pharmaceuticals and clinical trials, in particular, were reviewed. A total of 6,720 advertisements covering 13,039 pages were included in the analysis. For the years 2005-2009, the percentages of total journal pages dedicated to advertising were 24.0%, 45.7%, 49.8%, 46.8%, and 49.8%, respectively. Package insert information and efficacy and safety explanations appeared in more than 80% of advertisements intended for pharmaceutical promotion. From 2005 to 2009, the overall quantity of drug advertisements decreased by approximately 13%, whereas advertisements calling for the enrollment of patients into registration trials increased by approximately 11%. CONCLUSION/SIGNIFICANCE: Throughout the study period, oncology-related pharmaceutical advertisements occupied a considerable number of pages relative to other journal content. The proportion of advertisements on ongoing clinical trials increased progressively throughout the study period.

  7. The Education Review Board: A Mechanism for Managing Potential Conflicts of Interest in Medical Education.

    Science.gov (United States)

    Borus, Jonathan F; Alexander, Erik K; Bierer, Barbara E; Bringhurst, F Richard; Clark, Christopher; Klanica, Kaley E; Stewart, Erin C; Friedman, Lawrence S

    2015-12-01

    Concerns about the influence of industry support on medical education, research, and patient care have increased in both medical and political circles. Some academic medical centers, questioning whether industry support of medical education could be appropriate and not a conflict of interest, banned such support. In 2009, a Partners HealthCare System commission concluded that interactions with industry remained important to Partners' charitable academic mission and made recommendations to transparently manage such relationships. An Education Review Board (ERB) was created to oversee and manage all industry support of Partners educational activities.Using a case review method, the ERB developed guidelines to implement the commission's recommendations. A multi-funder rule was established that prohibits industry support from only one company for any Partners educational activity. Within that framework, the ERB established guidelines on industry support of educational conferences, clinical fellowships, and trainees' expenses for attending external educational programs; gifts of textbooks and other educational materials; promotional opportunities associated with Partners educational activities; Partners educational activities under contract with an industry entity; and industry-run programs using Partners resources.Although many changes have resulted from the implementation of the ERB guidelines, the number of industry grants for Partners educational activities has remained relatively stable, and funding for these activities declined only moderately during the first three full calendar years (2011-2013) of ERB oversight. The ERB continually educates both the Partners community and industry about the rationale for its guidelines and its openness to their refinement in response to changes in the external environment. PMID:26083402

  8. Review of cases of nosocomial Lassa fever in Nigeria: the high price of poor medical practice.

    Science.gov (United States)

    Fisher-Hoch, S. P.; Tomori, O.; Nasidi, A.; Perez-Oronoz, G. I.; Fakile, Y.; Hutwagner, L.; McCormick, J. B.

    1995-01-01

    OBJECTIVE--To investigate two hospital outbreaks of Lassa fever in southern central Nigeria. SETTING--Hospitals and clinics in urban and rural areas of Imo State, Nigeria. DESIGN--Medical records were reviewed in hospitals and clinics in both areas. Patients with presumed and laboratory confirmed Lassa fever were identified and contracts traced. Hospital staff, patients, and local residents were questioned, records were carefully reviewed, and serum samples were taken. Serum samples were assayed for antibody specific to Lassa virus, and isolates of Lassa virus were obtained. RESULTS--Among 34 patients with Lassa fever, including 20 patients, six nurses, two surgeons, one physician, and the son of a patient, there were 22 deaths (65% fatality rate). Eleven cases were laboratory confirmed, five by isolation of virus. Most patients had been exposed in hospitals (attack rate in patients in one hospital 55%). Both outbreak hospitals were inadequately equipped and staffed, with poor medical practice. Compelling, indirect evidence revealed that parenteral drug rounds with sharing of syringes, conducted by minimally educated and supervised staff, fuelled the epidemic among patients. Staff were subsequently infected during emergency surgery and while caring for nosocomially infected patients. CONCLUSION--This outbreak illustrates the high price exacted by the practice of modern medicine, particularly use of parenteral injections and surgery, without due attention to good medical practice. High priority must be given to education of medical staff in developing countries and to guidelines for safe operation of clinics and hospitals. Failure to do so will have far reaching, costly, and ultimately devastating consequences. PMID:7580496

  9. A Systematic Review and Meta-Analysis of Medical Students' Perspectives on the Engagement in Research.

    Science.gov (United States)

    Naing, Cho; Wai, Victor Nyunt; Durham, Jo; Whittaker, Maxine A; Win, Ni Ni; Aung, Kyan; Mak, Joon Wah

    2015-07-01

    Engaging students in active learning lies at the center of effective higher education. In medical schools, students' engagement in learning and research has come under increasing attention. The objective of this study was to synthesize evidence on medical students' perspectives on the engagement in research. We performed a systematic review and meta-analysis. Relevant studies were searched in electronic databases. The methodological quality of the included studies was assessed. Overall, 14 observational studies (with 17 data sets) were included. In general, many studies did not use the same questionnaires and the outcome measurements were not consistently reported; these presented some difficulties in pooling the results. Whenever data permitted, we performed pooled analysis for the 4 education outcomes. A Bayesian meta-analytical approach was supplemented as a measure of uncertainty. A pooled analysis showed that 74% (95% confidence interval [CI]: 1.57%-11.07%; I2: 95.2%) of those students who engaged in research (while at the medical school) had positive attitudes toward their research experiences, whereas 49.5% (95% CI: 36.4%-62.7%; I2: 93.4%) had positive attitudes toward the study of medical sciences, 62.3% (95% CI: 46.7%-77.9%; I2: 96.3%) had self-reported changes in their practices, and 64% (95% CI: 30.8%-96.6%; I2: 98.5%) could have published their work. There was substantial heterogeneity among studies. We acknowledged the caveats and the merit of the current review. Findings showed that engagement in research resulted in favorable reactions toward research and academic learning. Future well-designed studies using standardized research tools on how to engage students in research are recommended. PMID:26181541

  10. A Systematic Review and Meta-Analysis of Medical Students’ Perspectives on the Engagement in Research

    Science.gov (United States)

    Naing, Cho; Wai, Victor Nyunt; Durham, Jo; Whittaker, Maxine A.; Win, Ni Ni; Aung, Kyan; Mak, Joon Wah

    2015-01-01

    Abstract Engaging students in active learning lies at the center of effective higher education. In medical schools, students’ engagement in learning and research has come under increasing attention. The objective of this study was to synthesize evidence on medical students’ perspectives on the engagement in research. We performed a systematic review and meta-analysis. Relevant studies were searched in electronic databases. The methodological quality of the included studies was assessed. Overall, 14 observational studies (with 17 data sets) were included. In general, many studies did not use the same questionnaires and the outcome measurements were not consistently reported; these presented some difficulties in pooling the results. Whenever data permitted, we performed pooled analysis for the 4 education outcomes. A Bayesian meta-analytical approach was supplemented as a measure of uncertainty. A pooled analysis showed that 74% (95% confidence interval [CI]: 1.57%–11.07%; I2: 95.2%) of those students who engaged in research (while at the medical school) had positive attitudes toward their research experiences, whereas 49.5% (95% CI: 36.4%–62.7%; I2: 93.4%) had positive attitudes toward the study of medical sciences, 62.3% (95% CI: 46.7%–77.9%; I2: 96.3%) had self-reported changes in their practices, and 64% (95% CI: 30.8%–96.6%; I2: 98.5%) could have published their work. There was substantial heterogeneity among studies. We acknowledged the caveats and the merit of the current review. Findings showed that engagement in research resulted in favorable reactions toward research and academic learning. Future well-designed studies using standardized research tools on how to engage students in research are recommended. PMID:26181541

  11. Standards of Helicopter Emergency Medical Service (HEMS for Patient Transport in Urban Areas: Review article

    Directory of Open Access Journals (Sweden)

    M Bahrami

    2008-06-01

    Full Text Available Background: Aeromedical transport provides immediate advanced medical treatment for certain critically ill and injured patients, bringing about rapid treatment and decreasing the time of hospitalization. With the great expense of helicopter emergency medical services (HEMS, research and review of experience is conducted to determine areas in which the enforcement of standards will enable the effective and optimal use of HEMS.Methods: We examined peer-reviewed published articles in French, English and Persian journals and medical texts to determine the best use of, and standards for, HEMS.Results: We found that HEMS effectively improves health care in three categories of services: the rapid transportation of medical personnel/equipment to an accident and of patients to the hospital (primary response; meeting road ambulances at an intermediate point coming from a hospital or accident to transport patients to a hospital (secondary response; the planned urgent inter-hospital transfers of critically ill patients for specialized care (tertiary response. HEMS standards have been set for: the flight equipment and crew, the types of emergencies to which HEMS should respond, the optimal length of time for each part of the mission (call out time, response time, on-scene time, transport time, and total rescue time and the affect on patient survival. Some other standards include: algorithms for patient screening, flight heights for different diseases and injuries, rooftop and parking garage helipad at hospital, approach of flight paths and the facility at the touchdown area. HEMS standard medical equipment includes those needed for telemedicine and basic and advanced life support. Standard drugs on board the HEMS vehicle depends on the type of the missions selected for HEMS. The area of medical crew members, as well as their fundamental and the continuing training, also has standards that must be met. The standard scoring system for severity of injury, and

  12. The Medical Nutritional Therapy for Glycogen Storage Diseases:Case Report and Literature Review

    Institute of Scientific and Technical Information of China (English)

    Chun-wei LI; Kang YU; Rong-rong LI; Ming LI; Min-jie ZHANG

    2014-01-01

    Glycogen storage diseases (GSDs) are a group of inherited metabolic diseases caused by inherited defects in one of enzymes in glycogenolysis or/and gluconeogenesis. The morbidity of GSDs ranges from 0.04% to 0.05%, according to European data. Since limited data are available, more studies are needed in diagnosis and treatment of GSDs. To date, medical nutritional therapy (MNT) has become an effective measure in improving the clinical outcome of GSDs patients. We reported 4 cases of GSDs with different manifestations, including hypoglycemia, hepatomegaly, splenomegaly and growth retardation. We also provided individualized nutritional interventions and literature review was conducted as well.

  13. Conjoined twins: three cases in one tertiary medical center and literature review.

    Science.gov (United States)

    Kongling, L; Shi, X; Yao, Q

    2014-01-01

    Conjoined twins are so rare that most obstetricians will not be personally exposed to such cases during their professional lifetimes. The authors report three cases including one of dicephalic parapagus conjoined twins and two thoracopagus conjoined twins in the present tertiary medical center, and discuss the diagnosis and management details. They also review the incidence, embryological, diagnostic, obstetrical, and prognostic aspects of conjoined twins. Regular antenatal visits and serial ultrasound scanning are crucial for early diagnosis of conjoined twins, optimal obstetric management and perinatal preparation still remain challenging, and multidisciplinary cooperation is urgently needed. PMID:25864269

  14. Medical Hypotheses 2006 impact factor rises to 1.3--a vindication of the 'editorial review' system for revolutionary science.

    Science.gov (United States)

    Charlton, Bruce G

    2007-01-01

    The Thomson Scientific Impact Factor (IF) for Medical Hypotheses has risen to 1.299 for 2006. This means that the IF has more than doubled since 2004, when it stood at 0.607. Using Elsevier's Scopus database; in 2004 there were 437 citations to Medical Hypotheses papers published in the previous two years--by 2006 this had trebled to 1216 citations. Monthly internet usage of Medical Hypotheses run at an average of about 26000 papers downloaded per month. An IF of 1.3 means that Medical Hypotheses has now entered the mainstream level of 'respectable' medical journals, in terms of its usage by other scientists. This is particularly pleasing given the aim of the journal is to publish radical and speculative ideas. A healthy IF is important to Medical Hypotheses because the journal deploys a system of editorial review, rather than peer review, for evaluation and selection of papers. Editorial review involves selection of a journal's content primarily by an editor who has broad experience and competence in the field, assisted by a relatively small editorial advisory board. The great advantage of editorial review is that it is able, by policy, to favour the publication of revolutionary science. But since editorial review relies on hard-to-quantify and non-transparent individual judgments, it is important for its outcomes to be open to objective evaluations. Scientometric measures of usage such as citations, impact factors and downloads constitute objective evidence concerning a journal's usefulness. Since Medical Hypotheses is performing adequately by such criteria, this provides a powerful answer to those who fetishize peer review and regard any other system of evaluation as suspect. Journal review procedures are merely a means to the end, and the end is a journal that serves a useful function in the dynamic process of science. Medical Hypotheses can now claim to perform such a role. PMID:17706892

  15. General practitioners' views of pharmacists' current and potential contributions to medication review and prescribing in New Zealand

    Directory of Open Access Journals (Sweden)

    Hatah E

    2013-09-01

    Full Text Available INTRODUCTION: Internationally, non-medical practitioners are increasingly involved in tasks traditionally undertaken by general practitioners (GPs, such as medication review and prescribing. This study aims to evaluate GPs' perceptions of pharmacists' contributions to those services. METHODS: Semi-structured interviews were carried out in two localities with GPs whose patients had and had not undergone a pharmacist-led adherence support Medication Use Review (MUR. GPs were asked their opinions of pharmacists' provision of MUR, clinical medication review and prescribing. Data were analysed thematically using NVivo 8 and grouped by strengths, weaknesses, opportunities and threats (SWOT category. FINDINGS: Eighteen GPs were interviewed. GPs mentioned their own skills, training and knowledge of clinical conditions. These were considered GPs' major strengths. GPs' perceived weaknesses were their time constraints and heavy workloads. GPs thought pharmacists' strengths were their knowledge of pharmacology and having more time for in-depth medication review than GPs. Nevertheless, GPs felt pharmacist-led medication reviews might confuse patients, and increase GP workloads. GPs were concerned that pharmacist prescribing might include pharmacists making a diagnosis. This is not the proposed model for New Zealand. In general, GPs were more accepting of pharmacists providing medication reviews than of pharmacist prescribing, unless appropriate controls, close collaboration and co-location of services took place. CONCLUSION: GPs perceived their own skills were well suited to reviewing medication and prescribing, but thought pharmacists might also have strengths and skills in these areas. In future, GPs thought that working together with pharmacists in these services might be possible in a collaborative setting.

  16. Beyond the Standard Curriculum: A Review of Available Opportunities for Medical Students to Prepare for a Career in Radiation Oncology

    International Nuclear Information System (INIS)

    Purpose: To review currently available opportunities for medical students to supplement their standard medical education to prepare for a career in radiation oncology. Methods and Materials: Google and PubMed were used to identify existing clinical, health policy, and research programs for medical students in radiation oncology. In addition, results publicly available by the National Resident Matching Program were used to explore opportunities that successful radiation oncology applicants pursued during their medical education, including obtaining additional graduate degrees. Results: Medical students can pursue a wide variety of opportunities before entering radiation oncology. Several national specialty societies, such as the American Society for Radiation Oncology and the Radiological Society of North America, offer summer internships for medical students interested in radiation oncology. In 2011, 30% of allopathic senior medical students in the United States who matched into radiation oncology had an additional graduate degree, including PhD, MPH, MBA, and MA degrees. Some medical schools are beginning to further integrate dedicated education in radiation oncology into the standard 4-year medical curriculum. Conclusions: To the authors' knowledge, this is the first comprehensive review of available opportunities for medical students interested in radiation oncology. Early exposure to radiation oncology and additional educational training beyond the standard medical curriculum have the potential to create more successful radiation oncology applicants and practicing radiation oncologists while also promoting the growth of the field. We hope this review can serve as guide to radiation oncology applicants and mentors as well as encourage discussion regarding initiatives in radiation oncology opportunities for medical students

  17. A holistic review of the medical school admission process: examining correlates of academic underperformance

    Directory of Open Access Journals (Sweden)

    Terry D. Stratton

    2014-04-01

    Full Text Available Background: Despite medical school admission committees’ best efforts, a handful of seemingly capable students invariably struggle during their first year of study. Yet, even as entrance criteria continue to broaden beyond cognitive qualifications, attention inevitably reverts back to such factors when seeking to understand these phenomena. Using a host of applicant, admission, and post-admission variables, the purpose of this inductive study, then, was to identify a constellation of student characteristics that, taken collectively, would be predictive of students at-risk of underperforming during the first year of medical school. In it, we hypothesize that a wider range of factors than previously recognized could conceivably play roles in understanding why students experience academic problems early in the medical educational continuum. Methods: The study sample consisted of the five most recent matriculant cohorts from a large, southeastern medical school (n=537. Independent variables reflected: 1 the personal demographics of applicants (e.g., age, gender; 2 academic criteria (e.g., undergraduate grade point averages [GPA], medical college admission test; 3 selection processes (e.g., entrance track, interview scores, committee votes; and 4 other indicators of personality and professionalism (e.g., Mayer-Salovey-Caruso Emotional Intelligence Test™ emotional intelligence scores, NEO PI-R™ personality profiles, and appearances before the Professional Code Committee [PCC]. The dependent variable, first-year underperformance, was defined as ANY action (repeat, conditionally advance, or dismiss by the college's Student Progress and Promotions Committee (SPPC in response to predefined academic criteria. This study protocol was approved by the local medical institutional review board (IRB. Results: Of the 537 students comprising the study sample, 61 (11.4% met the specified criterion for academic underperformance. Significantly increased

  18. US biosimilar pathway unlikely to be used: developers will opt for a traditional BLA filing.

    Science.gov (United States)

    Wiatr, Claudia

    2011-02-01

    In March 2010, the US passed the healthcare reform bill, including The Biologics Price Competition and Innovation Act of 2009, which established an abbreviated Biologic License Application (aBLA) pathway for the approval of biosimilars. The aBLA pathway may never be used. At the "Business of Biosimilars" meeting in Boston in September, developers of both innovator and generic biologics as well as representatives from the scientific, regulatory, and legal communities noted that, because of unclear requirements for clinical data and the need for public disclosure of proprietary data, manufacturers of generic biologics are unlikely to take advantage of the aBLA process, opting instead for a standard Biologic License Application (BLA). The implications of an unusable biosimilars pathway in the US dampen our already soft outlook for biosimilars. Companies will still develop follow-on biologics, but approved compounds will behave as new branded drugs. Biosimilars in the US are therefore not likely to lead to aggressive pricing, but will more likely mirror current situations where several similar biologics are available. For example, the interferon (IFN) β-1a products Avonex® and Rebif®, and Betaseron® (IFN β-1b) have all enjoyed >10% price increases for the last several years in spite of their clinical similarities. inThought reiterates its outlook for generic erosion of a typical biologic that projects a loss of revenue of 30% over 5 years compared to the 90% revenue loss for a typical branded small molecule. PMID:21222498

  19. Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients.

    LENUS (Irish Health Repository)

    Pope, George

    2012-01-31

    OBJECTIVES: to evaluate specialist geriatric input and medication review in patients in high-dependency continuing care. DESIGN: prospective, randomised, controlled trial. SETTING: two residential continuing care hospitals. PARTICIPANTS: two hundred and twenty-five permanent patients. INTERVENTION: patients were randomised to either specialist geriatric input or regular input. The specialist group had a medical assessment by a geriatrician and medication review by a multidisciplinary expert panel. Regular input consisted of review as required by a medical officer attached to each ward. Reassessment occurred after 6 months. RESULTS: one hundred and ten patients were randomised to specialist input and 115 to regular input. These were comparable for age, gender, dependency levels and cognition. After 6 months, the total number of medications per patient per day fell from 11.64 to 11.09 in the specialist group (P = 0.0364) and increased from 11.07 to 11.5 in the regular group (P = 0.094). There was no significant difference in mortality or frequency of acute hospital transfers (11 versus 6 in the specialist versus regular group, P = 0.213). CONCLUSION: specialist geriatric assessment and medication review in hospital continuing care resulted in a reduction in medication use, but at a significant cost. No benefits in hard clinical outcomes were demonstrated. However, qualitative benefits and lower costs may become evident over longer periods.

  20. SU-E-P-01: An Informative Review On the Role of Diagnostic Medical Physicist in the Academic and Private Medical Centers

    International Nuclear Information System (INIS)

    Purpose: The role of physicist in the academic and private hospital environment continues to evolve and expand. This becomes more obvious with the newly revised requirements of the Joint Commission (JC) on imaging modalities and the continued updated requirements of ACR accreditation for medical physics (i.e., starting in June 2014, a physicists test will be needed before US accreditation). We provide an informative review on the role of diagnostic medical physicist and hope that our experience will expedite junior physicists in understanding their role in medical centers, and be ready to more opportunities. Methods: Based on our experience, diagnostic medical physicists in both academic and private medical centers perform several clinical functions. These include providing clinical service and physics support, ensuring that all ionizing radiation devices are tested and operated in compliance with the State and Federal laws, regulations and guidelines. We also discuss the training and education required to ensure that the radiation exposure to patients and staff is as low as reasonably achievable. We review the overlapping roles of medical and health physicist in some institutions. Results: A detailed scheme on the new requirements (effective 7/1/2014) of the JC is provided. In 2015, new standards for fluoroscopy, cone beam CT and the qualifications of staff will be phased in. A summary of new ACR requirements for different modalities is presented. Medical physicist have other duties such as sitting on CT and fluoroscopy committees for protocols design, training of non-radiologists to meet the new fluoroscopy rules, as well as helping with special therapies such as Yittrium 90 cases. Conclusion: Medical physicists in both academic and private hospitals are positioned to be more involved and prominent. Diagnostic physicists need to be more proactive to involve themselves in the day to day activities of the radiology department

  1. SU-E-P-01: An Informative Review On the Role of Diagnostic Medical Physicist in the Academic and Private Medical Centers

    Energy Technology Data Exchange (ETDEWEB)

    Weir, V [Baylor Health Care System, Dallas, TX (United States); Zhang, J [University of Kentucky, Lexington, KY (United States)

    2014-06-01

    Purpose: The role of physicist in the academic and private hospital environment continues to evolve and expand. This becomes more obvious with the newly revised requirements of the Joint Commission (JC) on imaging modalities and the continued updated requirements of ACR accreditation for medical physics (i.e., starting in June 2014, a physicists test will be needed before US accreditation). We provide an informative review on the role of diagnostic medical physicist and hope that our experience will expedite junior physicists in understanding their role in medical centers, and be ready to more opportunities. Methods: Based on our experience, diagnostic medical physicists in both academic and private medical centers perform several clinical functions. These include providing clinical service and physics support, ensuring that all ionizing radiation devices are tested and operated in compliance with the State and Federal laws, regulations and guidelines. We also discuss the training and education required to ensure that the radiation exposure to patients and staff is as low as reasonably achievable. We review the overlapping roles of medical and health physicist in some institutions. Results: A detailed scheme on the new requirements (effective 7/1/2014) of the JC is provided. In 2015, new standards for fluoroscopy, cone beam CT and the qualifications of staff will be phased in. A summary of new ACR requirements for different modalities is presented. Medical physicist have other duties such as sitting on CT and fluoroscopy committees for protocols design, training of non-radiologists to meet the new fluoroscopy rules, as well as helping with special therapies such as Yittrium 90 cases. Conclusion: Medical physicists in both academic and private hospitals are positioned to be more involved and prominent. Diagnostic physicists need to be more proactive to involve themselves in the day to day activities of the radiology department.

  2. [Second victims of medical errors: a systematic review of the literature].

    Science.gov (United States)

    Panella, Massimiliano; Rinaldi, Carmela; Vanhaecht, Kris; Donnarumma, Chiara; Tozzi, Quinto; Di Stanislao, Francesco

    2014-01-01

    "Second victims" are health care providers who remain traumatized and suffer at the psycho-physical level after being involved in a patient adverse event. A systematic review of the literature was conducted to: a) estimate the prevalence of second victims among healthcare workers, b) describe personal and work outcomes of second victims, c) identify coping strategies used by second victims to face their problems, and d) describe current support strategies. Findings reveal that the prevalence of "second victims" of medical errors is high, ranging in four studies from 10.4% to 43.3%. Medical errors have a negative impact on healthcare providers involved, leading to physical, cognitive and behavioural symptoms including the practice of defensive medicine. Managers of health organizations need to be aware of the "second victim" phenomenon and ensure adequate support is given to healthcare providers involved. The best strategy seems to be the creation of networks of support at both the individual and organizational levels. More research is needed to evaluate the efficacy of support structures for second victims and to quantify the extent of the practice of defensive medicine following medical error. PMID:24770362

  3. Switching from brand-name to generic psychotropic medications: a literature review.

    Science.gov (United States)

    Desmarais, Julie Eve; Beauclair, Linda; Margolese, Howard C

    2011-12-01

    Generic medications do not undergo the rigorous approval process required of original medications. Their effectiveness and safety is expected to be equal to that of their more expensive counterparts. However, several case reports and studies describe clinical deterioration and decreased tolerability with generic substitution. Pubmed was searched from January 1, 1974 to March 1, 2010. The MeSH term "generic, drugs" was combined with "anticonvulsants," "mood stabilizers," "lithium," "antidepressants," "antipsychotics," "anxiolytics," and "benzodiazepines." Additional articles were obtained by searching the bibliographies of relevant references. Articles in English, French, or Spanish were considered if they discussed clinical equivalence of generic and brand-name medications, generic substitution, or issues about effectiveness, tolerability, compliance, or economics encountered with generics. Clinical deterioration, adverse effects, and changes in pharmacokinetics are described with generic substitution of several anticonvulsants/mood stabilizers (carbamazepine, valproate, lamotrigine, gabapentin, topiramate, lithium), antidepressants (amitriptyline, nortriptyline, desipramine, fluoxetine, paroxetine, citalopram, sertraline, venlafaxine, mirtazapine, bupropion), antipsychotics (risperidone, clozapine), and anxiolytics (clonazepam, alprazolam). Generics do not always lead to the anticipated monetary savings and also raise compliance issues. Although the review is limited by publication bias and heterogeneity of the studies in the literature, we believe there is enough concern to advise generic switching on an individual basis with close monitoring throughout the transition. Health professionals should be aware of the stakes around generic substitution especially when health economics promote universal use of generics. PMID:21114789

  4. Review of cost-effectiveness analysis of medical treatment for myocardial infarction

    Directory of Open Access Journals (Sweden)

    Yanmei Liu

    2011-01-01

    Full Text Available Objectives: Myocardial infarction (MI is a leading cause of death in both the industrialized and developing countries globally. The economic evaluation of MI is undertaken to rationale the allocation of scarce healthcare resource. The objective is to review cost-effectiveness analysis of MI with medications. Methods: We searched PubMed using the key words: "cost effectiveness analysis" and "myocardial infarction". After applying the selection criteria, eight articles were selected for the present study. Results: Out of eight articles, five had studied thrombolytic agents. All of these papers clearly explain the costs and benefits of different drugs for MI. ICER was assessed in six out of the eight articles to compare the costs and health effects between alternative medications. ICER was expressed in different effect units. Conclusions: This study found that various medications including thrombolytic agents, ACEI and heparin are administered to treat MI in many countries. It is also found that five of eight studies focus on thrombolytic therapies. It implies that thrombolytic is generally very cost effective for MI to the whole society.

  5. Psychotropic Medications in Children with Autism Spectrum Disorders: A Systematic Review and Synthesis for Evidence-Based Practice

    Science.gov (United States)

    Siegel, Matthew; Beaulieu, Amy A.

    2012-01-01

    This paper presents a systematic review, rating and synthesis of the empirical evidence for the use of psychotropic medications in children with autism spectrum disorders (ASD). Thirty-three randomized controlled trials (RCTs) published in peer-reviewed journals qualified for inclusion and were coded and analyzed using a systematic evaluative…

  6. Factor analysis methods and validity evidence: A systematic review of instrument development across the continuum of medical education

    Science.gov (United States)

    Wetzel, Angela Payne

    Previous systematic reviews indicate a lack of reporting of reliability and validity evidence in subsets of the medical education literature. Psychology and general education reviews of factor analysis also indicate gaps between current and best practices; yet, a comprehensive review of exploratory factor analysis in instrument development across the continuum of medical education had not been previously identified. Therefore, the purpose for this study was critical review of instrument development articles employing exploratory factor or principal component analysis published in medical education (2006--2010) to describe and assess the reporting of methods and validity evidence based on the Standards for Educational and Psychological Testing and factor analysis best practices. Data extraction of 64 articles measuring a variety of constructs that have been published throughout the peer-reviewed medical education literature indicate significant errors in the translation of exploratory factor analysis best practices to current practice. Further, techniques for establishing validity evidence tend to derive from a limited scope of methods including reliability statistics to support internal structure and support for test content. Instruments reviewed for this study lacked supporting evidence based on relationships with other variables and response process, and evidence based on consequences of testing was not evident. Findings suggest a need for further professional development within the medical education researcher community related to (1) appropriate factor analysis methodology and reporting and (2) the importance of pursuing multiple sources of reliability and validity evidence to construct a well-supported argument for the inferences made from the instrument. Medical education researchers and educators should be cautious in adopting instruments from the literature and carefully review available evidence. Finally, editors and reviewers are encouraged to recognize

  7. Cardiovascular safety of type 2 diabetes medications: Review of existing literature and clinical implications.

    Science.gov (United States)

    Paredes, Sílvia; Matta-Coelho, Claudia; Monteiro, Ana Margarida; Brás, Alice; Marques, Olinda; Alves, Marta; Ribeiro, Laura

    2016-04-01

    Type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD) and the cardiovascular effect of antidiabetic drugs are today critical medical issues, with the prevalence of T2DM in particular showing a steep increase worldwide, mainly due to unhealthy lifestyle habits. T2DM in association with obesity and other cardiovascular risk factors, results in the development of CVD, the leading cause of morbidity and mortality in patients with T2DM. Thus, treatment of T2DM is an individualized and complex challenge in which targeting cardiovascular risk factors is an important component in the decision making. Given the cardiovascular adverse events associated with rosiglitazone, both the Food and Drug Administration and the European Medicines Agency currently require the demonstration of cardiovascular safety of new antidiabetic drugs. Consequently, clinical trials to guarantee their cardiovascular safety are now obligatory. This review aims to summarize the available evidence on the cardiovascular effects and safety of the major drugs used in T2DM treatment and also to provide an overview of upcoming and ongoing clinical trials in this field. Our belief is that this review will be of substantial assistance to all medical doctors who are treating diabetic patients, namely primary care physicians, internal medicine doctors, endocrinologists, diabetologists and less well experienced personnel such as young doctors in training. PMID:27376421

  8. Basic practical skills teaching and learning in undergraduate medical education – a review on methodological evidence

    Science.gov (United States)

    Vogel, Daniela; Harendza, Sigrid

    2016-01-01

    Objective: Practical skills are an essential part of physicians’ daily routine. Nevertheless, medical graduates’ performance of basic skills is often below the expected level. This review aims to identify and summarize teaching approaches of basic practical skills in undergraduate medical education which provide evidence with respect to effective students’ learning of these skills. Methods: Basic practical skills were defined as basic physical examination skills, routine skills which get better with practice, and skills which are also performed by nurses. We searched PubMed with different terms describing these basic practical skills. In total, 3467 identified publications were screened and 205 articles were eventually reviewed for eligibility. Results: 43 studies that included at least one basic practical skill, a comparison of two groups of undergraduate medical students and effects on students’ performance were analyzed. Seven basic practical skills and 15 different teaching methods could be identified. The most consistent results with respect to effective teaching and acquisition of basic practical skills were found for structured skills training, feedback, and self-directed learning. Simulation was effective with specific teaching methods and in several studies no differences in teaching effects were detected between expert or peer instructors. Multimedia instruction, when used in the right setting, also showed beneficial effects for basic practical skills learning. Conclusion: A combination of voluntary or obligatory self-study with multimedia applications like video clips in combination with a structured program including the possibility for individual exercise with personal feedback by peers or teachers might provide a good learning opportunity for basic practical skills.

  9. Prevalence and Cause of Self-Medication in Iran: A Systematic Review and Meta-Analysis Article

    Directory of Open Access Journals (Sweden)

    Saber AZAMI-AGHDASH

    2015-12-01

    Full Text Available Background: Nowadays self-medication is one of the most common public health issues in many countries, as well as in Iran. According to need to epidemiological information about self-medication, the aim of this study was to systematic review and meta-analysis of prevalence and cause of self-medication in community setting of Iran.Methods: Required data were collected searching following key words: medication, self-medication, over-the-counter, non-prescription, prevalence, epidemiology, etiology, occurrence and Iran in Google Scholar, PubMed, Scopus, Magiran, SID and IranMedex (from 2000 to 2015. To estimate the overall self-medication prevalence, computer software CMA: 2 applied. In order to report the results, forest plot was employed.Results: Out of 1256 articles, 25 articles entered to study. The overall prevalence of self-medication based on the random effect model was estimated to be 53% (95% CI, lowest= 42%, highest=67%. The prevalence of self-medication in students was 67% (95% CI, lowest=55%, highest=81%, in the household 36% (95% CI, lowest=17%, highest= 77% and in the elderly people 68% (95% CI, lowest=54%, highest=84%.The most important cause of self-medication was mild symptoms of disease. The most important group of disease in which patients self-medicated was respiratory diseases and the most important group of medication was analgesics.Conclusion: The results show a relatively higher prevalence of self-medication among the Iranian community setting as compared to other countries. Raising public awareness, culture building and control of physicians and pharmacies’ performance can have beneficial effects in reduce of prevalence of self-medication. Keywords: Self-medication, Prevalence, Cause, Community setting, Iran

  10. Colistin-Nonsusceptible Pseudomonas aeruginosa Sequence Type 654 with blaNDM-1 Arrives in North America.

    Science.gov (United States)

    Mataseje, L F; Peirano, G; Church, D L; Conly, J; Mulvey, M; Pitout, J D

    2016-01-01

    This study describes 3 different blaNDM-1 genetic platforms in 3 different species obtained from the same patient who was directly transferred to an institution in Calgary, Alberta, Canada, following a prolonged hospital stay in India. The blaNDM-1 in the Escherichia coli isolate was located on a 176-kb IncA/C plasmid contained within an ISCR1 region. The blaNDM-1 in the Providencia rettgeri isolate was located on a 117-kb IncT plasmid contained within Tn3000, while the blaNDM-1 in the Pseudomonas aeruginosa isolate was located on the chromosome within an ISCR3 region. This report highlights the plasticity of the genetic regions and environments associated with blaNDM-1. To the best of our knowledge, this is the first report of P. aeruginosa with blaNDM-1 identified in North America and the first report of blaOXA-181 in P. rettgeri. The P. aeruginosa isolate belonged to the international high-risk sequence type 654 clone and was nonsusceptible to colistin. This case emphasizes the need for the use of appropriate infection prevention and control measures and vigilant screening for carbapenem-resistant Gram-negative bacteria in patients with a history of travel to areas of endemicity, such as the Indian subcontinent. PMID:26824951

  11. Tools used to assess medical students competence in procedural skills at the end of a primary medical degree: a systematic review

    Directory of Open Access Journals (Sweden)

    Marie C. Morris

    2012-08-01

    Full Text Available The objective was to systematically review the literature to identify and grade tools used for the end point assessment of procedural skills (e.g., phlebotomy, IV cannulation, suturing competence in medical students prior to certification. The authors searched eight bibliographic databases electronically – ERIC, Medline, CINAHL, EMBASE, Psychinfo, PsychLIT, EBM Reviews and the Cochrane databases. Two reviewers independently reviewed the literature to identify procedural assessment tools used specifically for assessing medical students within the PRISMA framework, the inclusion/exclusion criteria and search period. Papers on OSATS and DOPS were excluded as they focused on post-registration assessment and clinical rather than simulated competence. Of 659 abstracted articles 56 identified procedural assessment tools. Only 11 specifically assessed medical students. The final 11 studies consisted of 1 randomised controlled trial, 4 comparative and 6 descriptive studies yielding 12 heterogeneous procedural assessment tools for analysis. Seven tools addressed four discrete pre-certification skills, basic suture (3, airway management (2, nasogastric tube insertion (1 and intravenous cannulation (1. One tool used a generic assessment of procedural skills. Two tools focused on postgraduate laparoscopic skills and one on osteopathic students and thus were not included in this review. The levels of evidence are low with regard to reliability – κ = 0.65–0.71 and minimum validity is achieved – face and content. In conclusion, there are no tools designed specifically to assess competence of procedural skills in a final certification examination. There is a need to develop standardised tools with proven reliability and validity for assessment of procedural skills competence at the end of medical training. Medicine graduates must have comparable levels of procedural skills acquisition entering the clinical workforce irrespective of the country of

  12. Voluntary medical male circumcision for HIV prevention and early resumption of sexual activity: a literature review.

    Science.gov (United States)

    Kamath, Veena; Limaye, Rupali J

    2015-01-01

    A number of programs have focused on scale-up and implementation research regarding voluntary medical male circumcision; however, there is limited research with regard to factors and strategies related to abstinence compliance and the effects of resuming sex during the wound healing period (42-day post-circumcision). We searched the literature for peer-reviewed articles examining early resumption of sex during this period. This review identifies factors that may predispose a client to engage in sex during the 42-day postoperative period, examines how early resumption of sex can inhibit wound healing and increase seroconversion, and reviews strategies that may increase adherence to abstinence during the wound healing period. We found that the most common factor that may predispose a client to engage in sex before the end of the postoperative period is marriage or cohabitation with a sexual partner. With regard to the effect of sex during the postoperative period on wound healing and seroconversion, we found that adverse events incurred were mild, and there was an increased risk of seroconversion. The only strategy studied to increase compliance to abstinence during the postoperative period utilized text messaging, and the trial results indicate that text messaging did not increase abstinence compliance. PMID:25738780

  13. Nanoparticles Biosynthesized by Fungi and Yeast: A Review of Their Preparation, Properties, and Medical Applications

    Directory of Open Access Journals (Sweden)

    Amin Boroumand Moghaddam

    2015-09-01

    Full Text Available In the field of nanotechnology, the use of various biological units instead of toxic chemicals for the reduction and stabilization of nanoparticles, has received extensive attention. Among the many possible bio resources, biologically active products from fungi and yeast represent excellent scaffolds for this purpose. Since fungi and yeast are very effective secretors of extracellular enzymes and number of species grow fast and therefore culturing and keeping them in the laboratory are very simple. They are able to produce metal nanoparticles and nanostructure via reducing enzyme intracellularly or extracellularly. The focus of this review is the application of fungi and yeast in the green synthesis of inorganic nanoparticles. Meanwhile the domain of biosynthesized nanoparticles is somewhat novel; the innovative uses in nano medicine in different areas including the delivery of drug, cancer therapy, antibacterial, biosensors, and MRI and medical imaging are reviewed. The proposed signaling pathways of nanoparticles induced apoptosis in cancerous cells and anti-angiogenesis effects also are reviewed. In this article, we provide a short summary of the present study universally on the utilization of eukaryotes like yeast and fungi in the biosynthesis of nanoparticles (NPs and their uses.

  14. A Systematic Literature Review: Workplace Violence Against Emergency Medical Services Personnel

    Science.gov (United States)

    Pourshaikhian, Majid; Abolghasem Gorji, Hassan; Aryankhesal, Aidin; Khorasani-Zavareh, Davood; Barati, Ahmad

    2016-01-01

    Context In spite of the high prevalence and consequences of much workplace violence against emergency medical services personnel, this phenomenon has been given insufficient attention. A systematic review can aid the development of guidelines to reduce violence. Objectives The research question addressed by this paper is, “What are the characteristics and findings of studies on workplace violence against emergency medical services personnel”? Data Sources A systematic literature review was conducted using online databases (PubMed, Scopus, Google Scholar, and Magiran) with the help of experienced librarians. Study Selection Inclusion criteria comprised studies in the English or Persian language and researcher’s access to the full text. There was no limit to the entry of the study design. Exclusion criteria included lack of access to the full text of the article, studies published in unreliable journals or conferences, and studies in which the results were shared with other medical or relief groups and there was no possibility of breaking down the results. Data Extraction A “Data extraction form” was designed by the researchers based on the goals of the study that included the title and author(s), study method (type, place of study, sample size, sampling method, and data collection/analysis tool), printing location, information related to the frequency of types of violence, characteristics of victims /perpetrators, and related factors. Results The papers reviewed utilized a variety of locations and environments, methods, and instrument samplings. The majority of the studies were performed using the quantitative method. No intervention study was found. Most studies focused on the prevalence of violence, and their results indicated that exposure to violence was high. The results are presented in six major themes. Conclusions Workplace violence and injuries incurred from it are extensive throughout the world. The important causes of violence include the

  15. A Systematic Literature Review: Workplace Violence Against Emergency Medical Services Personnel

    Directory of Open Access Journals (Sweden)

    Pourshaikhian

    2016-01-01

    Full Text Available Context In spite of the high prevalence and consequences of much workplace violence against emergency medical services personnel, this phenomenon has been given insufficient attention. A systematic review can aid the development of guidelines to reduce violence. Objectives The research question addressed by this paper is, “What are the characteristics and findings of studies on workplace violence against emergency medical services personnel”? Data Sources A systematic literature review was conducted using online databases (PubMed, Scopus, Google Scholar, and Magiran with the help of experienced librarians. Study Selection Inclusion criteria comprised studies in the English or Persian language and researcher’s access to the full text. There was no limit to the entry of the study design. Exclusion criteria included lack of access to the full text of the article, studies published in unreliable journals or conferences, and studies in which the results were shared with other medical or relief groups and there was no possibility of breaking down the results. Data Extraction A “Data extraction form” was designed by the researchers based on the goals of the study that included the title and author(s, study method (type, place of study, sample size, sampling method, and data collection/analysis tool, printing location, information related to the frequency of types of violence, characteristics of victims /perpetrators, and related factors. Results The papers reviewed utilized a variety of locations and environments, methods, and instrument samplings. The majority of the studies were performed using the quantitative method. No intervention study was found. Most studies focused on the prevalence of violence, and their results indicated that exposure to violence was high. The results are presented in six major themes. Conclusions Workplace violence and injuries incurred from it are extensive throughout the world. The important causes of violence

  16. Multiplex Real-Time PCR Assay for Detection and Classification of Klebsiella pneumoniae Carbapenemase Gene (blaKPC) Variants▿

    OpenAIRE

    Chen, Liang; Mediavilla, José R.; Endimiani, Andrea; Rosenthal, Marnie E.; Zhao, Yanan; Robert A Bonomo; Kreiswirth, Barry N.

    2011-01-01

    Carbapenem resistance mediated by plasmid-borne Klebsiella pneumoniae carbapenemases (KPC) is an emerging problem of significant clinical importance in Gram-negative bacteria. Multiple KPC gene variants (blaKPC) have been reported, with KPC-2 (blaKPC-2) and KPC-3 (blaKPC-3) associated with epidemic outbreaks in New York City and various international settings. Here, we describe the development of a multiplex real-time PCR assay using molecular beacons (MB-PCR) for rapid and accurate identific...

  17. Substantial agreement of referee recommendations at a general medical journal--a peer review evaluation at Deutsches Arzteblatt International.

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    Christopher Baethge

    Full Text Available BACKGROUND: Peer review is the mainstay of editorial decision making for medical journals. There is a dearth of evaluations of journal peer review with regard to reliability and validity, particularly in the light of the wide variety of medical journals. Studies carried out so far indicate low agreement among reviewers. We present an analysis of the peer review process at a general medical journal, Deutsches Ärzteblatt International. METHODOLOGY/PRINCIPAL FINDINGS: 554 reviewer recommendations on 206 manuscripts submitted between 7/2008 and 12/2009 were analyzed: 7% recommended acceptance, 74% revision and 19% rejection. Concerning acceptance (with or without revision versus rejection, there was a substantial agreement among reviewers (74.3% of pairs of recommendations that was not reflected by Fleiss' or Cohen's kappa (<0.2. The agreement rate amounted to 84% for acceptance, but was only 31% for rejection. An alternative kappa-statistic, however, Gwet's kappa (AC1, indicated substantial agreement (0.63. Concordance between reviewer recommendation and editorial decision was almost perfect when reviewer recommendations were unanimous. The correlation of reviewer recommendations and citations as counted by Web of Science was low (partial correlation adjusted for year of publication: -0.03, n.s.. CONCLUSIONS/SIGNIFICANCE: Although our figures are similar to those reported in the literature our conclusion differs from the widely held view that reviewer agreement is low: Based on overall agreement we consider the concordance among reviewers sufficient for the purposes of editorial decision making. We believe that various measures, such as positive and negative agreement or alternative Kappa values are superior to the application of Cohen's or Fleiss' Kappa in the analysis of nominal or ordinal level data regarding reviewer agreement. Also, reviewer recommendations seem to be a poor proxy for citations because, for example, manuscripts will be

  18. Literature review on the tele medical advice for ships (TMAS) 2005-2015

    DEFF Research Database (Denmark)

    Canals, M. Luisa; Jensen, Olaf Chresten; Eliseo Prisno-III, Don;

    Background: The presentation will provide a review of the international scientific literature on telemedical assistance for ships (TMAS) during the latest 10 years. Materials and Methods: The literature search was done in collaboration in the three geographical IMHA-research groups by using Pub......Med and the respective national scientific journals. The search terms used: "telemedicine AND maritime, seafarers, ships, shipping, fishermen, fisherman, fishing, passengers". Results: All the abstracts (n= 54) were entered in the Zotero database and distributed in 5 categories: TMAS cross...... that other interesting articles can be found. Conclusions: The cross-sectional studies show that cardio-vascular disease and injuries form the main parts of the radio medical advice in the merchant, the fishing and the passenger/cruise ships segments. Even if the national TMAS centres have highly...

  19. Physicians’ use of computerized clinical decision supports to improve medication management in the elderly – the Seniors Medication Alert and Review Technology intervention

    Directory of Open Access Journals (Sweden)

    Alagiakrishnan K

    2016-01-01

    Full Text Available Kannayiram Alagiakrishnan,1 Patricia Wilson,2 Cheryl A Sadowski,3 Darryl Rolfson,1 Mark Ballermann,4,5 Allen Ausford,6,7 Karla Vermeer,7 Kunal Mohindra,8 Jacques Romney,9 Robert S Hayward10 1Department of Medicine, Division of Geriatric Medicine, 2Department of Medicine, 3Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 4Chief Medical Information Office, Alberta Health Services, 5Division of Critical Care, Department of Medicine, University of Alberta, 6Department of Family Medicine, University of Alberta, 7Lynwood Family Physician, 8eClinician EMR, Alberta Health Services-Information Systems, 9Department of Medicine, Division of Endocrinology, 10Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada Background: Elderly people (aged 65 years or more are at increased risk of polypharmacy (five or more medications, inappropriate medication use, and associated increased health care costs. The use of clinical decision support (CDS within an electronic medical record (EMR could improve medication safety.Methods: Participatory action research methods were applied to preproduction design and development and postproduction optimization of an EMR-embedded CDS implementation of the Beers’ Criteria for medication management and the Cockcroft–Gault formula for estimating glomerular filtration rates (GFR. The “Seniors Medication Alert and Review Technologies” (SMART intervention was used in primary care and geriatrics specialty clinics. Passive (chart messages and active (order-entry alerts prompts exposed potentially inappropriate medications, decreased GFR, and the possible need for medication adjustments. Physician reactions were assessed using surveys, EMR simulations, focus groups, and semi-structured interviews. EMR audit data were used to identify eligible patient encounters, the frequency of CDS events, how alerts were managed, and when evidence links were followed.Results: Analysis of

  20. Variability in measuring (instrumental) activities of daily living functioning and functional decline in hospitalized older medical patients: a systematic review.

    OpenAIRE

    Buurman, B.M.; Munster, B.C.; Korevaar, J.C.; Haan, R.J. de; Rooij, S.E. de

    2011-01-01

    OBJECTIVE: To study instruments used and definitions applied in order to measure (instrumental) activities of daily living (I [ADL]) functioning and functional decline in hospitalized older medical patients. STUDY DESIGN: We systematically searched Medline, Embase, and the Cochrane Database of Systematic Reviews from 1990 to January 2010. Articles were included if they (1) focused on acute hospitalization for medical illness in older patients; (2) described the instrument used to measure func...

  1. Comparison of methodological quality of positive versus negative comparative studies published in Indian medical journals: a systematic review

    OpenAIRE

    Charan, Jaykaran; Chaudhari, Mayur; Jackson, Ryan; Mhaskar, Rahul; Reljic, Tea; Kumar, Ambuj

    2015-01-01

    Objectives Published negative studies should have the same rigour of methodological quality as studies with positive findings. However, the methodological quality of negative versus positive studies is not known. The objective was to assess the reported methodological quality of positive versus negative studies published in Indian medical journals. Design A systematic review (SR) was performed of all comparative studies published in Indian medical journals with a clinical science focus and im...

  2. Overcoming Structural Constraints to Patient Utilization of Electronic Medical Records: A Critical Review and Proposal for an Evaluation Framework

    OpenAIRE

    Winkelman, Warren J.; Leonard, Kevin J.

    2004-01-01

    There are constraints embedded in medical record structure that limit use by patients in self-directed disease management. Through systematic review of the literature from a critical perspective, four characteristics that either enhance or mitigate the influence of medical record structure on patient utilization of an electronic patient record (EPR) system have been identified: environmental pressures, physician centeredness, collaborative organizational culture, and patient centeredness. An ...

  3. Patients’ perspectives on the medical primary–secondary care interface: systematic review and synthesis of qualitative research

    OpenAIRE

    Sampson, Rod; Cooper, Jamie; Barbour, Rosaline; Polson, Rob; Wilson, Philip

    2015-01-01

    Objectives To synthesise the published literature on the patient experience of the medical primary–secondary care interface and to determine priorities for future work in this field aimed at improving clinical outcomes. Design Systematic review and metaethnographic synthesis of primary studies that used qualitative methods to explore patients’ perspectives of the medical primary–secondary care interface. Setting International primary–secondary care interface. Data sources EMBASE, MEDLINE, CIN...

  4. Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis.

    Science.gov (United States)

    Conn, Vicki S; Ruppar, Todd M; Chase, Jo-Ana D; Enriquez, Maithe; Cooper, Pamela S

    2015-12-01

    This systematic review applied meta-analytic procedures to synthesize medication adherence interventions that focus on adults with hypertension. Comprehensive searching located trials with medication adherence behavior outcomes. Study sample, design, intervention characteristics, and outcomes were coded. Random-effects models were used in calculating standardized mean difference effect sizes. Moderator analyses were conducted using meta-analytic analogues of ANOVA and regression to explore associations between effect sizes and sample, design, and intervention characteristics. Effect sizes were calculated for 112 eligible treatment-vs.-control group outcome comparisons of 34,272 subjects. The overall standardized mean difference effect size between treatment and control subjects was 0.300. Exploratory moderator analyses revealed interventions were most effective among female, older, and moderate- or high-income participants. The most promising intervention components were those linking adherence behavior with habits, giving adherence feedback to patients, self-monitoring of blood pressure, using pill boxes and other special packaging, and motivational interviewing. The most effective interventions employed multiple components and were delivered over many days. Future research should strive for minimizing risks of bias common in this literature, especially avoiding self-report adherence measures. PMID:26560139

  5. Sequence analysis of bla CTX-M-28 , an ESBL responsible for third-generation cephalosporin resistance in Enterobacteriaceae, for the first time in India

    Directory of Open Access Journals (Sweden)

    Kingsley Jemima

    2008-04-01

    Full Text Available The most common group of ESBLs not belonging to the bla TEM or bla SHV families were termed bla CTX-M , to highlight their ESBLs′ greater activity against cefotaxime than against ceftazidime. The presence of nosocomial bla CTX-M-28 -producing Enterobacteriaceae strains has not been reported earlier in Indian hospitals. The sequences of bla CTX-M-28 gene from cephalosporin-resistant Enterobacteriaceae were analyzed. The structural gene encodes a 290 amino-acid protein, which is most related to the bla CTX-M β-lactamases. The conserved K-T-G was identified in the bla CTX-M-28 protein sequence, but significantly, two point mutations (N→T and (F→S were identified in the Y-G-N- and S-T-F-K-conserved motifs respectively. These point mutations were seen in all the three sequenced isolates

  6. What is known about the effects of medical tourism in destination and departure countries? A scoping review

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    Snyder Jeremy

    2010-11-01

    Full Text Available Abstract Background Medical tourism involves patients intentionally leaving their home country to access non-emergency health care services abroad. Growth in the popularity of this practice has resulted in a significant amount of attention being given to it from researchers, policy-makers, and the media. Yet, there has been little effort to systematically synthesize what is known about the effects of this phenomenon. This article presents the findings of a scoping review examining what is known about the effects of medical tourism in destination and departure countries. Methods Drawing on academic articles, grey literature, and media sources extracted from18 databases, we follow a widely used scoping review protocol to synthesize what is known about the effects of medical tourism in destination and departure countries. The review design has three main stages: (1 identifying the question and relevant literature; (2 selecting the literature; and (3 charting, collating, and summarizing the data. Results The large majority of the 203 sources accepted into the review offer a perspective of medical tourism from the Global North, focusing on the flow of patients from high income nations to lower and middle income countries. This greatly shapes any discussion of the effects of medical tourism on destination and departure countries. Five interrelated themes that characterize existing discussion of the effects of this practice were extracted from the reviewed sources. These themes frame medical tourism as a: (1 user of public resources; (2 solution to health system problems; (3 revenue generating industry; (4 standard of care; and (5 source of inequity. It is observed that what is currently known about the effects of medical tourism is minimal, unreliable, geographically restricted and mostly based on speculation. Conclusions Given its positive and negative effects on the health care systems of departure and destination countries, medical tourism is a

  7. Isolation of Enterobacter aerogenes carrying blaTEM-1 and blaKPC-3 genes recovered from a hospital Intensive Care Unit.

    Science.gov (United States)

    Pulcrano, Giovanna; Pignanelli, Salvatore; Vollaro, Adriana; Esposito, Matilde; Iula, Vita Dora; Roscetto, Emanuela; Soriano, Amata Amy; Catania, Maria Rosaria

    2016-06-01

    Enterobacter aerogenes has recently emerged as an important hospital pathogen. In this study, we showed the emergence of E. aerogenes isolates carrying the blaKPC gene in patients colonized by carbapenem-resistant Klebsiella pneumoniae strains. Two multiresistant E. aerogenes isolates were recovered from bronchial aspirates of two patients hospitalized in the Intensive Care Unit at the "Santa Maria della Scaletta" Hospital, Imola. The antimicrobial susceptibility test showed the high resistance to carbapenems and double-disk synergy test confirmed the phenotype of KPC and AmpC production. Other investigation revealed that ESBL and blaKPC genes were carried on the conjugative pKpQIL plasmid. This is a relevant report in Italy that describes a nosocomial infection due to the production of KPC beta-lactamases by an E. aerogenes isolate in patients previously colonized by K. pneumoniae carbapenem-resistant. In conclusion, it's necessary a continuous monitoring of multidrug-resistant strains for the detection of any KPC-producing bacteria that could expand the circulation of carbapenem-resistant pathogens. PMID:27004836

  8. blaGES carrying Pseudomonas aeruginosa isolates from a public hospital in Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Flávia L. P. C. Pellegrino

    2006-08-01

    Full Text Available Previous analysis of Pseudomonas aeruginosa class-1 integrons from Rio de Janeiro, Brazil, revealed the blaGES gene in one isolate. We screened isolates of two widespread PFGE genotypes, A and B, at a public hospital in Rio, for the presence of blaGES. The gene was detected in all seven P. aeruginosa isolates belonging to genotype B. Three of the seven genotype-B isolates were resistant to amikacin, aztreonam, ceftazidime, cefepime, ciprofloxacin, gentamicin, imipenem, meropenem, piperacillin-tazobactam and ticarcillin-clavulanic acid. The other four isolates were resistant to all these agents, except gentamicin, imipenem, meropenem and piperacillin-tazobactam. A synergistic effect between ceftazidime and imipenem or clavulanic acid suggested the production of GES-type ESBL.

  9. Diversity and evolution of blaZ from Staphylococcus aureus and coagulase-negative staphylococci

    DEFF Research Database (Denmark)

    Olsen, John E.; Christensen, Henrik; Aarestrup, Frank Møller

    2006-01-01

    NS) and Staphylococcus aureus of bovine origin. Methods: blaZ was detected in 143 strains of penicillin-resistant S. aureus and CoNS from five Danish cattle herds (n = 25/23), random CoNS isolates from Denmark (n = 37), a collection of S. aureus from six different countries (n = 52), humans in Denmark (n = 3) and beta...... types. The major types all contained strains of both human and bovine origin, and more than one Staphylococcus species, demonstrating a shared gene pool. In a comparison of S. aureus and CoNS obtained from five Danish cattle herds, the same type of blaZ was only detected in one case. Conclusions...

  10. Identification of emergent blaCMY-2-carrying Proteus mirabilis lineages by whole-genome sequencing

    OpenAIRE

    Mac Aogáin, M.; Rogers, T.R.; Crowley, B.

    2016-01-01

    Whole-genome sequencing of 24 Proteus mirabilis isolates revealed the clonal expansion of two cefoxitin-resistant strains among patients with community-onset infection. These strains harboured bla CMY-2 within a chromosomally located integrative and conjugative element and exhibited multidrug resistance phenotypes. A predominant strain, identified in 18 patients, also harboured the PGI-1 genomic island and associated resistance genes, accounting for its broader antibiotic resistance profile. ...

  11. Antibiotic sensitivity pattern in blaNDM-1-positive and carbapenemase-producing Enterobacteriaceae

    OpenAIRE

    Mulla, Summaiya; Charan, Jaykaran; Rajdev, Sangita

    2016-01-01

    Background: Some studies published in recent time revealed that many bacteria from Enterobacteriaceae group are multi-antibiotic-resistant because of the production enzymes carbapenemase particularly New Delhi metallo-beta-lactamase encoded by gene called blaNDM-1. Looking at public health importance of this issue there is a need for studies at other centers to confirm or refute published findings. Objectives: This study was designed with the aim of exploring antibiotic resistance in Enteroba...

  12. From QUOROM to PRISMA: A Survey of High-Impact Medical Journals' Instructions to Authors and a Review of Systematic Reviews in Anesthesia Literature

    OpenAIRE

    Tao, Kun-ming; Li, Xiao-qian; Zhou, Qing-Hui; Moher, David; Ling, Chang-Quan; Yu, Wei-Feng

    2011-01-01

    Background The PRISMA (Preferred Reporting Items of Systematic reviews and Meta-Analyses) Statement was published to help authors improve how they report systematic reviews. It is unknown how many journals mention PRISMA in their instructions to authors, or whether stronger journal language regarding use of PRISMA improves author compliance. Methodology/Principal Findings An Internet-based investigation examined the extent to which 146 leading medical journals have incorporated the PRISMA Sta...

  13. MEDICAL AUDIT OF CHILDREN WITH AMBIGUOUS GENITALIA- REVIEW OF CHILDREN TREATED OVER 18 YEARS

    Directory of Open Access Journals (Sweden)

    Praburam P. M

    2015-10-01

    Full Text Available Introduction: The survival of a newborn or a child presenting with ambiguous genitalia depends upon the timely diagnosis and institution of appropriate medical care. We undertook this study with the aim to determine if appropriate clinical and confirmatory diagnosis was arrived on time and if the treatment instituted was relevant and satisfactory. Methods: All children who were evaluated for ambiguous genitalia under the Department of Pediatric Endocrinology over the preceding 18 years were invited for a review. Data including time taken to make a clinical diagnosis, time taken to confirm the diagnosis, reasons for delay if any, and appropriateness of the sex assigned for rearing and treatment instituted were collected from the charts. Patients were evaluated for adequacy of response to treatment, compliance, problems encountered if any and subjective parental satisfaction. Results: A total of 165 children were diagnosed to have conditions with ambiguous genitalia and were called for a review. 33 children attended the review. 15 were being raised as boys and 18 as girls. 12 children had virilising congenital adrenal hyperplasia (CAH, 6 had cryptorchidism, 6 had hypospadias, 3 had complete and 1 had partial testicular feminisation, 2 had mixed gonadal dysgenesis (MGD, 2 had hypogonadism and 1 was a true hermaphrodite. An appropriate clinical diagnosis was made in 30childrenon the day one and a final confirmatory diagnosis was made within a month in 23. Conclusion: In most conditions presenting with ambiguous genitalia, a clinical and confirmatory diagnosis can be made in a short duration. Initiation of appropriate treatment results in favourable outcomes in terms of growth sexual identity and adaptation.

  14. Adherence, persistence, and medication discontinuation in patients with attention-deficit/hyperactivity disorder – a systematic literature review

    Science.gov (United States)

    Gajria, Kavita; Lu, Mei; Sikirica, Vanja; Greven, Peter; Zhong, Yichen; Qin, Paige; Xie, Jipan

    2014-01-01

    Untreated attention-deficit/hyperactivity disorder (ADHD) can lead to substantial adverse social, economic, and emotional outcomes for patients. The effectiveness of current pharmacologic treatments is often reduced, due to low treatment adherence and medication discontinuation. This current systematic literature review analyzes the current state of knowledge surrounding ADHD medication discontinuation, focusing on: 1) the extent of patient persistence; 2) adherence; and 3) the underlying reasons for patients’ treatment discontinuation and how discontinuation rates and reasons vary across patient subgroups. We selected 91 original studies (67 with persistence/discontinuation results, 26 with adherence results, and 41 with reasons for discontinuation, switching, or nonadherence) and 36 expert opinion reviews on ADHD medication discontinuation, published from 1990 to 2013. Treatment persistence on stimulants, measured by treatment duration during the 12-month follow-up periods, averaged 136 days for children and adolescents and 230 days for adults. Owing to substantial study heterogeneity, comparisons across age or medication type subgroups were generally inconclusive; however, long-acting formulations and amphetamines were associated with longer treatment duration than short-acting formulations and methylphenidates. The medication possession ratio, used to measure adherence, was medication classes during a 12-month period. Adverse effects were the most commonly cited reason for discontinuation in all studies. Original research studies reported the lack of symptom control as a common discontinuation reason, followed by dosing inconvenience, social stigma associated with ADHD medication, and the patient’s attitude. In summary, although there was a lack of consistency in the measurement of adherence and persistence, these findings indicate that drug adherence and persistence are generally poor among patients with ADHD. Clinicians may be able to help improve

  15. Improving medication adherence among kidney transplant recipients: Findings from other industries, patient engagement, and behavioral economics-A scoping review.

    Science.gov (United States)

    Oberlin, Shelley R; Parente, Stephen T; Pruett, Timothy L

    2016-01-01

    The immune system is a powerful barrier to successful organ transplantation, but one that has been routinely thwarted through modern pharmacotherapeutics. Despite the benefits of immunosuppressive therapy, medication non-adherence leads to an increased risk of graft rejection, higher hospital utilization and costs, and poor outcomes. We conduct a scoping review following Arksey and O'Malley's five-stage framework methodology to identify established or novel interventions that could be applied to kidney transplant recipients to improve medication adherence. As the desired outcome is a behavior (taking a pill), we assess three areas: behavioral-focused interventions in other industries, patient engagement theories, and behavioral economic principles. Search strategies included mining business, social sciences, and medical literature with additional guidance from six consultative interviews. Our review suggests that no intervention stands out as superior or likely to be more effective than any other intervention; yet promising strategies and interventions were identified across all three areas examined. Based on our findings, we believe there are five strategies that transplant centers and other organizations can implement to improve medication adherence: (1) Build a foundation of trust; (2) Employ multiple interventions; (3) Stratify the population; (4) Develop collaborative partnerships; and (5) Embed medication adherence into the organization's culture. The effectiveness of these interventions will need to be investigated further, but we believe they are a step in the right direction for organizations to consider in their efforts to improve medication adherence. PMID:26835016

  16. Improving medication adherence among kidney transplant recipients: Findings from other industries, patient engagement, and behavioral economics—A scoping review

    Science.gov (United States)

    Oberlin, Shelley R; Parente, Stephen T; Pruett, Timothy L

    2016-01-01

    The immune system is a powerful barrier to successful organ transplantation, but one that has been routinely thwarted through modern pharmacotherapeutics. Despite the benefits of immunosuppressive therapy, medication non-adherence leads to an increased risk of graft rejection, higher hospital utilization and costs, and poor outcomes. We conduct a scoping review following Arksey and O’Malley’s five-stage framework methodology to identify established or novel interventions that could be applied to kidney transplant recipients to improve medication adherence. As the desired outcome is a behavior (taking a pill), we assess three areas: behavioral-focused interventions in other industries, patient engagement theories, and behavioral economic principles. Search strategies included mining business, social sciences, and medical literature with additional guidance from six consultative interviews. Our review suggests that no intervention stands out as superior or likely to be more effective than any other intervention; yet promising strategies and interventions were identified across all three areas examined. Based on our findings, we believe there are five strategies that transplant centers and other organizations can implement to improve medication adherence: (1) Build a foundation of trust; (2) Employ multiple interventions; (3) Stratify the population; (4) Develop collaborative partnerships; and (5) Embed medication adherence into the organization’s culture. The effectiveness of these interventions will need to be investigated further, but we believe they are a step in the right direction for organizations to consider in their efforts to improve medication adherence. PMID:26835016

  17. Review and state of the art on radiation sterilization of medical devices

    Science.gov (United States)

    Dorpema, J. W.

    Review and state of art of radiation sterilization Radiation as a sterilization method was designed in the years 1950-1960. The decade afterwards the application for sterilization of medical products and devices was developped. Extensive studies performed on both the physical, chemical and (micro) biological aspects revealed the requirements for safety and efficacy. These efforts were highly stimulated by the IAEA and resulted in a elegant sterilization method. In product manufacturing, where sterilization represents a final step in the production sequence, radiation has eversince reached its widest application in the field of medical devices. As a spin off it initiated new ideas and approaches towards sterilization in general. Consequently sterility was redefined in terms of a probabilistic concept (10-6) and the bioburden determination method was introduced as a tool for both quality control and potential instrument for dose setting. However these refinements also created controversies, whereby the dose requirements became divided for Europe and North America. Moreover studies recently performed in Europe suggest even a further extension of this opinion gap. Detailed studies, on the clinical effects of low dose treated products (12.5 - 17.5 kGy) are needed to counterbalance the dose suggestions extracted from statistically based dose determinations (> 28 kGy ) and the microbiological resistance determinations ( > 28 - 30 kGy). Dose setting based on risk classification could be considered for distinct product categories. In the mean time a general acceptance of the originally, in the early seventhies, established minimum dose of 25 kGy would seem a reasonable compromise. As the interest for radiation sterilization as the favourable, non polluting and simple method is increasing rapidly over the last five years, both gamma- and beta driven sterilization plants will be needed. Harmonization on sterilization dose therfore requires high priority.

  18. Should authors submit previous peer-review reports when submitting research papers? Views of general medical journal editors.

    Science.gov (United States)

    Cals, Jochen W L; Mallen, Christian D; Glynn, Liam G; Kotz, Daniel

    2013-01-01

    Publishing research can be time consuming, as papers are often submitted and reviewed by multiple journals before final acceptance. We hypothesized that attaching previous peer-review reports to the next submission of the paper to a different journal (possibly with point-to-point responses and amendments) could decrease the workload for both reviewers and editors and could shorten the time from final draft to actual publication. We therefore performed an online survey to assess the views of the editors-in-chief of all 100 general medical journals from the citation impact factor report category "internal & general medicine" (ISI Web of Knowledge). Of contacted editors, 61% responded. One of 4 journals do currently receive peer-review reports on occasion. Editors recognized potential advantages but also concerns on using previous peer-review reports across 3 themes: scientific community, quality of papers, and the publication process. The use of previous peer-review reports has the potential to facilitate authors, reviewers, and editors in optimizing peer review in general medical science. PMID:23508606

  19. The effect of medicated, sugar-free chewing gum on plaque and clinical parameters of gingival inflammation: a systematic review

    NARCIS (Netherlands)

    R.S. Keukenmeester; D.E. Slot; M.S. Putt; G.A. van der Weijden

    2014-01-01

    Objective This study aimed to systematically review the present literature to establish the clinical effect of medicated, sugar-free chewing gum on plaque indices and parameters of gingival inflammation. Materials and methods MEDLINE-PubMed, Cochrane CENTRAL and EMBASE databases were searched up to

  20. A study of medication reviews to identify drug-related problems of polypharmacy patients in the Dutch nursing home setting

    NARCIS (Netherlands)

    Finkers, F.; Maring, J. G.; Boersma, F.; Taxis, K.

    2007-01-01

    Background: Little is known about the extent of drug-related problems of polypharmacy patients in Dutch nursing homes. Objectives: We investigated the feasibility of teams of hospital pharmacists and nursing home physicians carrying out medication reviews. We aimed to identify the number and nature

  1. Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials.

    NARCIS (Netherlands)

    Knols, R.H.; Aaronson, N.K.; Uebelhart, D.; Fransen, J.; Aufdemkampe, G.

    2005-01-01

    PURPOSE: To systematically review the methodologic quality of, and summarize the evidence from trials examining the effectiveness of physical exercise in improving the level of physical functioning and psychological well-being of cancer patients during and after medical treatment. METHODS: Thirty-fo

  2. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions

    NARCIS (Netherlands)

    Boonstra, Albert; Broekhuis, Manda

    2010-01-01

    Background: The main objective of this research is to identify, categorize, and analyze barriers perceived by physicians to the adoption of Electronic Medical Records (EMRs) in order to provide implementers with beneficial intervention options. Methods: A systematic literature review, based on resea

  3. The Effectiveness of Antidepressant Medication in the Management of Behaviour Problems in Adults with Intellectual Disabilities: A Systematic Review

    Science.gov (United States)

    Sohanpal, S. K.; Deb, S.; Thomas, C.; Soni, R.; Lenotre, L.; Unwin, G.

    2007-01-01

    Background: A comprehensive systematic review was performed to establish the current evidence base regarding the effectiveness of antidepressant medication for the management of behaviour problems in adults with intellectual disabilities. Method: An electronic search of PsycInfo, Embase, Medline and Cinahl databases was conducted spanning the time…

  4. Off-site medical activities, Nevada Test Site and the medical liaison officer network: a historical review

    International Nuclear Information System (INIS)

    The ''off-site'' was originally defined as ''that area surrounding the Nevada Test Site (NTS) for a radius of about 300 miles.'' Prior to 1954, the off-site radiological safety activities were conducted by the Atomic Energy Commission. In 1954, the Public Health Service was given the responsibility for off-site monitoring, and, in addition, a physician was also on temporary assignment. This physician, in addition to functioning as a monitor, also functioned part time as a physical liaison in regard to possible or alleged radiation injury. Medical concern was based upon two crude guidelines: possible radiation ''overexposure'' based upon extrapolation from surface and air radiological monitoring; and determination of actual radiation injury based upon signs and symptoms among people alleging radiation injury. The area of concern expanded to 13 areas surrounding the Nevada Test Site, and in 1956, the first Medical Liaison Officer Network (MLON) was initiated. Over the years, MLON increased to a point where there was a representative from every state in the Union; the area of concern expanded to include the entire United States, parts of the South Pacific, Hawaii, and Alaska; and sophisticated methods of evaluation were added--urine sampling, thyroid scanning, blood counts, and whole-body counting. Epidemiological studies were initiated on body burdens of radionuclides and certain disease clusters

  5. Medication (re)fill adherence measures derived from pharmacy claims data in older Americans: a review of the literature.

    Science.gov (United States)

    Sattler, Elisabeth Lilian Pia; Lee, Jung Sun; Perri, Matthew

    2013-06-01

    Medication nonadherence is a significant public health problem that affects the health and well-being of older Americans while burdening the US healthcare system. Pharmacy claims data have gained importance in deriving objective medication (re)fill adherence measures; however, little is known about application of such measures in older Americans. The objective of this study was to assess the types and characteristics of pharmacy claims-derived medication (re)fill adherence measures used in older Americans. A comprehensive literature search strategy was employed to identify all articles using pharmacy claims data to measure (re)fill adherence to prescription medications in older Americans aged 65+ years. Included were articles reporting original research studies conducted and published in the USA in English between 1 January 2000 and 1 November 2012. The basic search used multiple key terms indicating adherence, combined with the term "medication" and the term "pharmacy claims or administrative claims." Due to the variety of measure names used in the literature, a more specific search was added to repeat the basic search for 29 previously used medication (re)fill adherence measure names. Articles identified through the database search were manually reviewed to select only articles meeting the inclusion criteria. The search resulted in a total of 36 articles. Information on medication (re)fill measurements were extracted and summarized. The 36 articles used 20 differently named measures under the three main concepts: medication adherence, persistence, and discontinuation. Measures of medication adherence cumulatively assessed the proportion of time at which medications were (not) filled over a predefined observation period (e.g., medication possession ratio). Measures of medication persistence assessed the continuity of medication filling over a specified time period, while medication discontinuation measures focused on termination of medication (re)fills. Overall

  6. Medication-related burden and patients’ lived experience with medicine: a systematic review and metasynthesis of qualitative studies

    Science.gov (United States)

    Mohammed, Mohammed A; Moles, Rebekah J; Chen, Timothy F

    2016-01-01

    Objective To explore medication-related burden (MRB) and patients’ lived experience with medicines (PLEM) without regard to particular medication therapies or medical conditions. Design Systematic review and metasynthesis of qualitative studies. Data sources MEDLINE, EMBASE, International Pharmaceutical Abstracts, PsycINFO, Global health, CINAHL and Web of Science were searched from January 2000 to August 2014 using medication burden and patients’ lived experience terms. Synthesis methods Synthesis was undertaken following metaethnography methods and a comparative thematic analysis technique. Results 34 articles from 12 countries with a total of 1144 participants were included. 3 major inter-related themes emerged central to PLEM: MRB, medication related beliefs and medication taking practice. The negative impact of MRB, due to its interference on patients’ daily lives and effects on well-being, its influence on patients’ beliefs and behaviours, and a potential risk for drug-related problems (DRPs) was evident. This resulted in non-adherence and poorer outcomes (unachieved therapeutic goals and damage to patients’ health). Patients who experienced MRB interference in their life over time begin to juggle their medicines. Others continue their medicines despite experiencing MRB resulting in compromised physical, social or psychological well-being. Conclusions There is a shared commonality of PLEM among the studies. MRB plays a central role in influencing patients’ health and well-being, beliefs and behaviour towards medicines. Given the complexity of MRB and its impact evident from this review, there is a need for healthcare practitioners to have insight into PLEM in therapeutic care plans. Understanding PLEM is an opportunity for practitioners to identify particular MRBs that patients encounter, and provide individualised care through selection of therapeutic care plans that suit a patient's life. This may assist in helping to achieve patients

  7. The use of medications approved for Alzheimer’s disease in autism spectrum disorder: a systematic review

    Directory of Open Access Journals (Sweden)

    Daniel eRossignol

    2014-08-01

    Full Text Available Autism spectrum disorder (ASD is a neurodevelopmental disorder that affects 1 in 68 children in the United States. Even though it is a common disorder, only two medications (Risperidone and Aripiprazole are approved by the U.S. Food and Drug Administration (FDA to treat symptoms associated with ASD. However these medications are approved to treat irritability, which is not a core symptom of ASD. A number of novel medications which have not been approved by the FDA to treat ASD have been used off-label in some studies to treat ASD symptoms, including medications approved for Alzheimer’s disease. Interestingly, some of these studies are high quality, double-blind, placebo-controlled (DBPC studies. This article systematically reviews studies published through April, 2014 which examined the use of Alzheimer’s medications in ASD, including donepezil (7 studies, 2 were DBPC, 5/7 reported improvements, galantamine (4 studies, 2 were DBPC, all reported improvements, rivastigmine (1 study reporting improvements, tacrine (1 study reporting improvements and memantine (9 studies, 1 was DBPC, 8 reported improvements. An evidence-based scale was used to rank each medication. Collectively, these studies reported improvements in expressive language and communication, receptive language, social interaction, irritability, hyperactivity, attention, eye contact, emotional lability, repetitive or self-stimulatory behaviors, motor planning, disruptive behaviors, obsessive-compulsive symptoms, lethargy, overall ASD behaviors and increased REM sleep. Reported side effects are reviewed and include irritability, gastrointestinal problems, verbal or behavioral regression, headaches, irritability, rash, tremor, sedation, vomiting, and speech problems. Both galantamine and memantine had sufficient evidence ranking for improving both core and associated symptoms of ASD. Given the lack of medications approved to treat ASD, further studies on novel medications, including

  8. Medication documentation in a primary care network serving North Carolina medicaid patients: results of a cross-sectional chart review

    Directory of Open Access Journals (Sweden)

    Olson Matthew D

    2012-08-01

    Full Text Available Abstract Background Medical records that do not accurately reflect the patient’s current medication list are an open invitation to errors and may compromise patient safety. Methods This cross-sectional study compares primary care provider (PCP medication lists and pharmacy claims for 100 patients seen in 8 primary care practices and examines the association of congruence with demographic, clinical, and practice characteristics. Medication list congruence was measured as agreement of pharmacy claims with the entire PCP chart, including current medication list, visit notes, and correspondence sections. Results Congruence between pharmacy claims and the PCP chart was 65%. Congruence was associated with large chronic disease burden, frequent PCP visits, group practice, and patient age ≥45 years. Conclusion Agreement of medication lists between the PCP chart and pharmacy records is low. Medication documentation was more accurate among patients who have more chronic conditions, those who have frequent PCP visits, those whose practice has multiple providers, and those at least 45 years of age. Improved congruence among patients with multiple chronic conditions and in group practices may reflect more frequent visits and reviews by providers.

  9. Medical negligence liability under the consumer protection act: A review of judicial perspective

    OpenAIRE

    Joga Rao, S. V.

    2009-01-01

    It is important to know what constitutes medical negligence. A doctor owes certain duties to the patient who consults him for illness. A deficiency in this duty results in negligence. A basic knowledge of how medical negligence is adjudicated in the various judicial courts of India will help a doctor to practice his profession without undue worry about facing litigation for alleged medical negligence.

  10. Adherence to Antipsychotic Medication in Bipolar Disorder and Schizophrenic Patients: A Systematic Review.

    Science.gov (United States)

    García, Saínza; Martínez-Cengotitabengoa, Mónica; López-Zurbano, Saioa; Zorrilla, Iñaki; López, Purificación; Vieta, Eduard; González-Pinto, Ana

    2016-08-01

    Antipsychotics are the drugs prescribed to treat psychotic disorders; however, patients often fail to adhere to their treatment, and this has a severe negative effect on prognosis in these kinds of illnesses. Among the wide range of risk factors for treatment nonadherence, this systematic review covers those that are most important from the point of view of clinicians and patients and proposes guidelines for addressing them. Analyzing 38 studies conducted in a total of 51,796 patients, including patients with schizophrenia spectrum disorders and bipolar disorder, we found that younger age, substance abuse, poor insight, cognitive impairments, low level of education, minority ethnicity, poor therapeutic alliance, experience of barriers to care, high intensity of delusional symptoms and suspiciousness, and low socioeconomic status are the main risk factors for medication nonadherence in both types of disorder. In the future, prospective studies should be conducted on the use of personalized patient-tailored treatments, taking into account risk factors that may affect each individual, to assess the ability of such approaches to improve adherence and hence prognosis in these patients. PMID:27307187

  11. Admission Factors Predicting Family Medicine Specialty Choice: A Literature Review and Exploratory Study among Students in the Rural Medical Scholars Program

    Science.gov (United States)

    Avery, Daniel M., Jr.; Wheat, John R.; Leeper, James D.; McKnight, Jerry T.; Ballard, Brent G.; Chen, Jia

    2012-01-01

    Purpose: The Rural Medical Scholars Program (RMSP) was created to increase production of rural family physicians in Alabama. Literature review reveals reasons medical students choose careers in family medicine, and these reasons can be categorized into domains that medical schools can address through admission, curriculum, and structural…

  12. Decreasing the load? : Is a Multidisciplinary Multistep Medication Review in older people an effective intervention to reduce a patient's Drug Burden Index? Protocol of a randomised controlled trial

    NARCIS (Netherlands)

    van der Meer, Helene G; Wouters, Hans; van Hulten, Rolf; Pras, Niesko; Taxis, Katja

    2015-01-01

    INTRODUCTION: Older people often use medications with anticholinergic or sedative side effects which increase the risk of falling and worsen cognitive impairment. The Drug Burden Index (DBI) is a measure of the burden of anticholinergic and sedative medications. Medication reviews are typically done

  13. Adherence, persistence, and medication discontinuation in patients with attention-deficit/hyperactivity disorder – a systematic literature review

    Directory of Open Access Journals (Sweden)

    Gajria K

    2014-08-01

    Full Text Available Kavita Gajria,1 Mei Lu,2 Vanja Sikirica,1 Peter Greven,3,4 Yichen Zhong,2 Paige Qin,2 Jipan Xie2 1Global Health Economics, Outcomes Research and Epidemiology, Shire, Wayne, PA, USA; 2Health Economics and Outcomes Research, Analysis Group, Inc., Boston, MA, USA; 3Institute of Child and Adolescent Psychiatry, Psychotherapy and Social Pediatrics, Berlin, Germany; 4Department of Psychology and Mental Health, H:G University of Health and Sport, Technology and Arts, Berlin, Germany Abstract: Untreated attention-deficit/hyperactivity disorder (ADHD can lead to substantial adverse social, economic, and emotional outcomes for patients. The effectiveness of current pharmacologic treatments is often reduced, due to low treatment adherence and medication discontinuation. This current systematic literature review analyzes the current state of knowledge surrounding ADHD medication discontinuation, focusing on: 1 the extent of patient persistence; 2 adherence; and 3 the underlying reasons for patients’ treatment discontinuation and how discontinuation rates and reasons vary across patient subgroups. We selected 91 original studies (67 with persistence/discontinuation results, 26 with adherence results, and 41 with reasons for discontinuation, switching, or nonadherence and 36 expert opinion reviews on ADHD medication discontinuation, published from 1990 to 2013. Treatment persistence on stimulants, measured by treatment duration during the 12-month follow-up periods, averaged 136 days for children and adolescents and 230 days for adults. Owing to substantial study heterogeneity, comparisons across age or medication type subgroups were generally inconclusive; however, long-acting formulations and amphetamines were associated with longer treatment duration than short-acting formulations and methylphenidates. The medication possession ratio, used to measure adherence, was <0.7 for all age groups and medication classes during a 12-month period. Adverse

  14. Additive effect of BLA GABAA receptor mechanism and (+)-MK-801 on memory retention deficit, an isobologram analysis.

    Science.gov (United States)

    Khakpoor, Mitra; Nasehi, Mohammad; Vahdati, Akbar; Hoseyni, Seyed-Ebrahim; Zarrindast, Mohammad-Reza

    2016-04-01

    There is a near correlation between N-methyl-d-aspartate (NMDA) and γ-aminobutyric acid (GABA) receptors in the modulation of learning and memory in the basolateral amygdala (BLA). In this study, we investigated the involvement of GABAA receptors in the BLA in amnesia induced by (+)-MK-801, a noncompetitive antagonist of NMDA receptors, in male Wistar rats. After guide cannulae were bilaterally placed in the BLA, animals were trained in a step-through type passive avoidance task and then tested 24h after training to measure memory retrieval and locomotor activity. Post-training intra-BLA microinjection of (+)-MK-801 (0.5μg/rat) and GABAA receptor agonists (muscimol at doses 0.05 and 0.1μg/rat) or antagonist (bicuculline at doses 0.05 and 0.1μg/rat) decreased step-through latency during retrieval but did not alter locomotor activity. Results also showed that a subthreshold dose of muscimol (0.025μg/rat) potentiated impairment induced by (+)-MK-801, whereas bicuculline (0.025μg/rat) restored it. Furthermore, the highest dose of muscimol (0.5μg/rat) increased locomotor activity induced by (+)-MK-801. Isobologram analysis showed that there was an additive but not synergistic effect between muscimol and (+)-MK-801 on memory retention deficits in the BLA. In conclusion, muscimol and bicuculline decreased retention of memory formation in the BLA, and GABAA receptors in the BLA may be involved in the additive effect on (+)-MK-801-induced memory retention deficits. PMID:26853734

  15. Measuring severe adverse events and medication selection using a “PEER Report” for nonpsychotic patients: a retrospective chart review

    Directory of Open Access Journals (Sweden)

    Hoffman DA

    2012-06-01

    Full Text Available Daniel A Hoffman,1 Charles DeBattista,2 Rob J Valuck,3 Dan V Iosifescu41Neuro-Therapy Clinic, Inc, Denver, CO, USA; 2Stanford University School of Medicine, Palo Alto, CA, USA; 3University of Colorado, SKAGES School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA; 4Mood and Anxiety Disorders Program, Mount Sinai School of Medicine, New York, NY, USAAbstract: We previously reported on an objective new tool that uses quantitative electroencephalography (QEEG normative- and referenced-electroencephalography sampling databases (currently called Psychiatric EEG Evaluation Registry [PEER], which may assist physicians in determining medication selection for optimal efficacy to overcome trial-and-error prescribing. The PEER test compares drug-free QEEG features for individual patients to a database of patients with similar EEG patterns and known outcomes after pharmacological interventions. Based on specific EEG data elements and historical outcomes, the PEER Report may also serve as a marker of future severe adverse events (eg, agitation, hostility, aggressiveness, suicidality, homicidality, mania, hypomania with specific medications. We used a retrospective chart review to investigate the clinical utility of such a registry in a naturalistic environment.Results: This chart review demonstrated significant improvement on the global assessment scales Clinical Global Impression – Improvement and Quality of Life Enjoyment and Satisfaction – Short Form as well as time to maximum medical improvement and decreased suicidality occurrences. The review also showed that 54.5% of previous medications causing a severe adverse event would have been raised as a caution had the PEER Report been available at the time the drug was prescribed. Finally, due to the significant amount of off-label prescribing of psychotropic medications, additional, objective, evidence-based data aided the prescriber toward better choices.Conclusion: The PEER Report may be

  16. Susceptibility Pattern and Distribution of Oxacillinases and blaPER-1 Genes among Multidrug Resistant Acinetobacter baumannii in a Teaching Hospital in Iran

    Directory of Open Access Journals (Sweden)

    Sareh Bagheri Josheghani

    2015-01-01

    Full Text Available Acinetobacter baumannii (A. baumannii is an important nosocomial pathogen in healthcare institutions. β-Lactamase-mediated resistance is the most common mechanism for carbapenem resistance in A. baumannii. The aim of this study was to determine the antibiotic resistance pattern, to detect OXA encoding genes, class A, blaPER-1, and to detect the presence of ISAba1. A total of 124 A. baumannii isolates were collected from hospitalized patients in a teaching hospital in Kashan, Iran. The susceptibility of isolates to different antibiotics was determined by disk-diffusion method. PCR was used to detect blaPER-1, blaOXA-23, blaOXA-24, blaOXA-51, blaOXA-58, and ISAba1 genes. All isolates were resistant to ceftazidime, ceftriaxone, and cefotaxime. All of the isolates revealed susceptibility to polymyxin B and colistin. Ninety-six percent of the isolates were extensive drug resistance (XDR, 5.6% extended spectrum beta-lactamase (ESBL, and 54.8% metallo-beta-lactamase (MBL. All isolates were positive for blaOXA-51 and ISAba1. blaOXA-23,  blaOXA-24, and blaOXA-58 were found in 79.8%, 25%, and 3.2%, respectively. The frequency rate of blaPER-1 gene was 52.4%. Multidrug resistant A. baumannii isolates are increasing in our setting and extensively limit therapeutic options. The high rate presence of class D carbapenemase-encoding genes, mainly blaOXA-23 carbapenemases, is worrying and alarming as an emerging threat in our hospital.

  17. Establishment and activity of medical societies in Lower Styria - a review.

    Science.gov (United States)

    Pivec, Gregor; Borko, Elko; Turk, Zmago

    2014-01-01

    In the 1860s, the medical societies in Habsburg Monarchy, undertook a part of the medical postgraduate training. Doctors and wound surgeons from Ljubljana established medical association in October 1861 («Ärztlicher Leseverein in Laibach»). At a meeting in October 1862 they decided to include all the doctors and wound surgeons from the Carniola region. Following the organization was renamed Medical Association in Carniola («Verein der Ärzte in Krain»). A similar provincial association was founded by the Styrian doctors in Graz as early as in May 1862 («Verein der Ärzte in Steiermark»). Similar medical associations were also established in the Lower Styria in the 1870s. The most important medical association was established in Maribor in 1876. Another medical association was established in Celje in 1877 and one in the Ptuj-Ljutomer region in 1877. As the associations were mostly communicating in German, this might have been the reason for the establishment of the Slovene medical society in Celje in 1906. The Slovenian national consciousness began to strengthen across the territory of today's Slovenia. Already after the First World War in 1918, they managed to achieve the establishment of the Slovene Medical Society. Due to the events during the Second World War, a uniform Slovene medical association was established in 1947. PMID:25310616

  18. BORDERLINE AND CLASSIFICATION IN THE COMMUNITY REGULATORY FRAMEWORK FOR MEDICAL DEVICES – BRIEF REVIEW ON SOME DENTISTRY PRODUCTS.

    Directory of Open Access Journals (Sweden)

    Maya Lyapina

    2015-02-01

    Full Text Available Defining a given product as a medical device and interpretation of the application of the classification rules fall within the competence of the competent authorities of the Member States where the product is on the market. Different interpretations of Community legislation occur, and, can put public health at risk and distort the internal market. Borderline cases are considered to be those cases where it is not clear from the outset whether a given product is a medical device, an in vitro diagnostic medical device, an active implantable medical device or not. Classification cases can be described as those cases where there exists a difficulty in the uniform application of the classification rules as laid down in the Medical Devices Directive (MDD, or where for a given device, depending on interpretation of the rules, different classifications can occur. The aim of the present work is to make a brief review on discussion on classification in the community regulatory framework for medical devices of some dentistry products.

  19. Impact of a structured review session on medical student psychiatry subject examination performance [version 2; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Shan H. Siddiqi

    2015-10-01

    Full Text Available Introduction: The National Board of Medical Examiners (NBME subject examinations are used as a standardized metric for performance in required clerkships for third-year medical students. While several medical schools have implemented a review session to help consolidate knowledge acquired during the clerkship, the effects of such an intervention are not yet well-established. An improvement in NBME psychiatry examination scores has previously been reported with a single end-of-clerkship review session, but this was limited by a small sample size and the fact that attendance at the review session was optional, leading to likely selection bias.   Methods: A 1.5-hour structured review session was conducted for medical students in the last week of each 4-week psychiatry clerkship between September 2014 and July 2015. Students were required to attend unless excused due to scheduling conflicts. Scores on the NBME psychiatry subject exam were compared with those of students taking the examination in the corresponding time period in each of the previous two academic years.   Results: 83 students took the exam during the experimental period, while 176 took the exam during the control period. Statistically significant improvements were found in mean score (p=0.03, mean for the two lowest scores in each group (p<0.0007, and percentage of students scoring 70 or less (p=0.03. Percentage of students achieving the maximum possible score (99 was higher in the experimental group, but did not reach significance (p=0.06.   Conclusions: An end-of-clerkship review session led to increased mean scores on the NBME psychiatry subject examination, particularly for students at the lower end of the score range. Future research should investigate the impact of such an intervention in other specialties and other institutions.

  20. Impact of a structured review session on medical student psychiatry subject examination performance [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Shan H. Siddiqi

    2015-09-01

    Full Text Available Introduction: The National Board of Medical Examiners (NBME subject examinations are used as a standardized metric for performance in required clerkships for third-year medical students. While several medical schools have implemented a review session to help consolidate knowledge acquired during the clerkship, the effects of such an intervention are not yet well-established. One prior study reported an improvement in NBME psychiatry examination scores with a 1.5-hour review session, but this study was limited by a small sample size and the fact that attendance at the review session was optional, leading to likely selection bias.   Methods: A 1.5-hour structured review session was conducted for medical students in the last week of each 4-week psychiatry clerkship between September 2014 and July 2015. Students were required to attend unless excused due to scheduling conflicts. Scores on the NBME psychiatry subject exam were compared with those of students taking the examination in the corresponding time period in each of the previous two academic years.   Results: 83 students took the exam during the experimental period, while 176 took the exam during the control period. Statistically significant improvements were found in mean score (p=0.03, mean for the two lowest scores in each group (p<0.0007, and percentage of students scoring 70 or less (p=0.03. Percentage of students achieving the maximum possible score (99 was higher in the experimental group, but did not reach significance (p=0.06.   Conclusions: An end-of-clerkship review session led to increased mean scores on the NBME psychiatry subject examination, particularly for students at the lower end of the score range. Future research should investigate the impact of such an intervention in other specialties and other institutions.

  1. The emerge of a new superbug gene blaNDM-1

    Institute of Scientific and Technical Information of China (English)

    Wang Kaiji

    2011-01-01

    @@ NDM-- 1 in detail: NDM-1, which is the abbreviation of 'New Delhi metallo-beta-lactamase', is a recently dis-covered enzyme that is produced by some gram-negative Enterobaeteriaceae such as E coil (Esehe-riehia toll) and Klebsiella pneumonia.It is named after 'New Delhi', which is the capital of India, be-cause the first patient who was diagnosed to be colo-nized by bacteria with blaNDM-1 gene had gone toa hospital in New Delhi for cosmetic surgery not long before he was diagnosed.

  2. Identification of emergent bla CMY-2 -carrying Proteus mirabilis lineages by whole-genome sequencing.

    Science.gov (United States)

    Mac Aogáin, M; Rogers, T R; Crowley, B

    2016-01-01

    Whole-genome sequencing of 24 Proteus mirabilis isolates revealed the clonal expansion of two cefoxitin-resistant strains among patients with community-onset infection. These strains harboured bla CMY-2 within a chromosomally located integrative and conjugative element and exhibited multidrug resistance phenotypes. A predominant strain, identified in 18 patients, also harboured the PGI-1 genomic island and associated resistance genes, accounting for its broader antibiotic resistance profile. The identification of these novel multidrug-resistant strains among community-onset infections suggests that they are endemic to this region and represent emergent P. mirabilis lineages of clinical significance. PMID:26865983

  3. Characterization of a novel plasmid type and various genetic contexts of bla OXA-58 in Acinetobacter spp. from multiple cities in China.

    Directory of Open Access Journals (Sweden)

    Yiqi Fu

    Full Text Available BACKGROUND/OBJECTIVE: Several studies have described the epidemiological distribution of blaOXA-58-harboring Acinetobacter baumannii in China. However, there is limited data concerning the replicon types of blaOXA-58-carrying plasmids and the genetic context surrounding blaOXA-58 in Acinetobacter spp. in China. METHODOLOGY/PRINCIPAL FINDINGS: Twelve non-duplicated blaOXA-58-harboring Acinetobacter spp. isolates were collected from six hospitals in five different cities between 2005 and 2010. The molecular epidemiology of the isolates was carried out using PFGE and multilocus sequence typing. Carbapenemase-encoding genes and plasmid replicase genes were identified by PCR. The genetic location of blaOXA-58 was analyzed using S1-nuclease method. Plasmid conjugation and electrotransformation were performed to evaluate the transferability of blaOXA-58-harboring plasmids. The genetic structure surrounding blaOXA-58 was determined by cloning experiments. The twelve isolates included two Acinetobacter pittii isolates (belong to one pulsotype, three Acinetobacter nosocomialis isolates (belong to two pulsotypes and seven Acinetobacter baumannii isolates (belong to two pulsotypes/sequence types. A. baumannii ST91 was found to be a potential multidrug resistant risk clone carrying both blaOXA-58 and blaOXA-23. blaOXA-58 located on plasmids varied from ca. 52 kb to ca. 143 kb. All plasmids can be electrotransformed to A. baumannii recipient, but were untypeable by the current replicon typing scheme. A novel plasmid replicase named repAci10 was identified in blaOXA-58-harboring plasmids of two A. pittii isolates, three A. nosocomialis isolates and two A. baumannii isolates. Four kinds of genetic contexts of blaOXA-58 were identified. The transformants of plasmids with structure of IS6 family insertion sequence (ISOur1, IS1008 or IS15-ΔISAba3-like element-blaOXA-58 displayed carbapenem nonsusceptible, while others with structure of intact ISAba3-like element-bla

  4. Dissemination and Characterization of Plasmids Carrying oqxAB-bla CTX-M Genes in Escherichia coli Isolates from Food-Producing Animals

    OpenAIRE

    Liu, Bao-Tao; Yang, Qiu-E.; Li, Liang; Sun, Jian; Liao, Xiao-Ping; Fang, Liang-Xing; Yang, Shou-Shen; Deng, Hui; Liu, Ya-Hong

    2013-01-01

    Background The association of PMQR and ESBLs in negative-bacteria isolates has been of great concern. The present study was performed to investigate the prevalence of co-transferability of oqxAB and bla CTX-M genes among the 696 Escherichia coli ( E. coli ) isolates from food-producing animals in South China, and to characterize these plasmids. Methods The ESBL-encoding genes (bla CTX-M, bla TEM and bla SHV), and PMQR (qnrA, qnrB, qnrS, qnrC, qnrD, aac(6’)-Ib-cr, qepA, and oqxAB) of these 696...

  5. In Vitro Analysis of ISEcp1B-Mediated Mobilization of Naturally Occurring β-Lactamase Gene blaCTX-M of Kluyvera ascorbata

    OpenAIRE

    Lartigue, Marie-Frédérique; Poirel, Laurent; Aubert, Daniel; Nordmann, Patrice

    2006-01-01

    ISEcp1B has been reported to be associated with and to mobilize the emerging expanded-spectrum β-lactamase blaCTX-M genes in Enterobacteriaceae. Thus, the ability of this insertion sequence to mobilize the blaCTX-M-2 gene was tested from its progenitor, Kluyvera ascorbata. Insertions of ISEcp1B upstream of the blaCTX-M-2 gene in K. ascorbata reference strain CIP7953 were first selected with cefotaxime (0.5 and 2 μg/ml). In those cases, ISEcp1B brought promoter sequences enhancing blaCTX-M-2 e...

  6. The emergence of bla CTX-M-15-carrying Escherichia coli of ST131 and new sequence types in Western China

    OpenAIRE

    Zhang, Lei; Lü, Xiaoju; Zong, Zhiyong

    2013-01-01

    Background bla CTX-M-15, the most widely distributed gene encoding extended-spectrum β-lactamases globally, was not common in China. This study was performed to characterize bla CTX-M-15-carrying Escherichia coli in western China. Findings Out of 144 Escherichia coli isolates from 20 hospitals in western China, 8 were found carrying bla CTX-M-15. bla CTX-M-15 was carried by isolates of ST131and 5 new STs (ST3342, ST3513, ST3516, ST3517 and ST3518). The 5 new STs shared 5 identical alleles out...

  7. A review of medical malpractice issues in Malaysia under tort litigation system.

    Science.gov (United States)

    Hambali, Siti Naaishah; Khodapanahandeh, Solmaz

    2014-07-01

    Medical malpractice cases are a matter of much concern in many countries including Malaysia where several cases caught the attention of the public and authorities. Although comprehensive annual statistics on medical negligence claims are not available in Malaysia since such data are not collected systematically in this country there are indications of an upward trend. Medical malpractice cases have been publicized by the media, academic researchers and in government annual reports prompting government policy makers, oversight agencies and the medical profession itself to take appropriate action. The increasing dissatisfaction with the current tort litigation system requires exploring alternatives and new approaches for handling medical malpractice cases. This study aims to examine the difficulties inherent in the tort system in Malaysia for solving medical malpractice claims and evaluates the structure of this system from the perspective of effectiveness, fairness, compensation, accessibility, and accountability. PMID:24999124

  8. Medication Errors Associated with Look-alike/Sound-alike Drugs: A Brief Review

    Directory of Open Access Journals (Sweden)

    Zaida Rahman

    2015-05-01

    Full Text Available The existence of confusing drug names is one of the most common causes of medication errors. There are many types of medication errors: wrong drug, wrong dose, wrong route of administration, wrong patient etc. Misreading medication names that look similar is a common mistake. These look-alike medication names may also sound alike and can lead to errors associated with verbal prescriptions. Similar sounding drugs may produce confusion and may lead to unintended interchange of drugs causing harm to patients or even patient death. The main aim of the study was to evaluate medication errors related to look alikesound alike drug names and to find out the strategies to prevent these medication errors.

  9. A review of objective structured practical examination (OSPE) in pharmacology at a rural medical college

    OpenAIRE

    Rushikesh P Deshpande; Vijay M. Motghare; Sudhir L. Padwal; Chetanraj G. Bhamare; Suvarna S. Rathod; Rakesh R. Pore

    2013-01-01

    Background: 1. To evaluate the attitudes of undergraduate medical students towards objectively structured practical examination (OSPE) component of Pharmacology practical examination. 2. To investigate any gender differences and any influence of medium of instruction in school on these attitudes. Methods: The scores of 40 undergraduate medical students were analysed at S R T R Government Medical College, Ambajogai, Maharashtra, India. A Likert scale containing 9 items was used to assess the a...

  10. Medical Tourism: Between Entrepreneurship Opportunities and Bioethics Boundaries: Narrative Review Article

    OpenAIRE

    Daniel Badulescu; Alina Badulescu

    2014-01-01

    Abstract Nowadays, medical tourism reports impressive growth in terms of number of persons, income and number of countries involved in cross-border flows. So this study was undertaken to clarify entrepreneurship opportunities and bio-ethics boundaries in medical tourism. For tourism entrepreneurs, these outgoing flows related to medical procedures and tourism become an opportunity that cannot be ignored, so a wide range of tourist services related to health care are provided on a private, ent...

  11. Review of Medical Malpractice Issues in Malaysia under Tort Litigation System

    OpenAIRE

    Hambali, Siti Naaishah; Khodapanahandeh, Solmaz

    2014-01-01

    Medical malpractice cases are a matter of much concern in many countries including Malaysia where several cases caught the attention of the public and authorities. Although comprehensive annual statistics on medical negligence claims are not available in Malaysia since such data are not collected systematically in this country there are indications of an upward trend. Medical malpractice cases have been publicized by the media, academic researchers and in government annual reports prompting g...

  12. Quality Indicators for Safe Medication Preparation and Administration: A Systematic Review

    OpenAIRE

    Marian Smeulers; Lotte Verweij; Maaskant, Jolanda M.; Monica de Boer; C T Paul Krediet; Nieveen van Dijkum, Els J. M.; Hester Vermeulen

    2015-01-01

    Background One-third of all medication errors causing harm to hospitalized patients occur in the medication preparation and administration phase, which is predominantly a nursing activity. To monitor, evaluate and improve the quality and safety of this process, evidence-based quality indicators can be used. Objectives The aim of study was to identify evidence-based quality indicators (structure, process and outcome) for safe in-hospital medication preparation and administration. Methods MEDLI...

  13. The predictive value of psychological assessment of candidates for gastric bypass: A medical chart review

    Directory of Open Access Journals (Sweden)

    Nathalie Aubert

    2010-06-01

    Full Text Available Background and Objectives: Guidelines for bariatric surgery demand a psychological evaluation of applicants. The aim of this study was to evaluate if the presence of "psychological risk factors" predicts postoperative weight loss after gastric bypass. Methods: Medical records of obese women who underwent bariatric surgery between 2000 and 2004 were reviewed. Psychological assessment consisted of a one-hour semi-structured interview, summarized in a written report. Anthropometric assessment at baseline and 6,12,18 and 24 months after surgery included body weight, height and body mass index. Results: The mean BMI of included patients (N = 92 was 46.2 + 6,3 kg/m² (range 38.4 - 69.7. Based on the psychological assessment, 27% (N = 25 of the patients were classified as having "psychological risk factors" and 28% (N = 26 were diagnosed with a psychiatric diagnosis, most often major depression. Two years after gastric bypass, 16% of patients with "psychological risk factors" achieved an excellent result (%EWL > 75 versus 39% of those without (p < 0.05. About 1 out of 4 patients was in postoperative psychiatric treatment, but only half of them were identified as having "psychological risk factors" at baseline. Weight loss of patients initiating a psychiatric treatment only after surgery was less than of patients who continued psychiatric treatment already initiated before surgery (55.7 + 14.8 versus 66.5 + 14.2 %EWL. Conclusions: A single semi-structured psychological interview may identify patients who are at risk for diminished postoperative weight loss; however, psychological assessment did not identify those patients who were in need of a psychiatric postoperative treatment.

  14. Preparing Academic Medical Centers for the Clinical Learning Environment Review: Alliance of Independent Academic Medical Centers National Initiative IV Outcomes and Evaluation

    Science.gov (United States)

    Wehbe-Janek, Hania; Markova, Tsveti; Polis, Rachael L.; Peters, Marguerite; Liu, Yang

    2016-01-01

    Background: Driven by changes to improve quality in patient care and population health while reducing costs, evolvement of the health system calls for restructuring health professionals' education and aligning it with the healthcare delivery system. In response to these changes, the Accreditation Council for Graduate Medical Education's Clinical Learning Environment Review (CLER) encourages the integration of health system leadership, faculty, and residents in restructuring graduate medical education (GME). Innovative approaches to achieving this restructuring and the CLER objectives are essential. Methods: The Alliance of Independent Academic Medical Centers National Initiative (NI) IV provided a multiinstitutional learning collaborative focused on supporting GME redesign. From October 2013 through March 2015, participants conducted relevant projects, attended onsite meetings, and participated in teleconferences and webinars addressing the CLER areas. Participants shared best practices, resources, and experiences. We designed a pre/post descriptive study to examine outcomes. Results: Thirty-three institutions completed NI IV, and at its conclusion, the majority reported greater CLER readiness compared with baseline. Twenty-two (88.0%) institutions reported that NI IV had a great impact on advancing their efforts in the CLER area of their project focus, and 15 (62.5%) reported a great impact in other CLER focus areas. Opportunities to share progress with other teams and the national group meetings were reported to contribute to teams' success. Conclusion: The NI IV learning collaborative prepared institutions for CLER, suggesting successful integration of the clinical and educational enterprises. We propose that national learning collaboratives of GME-sponsoring health systems enable advancement of their education mission, leading ultimately to better healthcare outcomes. This learning model may be generalizable to newfound programs for academic medical centers

  15. Review of Intelligent Techniques Applied for Classification and Preprocessing of Medical Image Data

    Directory of Open Access Journals (Sweden)

    H S Hota

    2013-01-01

    Full Text Available Medical image data like ECG, EEG and MRI, CT-scan images are the most important way to diagnose disease of human being in precise way and widely used by the physician. Problem can be clearly identified with the help of these medical images. A robust model can classify the medical image data in better way .In this paper intelligent techniques like neural network and fuzzy logic techniques are explored for MRI medical image data to identify tumor in human brain. Also need of preprocessing of medical image data is explored. Classification technique has been used extensively in the field of medical imaging. The conventional method in medical science for medical image data classification is done by human inspection which may result misclassification of data sometime this type of problem identification are impractical for large amounts of data and noisy data, a noisy data may be produced due to some technical fault of the machine or by human errors and can lead misclassification of medical image data. We have collected number of papers based on neural network and fuzzy logic along with hybrid technique to explore the efficiency and robustness of the model for brain MRI data. It has been analyzed that intelligent model along with data preprocessing using principal component analysis (PCA and segmentation may be the competitive model in this domain.

  16. Review of Intelligent Techniques Applied for Classification and Preprocessing of Medical Image Data

    OpenAIRE

    H S Hota; Shukla, S.P.; Kajal Gulhare

    2013-01-01

    Medical image data like ECG, EEG and MRI, CT-scan images are the most important way to diagnose disease of human being in precise way and widely used by the physician. Problem can be clearly identified with the help of these medical images. A robust model can classify the medical image data in better way .In this paper intelligent techniques like neural network and fuzzy logic techniques are explored for MRI medical image data to identify tumor in human brain. Also need of preprocessing of me...

  17. The influence of peer reviewers as literacy brokers on the construction of texts for publication in ISI-indexed journals: A study of medical research articles

    OpenAIRE

    Kheradparvar Najmeh; Shokrpour Nasrin

    2015-01-01

    This study focused on the “text histories,” peer reviewers' comments, and authors' responses of 20 medical research articles published in ISI indexed journals. To identify the types of comments peer reviewers frequently make on submitted articles to shape suitable texts for publication in medical ISI indexed journals, 368 comments are categorized into four groups. The results revealed that peer reviewers' comments can be categorized into four different classes: Comments made with regard to sc...

  18. The potential use of intrauterine insemination as a basic option for infertility: a review for technology-limited medical settings.

    Science.gov (United States)

    Abdelkader, Abdelrahman M; Yeh, John

    2009-01-01

    Objective. There is an asymmetric allocation of technology and other resources for infertility services. Intrauterine insemination (IUI) is a process of placing washed spermatozoa transcervically into the uterine cavity for treatment of infertility. This is a review of literature for the potential use of IUI as a basic infertility treatment in technology-limited settings. Study design. Review of articles on treatment of infertility using IUI. Results. Aspects regarding the use of IUI are reviewed, including ovarian stimulation, semen parameters associated with good outcomes, methods of sperm preparation, timing of IUI, and number of inseminations. Implications of the finding in light of the needs of low-technology medical settings are summarized. Conclusion. The reviewed evidence suggests that IUI is less expensive, less invasive, and comparably effective for selected patients as a first-line treatment for couples with unexplained or male factor infertility. Those couples may be offered three to six IUI cycles in technology-limited settings. PMID:20011061

  19. The Potential Use of Intrauterine Insemination as a Basic Option for Infertility: A Review for Technology-Limited Medical Settings

    Directory of Open Access Journals (Sweden)

    Abdelrahman M. Abdelkader

    2009-01-01

    Full Text Available Objective. There is an asymmetric allocation of technology and other resources for infertility services. Intrauterine insemination (IUI is a process of placing washed spermatozoa transcervically into the uterine cavity for treatment of infertility. This is a review of literature for the potential use of IUI as a basic infertility treatment in technology-limited settings. Study design. Review of articles on treatment of infertility using IUI. Results. Aspects regarding the use of IUI are reviewed, including ovarian stimulation, semen parameters associated with good outcomes, methods of sperm preparation, timing of IUI, and number of inseminations. Implications of the finding in light of the needs of low-technology medical settings are summarized. Conclusion. The reviewed evidence suggests that IUI is less expensive, less invasive, and comparably effective for selected patients as a first-line treatment for couples with unexplained or male factor infertility. Those couples may be offered three to six IUI cycles in technology-limited settings.

  20. How does medical device regulation perform in the United States and the European union? A systematic review.

    Directory of Open Access Journals (Sweden)

    Daniel B Kramer

    Full Text Available BACKGROUND: Policymakers and regulators in the United States (US and the European Union (EU are weighing reforms to their medical device approval and post-market surveillance systems. Data may be available that identify strengths and weakness of the approaches to medical device regulation in these settings. METHODS AND FINDINGS: We performed a systematic review to find empirical studies evaluating medical device regulation in the US or EU. We searched Medline using two nested categories that included medical devices and glossary terms attributable to the US Food and Drug Administration and the EU, following PRISMA guidelines for systematic reviews. We supplemented this search with a review of the US Government Accountability Office online database for reports on US Food and Drug Administration device regulation, consultations with local experts in the field, manual reference mining of selected articles, and Google searches using the same key terms used in the Medline search. We found studies of premarket evaluation and timing (n = 9, studies of device recalls (n = 8, and surveys of device manufacturers (n = 3. These studies provide evidence of quality problems in pre-market submissions in the US, provide conflicting views of device safety based largely on recall data, and relay perceptions of some industry leaders from self-surveys. CONCLUSIONS: Few studies have quantitatively assessed medical device regulation in either the US or EU. Existing studies of US and EU device approval and post-market evaluation performance suggest that policy reforms are necessary for both systems, including improving classification of devices in the US and promoting transparency and post-market oversight in the EU. Assessment of regulatory performance in both settings is limited by lack of data on post-approval safety outcomes. Changes to these device approval and post-marketing systems must be accompanied by ongoing research to ensure that there is

  1. Detection of extended-spectrum β-lactamases (blaCTX-M-1 and blaTEM in Escherichia coli, Salmonella spp., and Klebsiella pneumoniae isolated from poultry in North Eastern India

    Directory of Open Access Journals (Sweden)

    H. Lalzampuia

    2014-11-01

    Full Text Available Aim: The present study was conducted to record the association of extended spectrum β-lactamases (ESBLs producing enteric bacteria with diarrhea of poultry birds in Mizoram, India. Materials and Methods: Fecal samples were collected from poultry birds with the history of diarrhea from different parts of Mizoram. Samples were processed for isolation and identification of Escherichia coli, Salmonella, and Klebsiella pneumoniae. All the isolates were subjected to antibiotic sensitivity assays. Phenotypically, ESBLs production ability was determined by double discs synergy test (DDST method. ESBLs producing isolates were subjected to polymerase chain reaction (PCR for detection of ESBLs genes. Plasmids were cured by acridine orange. Transfer of resistance from donor to recipient strains was done by in vitro horizontal method. Results: A total of 134 enteric bacteria was isolated, of which 102 (76.12%, 21 (15.67% and 11 (8.21% were E. coli, Salmonella spp. and K. pneumoniae, respectively. By DDST 7 (5.22% isolates (6 E. coli and 1 K. pneumoniae were ESBLs producer. PCR analysis confirmed 5 (3.73% (4 E. coli and 1 K. pneumoniae isolates harboured blaCTX-M-1 gene and/or blaTEM gene. All the isolates were carrying plasmids ranging between 0.9 kb and ~30 kb. Of the 4 isolates positive for blaCTX-M-1 and/or blaTEM, 2 (1.84% were confirmed for blaCTX-M-1 gene in their plasmid. No blaTEM gene was detected from plasmid. The resistance plasmid could not be transferred to the recipient by in vitro horizontal gene transfer method. Conclusion: ESBLs producing enteric bacteria are circulating in poultry in North Eastern Region of India. As poultry is one of the most common food animals in this region, these organisms may enter in human population through them.

  2. Quality of anticoagulation and use of warfarin-interacting medications in long-term care: A chart review

    Directory of Open Access Journals (Sweden)

    Campbell Glenda

    2008-07-01

    Full Text Available Abstract Background Maintenance of therapeutic International Normalized Ratio (INR in the community is generally poor. The supervised environment in long-term care facilities may represent a more ideal setting for warfarin therapy since laboratory monitoring, compliance, dose adjustment, and interacting medications can all be monitored and controlled. The objectives of this study were to determine how effectively warfarin was administered to a cohort of residents in long-term care facilities, to identify the proportion of residents prescribed warfarin-interacting drugs and to ascertain factors associated with poor INR control. Methods A chart review of 105 residents receiving warfarin therapy in five long-term care facilities in Hamilton, Ontario was performed. Data were collected on INR levels, warfarin prescribing and monitoring practices, and use of interacting medications. Results Over a 12 month period (28,555 resident-days, 78.2 resident years 3065 INR values were available. Residents were within, below and above the therapeutic range 54%, 35% and 11% of the time, respectively. Seventy-nine percent of residents were prescribed at least one warfarin-interacting medication during the period in review. Residents receiving interacting medications spent less time in the therapeutic range (53.0% vs. 58.2%, OR = 0.93, 95% confidence interval 0.88 to 0.97, P = 0.002. Adequacy of anticoagulation varied significantly between physicians (time in therapeutic range 45.9 to 63.9%. Conclusion In this group of long-term care residents, warfarin control was suboptimal. Both prescriber and co-prescription of interacting medications were associated with poorer INR control. Future studies should seek strategies to improve prescriber skill and decrease use of interacting medications.

  3. To what extent is clinical and laboratory information used to perform medication reviews in the nursing home setting? the CLEAR study

    Directory of Open Access Journals (Sweden)

    Mestres Gonzalvo C

    2015-05-01

    Full Text Available Carlota Mestres Gonzalvo,1 Kim PGM Hurkens,2 Hugo AJM de Wit,3 Brigit PC van Oijen,1 Rob Janknegt,1 Jos MGA Schols,4 Wubbo J Mulder,5 Frans R Verhey,6 Bjorn Winkens,7 Paul-Hugo M van der Kuy1 1Department of Clinical Pharmacology and Toxicology, Orbis Medical Centre, Sittard, 2Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Centre, Amsterdam, 3Department of Clinical Pharmacy and Toxicology, Atrium Medical Centre, Heerlen, 4Department of Family Medicine and Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, 5Department of Internal Medicine, Maastricht University Medical Centre, 6Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg/School for Mental Health and Neurosciences, 7Department of Methodology and Statistics, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands Background: The aim of this study was to evaluate to what extent laboratory data, actual medication, medical history, and/or drug indication influence the quality of medication reviews for nursing home patients. Methods: Forty-six health care professionals from different fields were requested to perform medication reviews for three different cases. Per case, the amount of information provided varied in three subsequent stages: stage 1, medication list only; stage 2, adding laboratory data and reason for hospital admission; and stage 3, adding medical history/drug indication. Following a slightly modified Delphi method, a multidisciplinary team performed the medication review for each case and stage. The results of these medication reviews were used as reference reviews (gold standard. The remarks from the participants were scored, according to their potential clinical impact, from relevant to harmful on a scale of 3 to -1. A total score per case and stage was calculated and expressed as a percentage of the total score from the expert

  4. Administrative data is as good as medical chart review for comorbidity ascertainment in patients with infections in Singapore.

    Science.gov (United States)

    Hwang, J; Chow, A; Lye, D C; Wong, C S

    2016-07-01

    The Charlson comorbidity index (CCI) is widely used for control of confounding from comorbidities in epidemiological studies. International Classification of Diseases (ICD)-coded diagnoses from administrative hospital databases is potentially an efficient way of deriving CCI. However, no studies have evaluated its validity in infectious disease research. We aim to compare CCI derived from administrative data and medical record review in predicting mortality in patients with infections. We conducted a cross-sectional study on 199 inpatients. Correlation analyses were used to compare comorbidity scores from ICD-coded administrative databases and medical record review. Multivariable regression models were constructed and compared for discriminatory power for 30-day in-hospital mortality. Overall agreement was fair [weighted kappa 0·33, 95% confidence interval (CI) 0·23-0·43]. Kappa coefficient ranged from 0·17 (95% CI 0·01-0·36) for myocardial infarction to 0·85 (95% CI 0·59-1·00) for connective tissue disease. Administrative data-derived CCI was predictive of CCI ⩾5 from medical record review, controlling for age, gender, resident status, ward class, clinical speciality, illness severity, and infection source (C = 0·773). Using the multivariable model comprising age, gender, resident status, ward class, clinical speciality, illness severity, and infection source to predict 30-day in-hospital mortality, administrative data-derived CCI (C = 0·729) provided a similar C statistic as medical record review (C = 0·717, P = 0·8548). In conclusion, administrative data-derived CCI can be used for assessing comorbidities and confounding control in infectious disease research. PMID:26758244

  5. Adherence to Antiretroviral Medications among Persons who Inject Drugs in Transitional, Low and Middle Income Countries: An International Systematic Review

    OpenAIRE

    Feelemyer, Jonathan; Jarlais, Don Des; Arasteh, Kamyar; Uuskula, Anneli

    2015-01-01

    Adherence to antiretroviral (ART) medication is vital to reducing morbidity and mortality among HIV positive persons. People who inject drugs (PWID) are at high risk for HIV infection in transitional/low/middle income countries (TLMIC). We conducted a systematic review of studies reporting adherence to ARTs among persons with active injection drug use and/or histories of injection drug use in TLMIC. Meta-regression was performed to examine relationships between location, adherence measurement...

  6. Systematic Review: Medical and Nutritional Interventions for the Management of Intestinal Failure and its Resultant Complications in Children

    OpenAIRE

    Barclay, Andrew; Beattie, Lynne M; Weaver, L T; Wilson, David C

    2010-01-01

    Abstract Background and Aims: Intestinal failure (IF) affects a growing number of children due to increasing numbers of preterm infants surviving intestinal resection for necrotising enterocolitis (NEC) and improving surgical techniques for congenital gut anomalies. Parenteral nutrition (PN) is the mainstay of therapy; enteral nutrition (EN) may have trophic effects on the gut. We aimed to systematically review evidence for the effectiveness of medical and nutritional interventions...

  7. Follow-up studies of children with birth defects in the Medical Birth Registry of Norway: A review

    OpenAIRE

    Lie, Rolv T.; Rolv Skjærven

    2009-01-01

    In two studies published from data in the Medical Birth Registry of Norway we described the survival, tendency to reproduce and subsequent recurrence of birth defects in offspring for children with a range of categories of birth defects. The studies were done separately for girls and boys. The current review summarizes data from these reports and makes some comparisons between boys and girls. More boys than girls are born with birth defects. The survival and tendency to reproduce showed great...

  8. Review of Ten Years' Use of St. Jude Medical Prosthetic Valve Replacement and Postoperative Management at Niigata University Hospital

    OpenAIRE

    Hayashi, Jun-Ichi; Oguma, Fumiaki; Tsuchida, Sho-ichi; Fujita, Yasuo; Nakazawa, Satoshi; Miyamura, Haruo; Eguchi, Shoji

    1993-01-01

    A ten-year period of using St. Jude Medical (SJM) prosthetic heart valves at Niigata University Hospital was reviewed. Between December 1979 and August 1990, 261 patients, 118 males and 143 females, ages ranging 6-75 years, underwent SJM prosthetic valve replacement. Aortic valve replacement was performed in 72 patients, mitral valve replacement in 140 patients, combined aortic and mitral valve replacement in 37 patients, and miscellaneous valve replacement in 12 patients. The actuarial survi...

  9. Epidemiology and Risk Factors for Isolation of Escherichia coli Producing CTX-M-Type Extended-Spectrum β-Lactamase in a Large U.S. Medical Center

    OpenAIRE

    Hayakawa, Kayoko; Gattu, Sureka; Marchaim, Dror; Bhargava, Ashish; Palla, Mohan; Alshabani, Khaled; Gudur, Uma Mahesh; Pulluru, Harish; Bathina, Pradeep; Sundaragiri, Pranathi Rao; Sarkar, Moumita; Kakarlapudi, Hari; Ramasamy, Balaji; Nanjireddy, Priyanka; Mohin, Shah

    2013-01-01

    A case-case-control study was conducted to identify independent risk factors for recovery of Escherichia coli strains producing CTX-M-type extended-spectrum β-lactamases (CTX-M E. coli) within a large Southeastern Michigan medical center. Unique cases with isolation of ESBL-producing E. coli from February 2010 through July 2011 were analyzed by PCR for blaCTX-M, blaTEM, and blaSHV genes. Patients with CTX-M E. coli were compared to patients with E. coli strains not producing CTX-M-type ESBLs ...

  10. Antecedents of the People and Organizational Aspects of Medical Informatics: Review of the Literature

    OpenAIRE

    Lorenzi, Nancy M.; Riley, Robert T.; Blyth, Andrew J. C.; Southon, Gray; Dixon, Bradley J.

    1997-01-01

    People and organizational issues are critical in both implementing medical informatics systems and in dealing with the altered organizations that new systems often create. The people and organizational issues area—like medical informatics itself—is a blend of many disciplines. The academic disciplines of psychology, sociology, social psychology, social anthropology, organizational behavior and organizational development, management, and cognitive sciences are rich with...

  11. A Systematic Review of Stress-Management Programs for Medical Students

    Science.gov (United States)

    Shiralkar, Malan T.; Harris, Toi B.; Eddins-Folensbee, Florence F.; Coverdale, John H.

    2013-01-01

    Objective: Because medical students experience a considerable amount of stress during training, academic leaders have recognized the importance of developing stress-management programs for medical students. The authors set out to identify all controlled trials of stress-management interventions and determine the efficacy of those interventions.…

  12. Editorial peer reviewers' recommendations at a general medical journal: are they reliable and do editors care?

    Directory of Open Access Journals (Sweden)

    Richard L Kravitz

    Full Text Available BACKGROUND: Editorial peer review is universally used but little studied. We examined the relationship between external reviewers' recommendations and the editorial outcome of manuscripts undergoing external peer-review at the Journal of General Internal Medicine (JGIM. METHODOLOGY/PRINCIPAL FINDINGS: We examined reviewer recommendations and editors' decisions at JGIM between 2004 and 2008. For manuscripts undergoing peer review, we calculated chance-corrected agreement among reviewers on recommendations to reject versus accept or revise. Using mixed effects logistic regression models, we estimated intra-class correlation coefficients (ICC at the reviewer and manuscript level. Finally, we examined the probability of rejection in relation to reviewer agreement and disagreement. The 2264 manuscripts sent for external review during the study period received 5881 reviews provided by 2916 reviewers; 28% of reviews recommended rejection. Chance corrected agreement (kappa statistic on rejection among reviewers was 0.11 (p<.01. In mixed effects models adjusting for study year and manuscript type, the reviewer-level ICC was 0.23 (95% confidence interval [CI], 0.19-0.29 and the manuscript-level ICC was 0.17 (95% CI, 0.12-0.22. The editors' overall rejection rate was 48%: 88% when all reviewers for a manuscript agreed on rejection (7% of manuscripts and 20% when all reviewers agreed that the manuscript should not be rejected (48% of manuscripts (p<0.01. CONCLUSIONS/SIGNIFICANCE: Reviewers at JGIM agreed on recommendations to reject vs. accept/revise at levels barely beyond chance, yet editors placed considerable weight on reviewers' recommendations. Efforts are needed to improve the reliability of the peer-review process while helping editors understand the limitations of reviewers' recommendations.

  13. XML Determination of Phylogenetic Group and Prevalence of blaCTX-M and blaCTX-M-15 Genes in Escherichia Coli Isolates from Intestinal and Urinary Tract Infections in under Five- Year- Old Children

    OpenAIRE

    Momeni, F. (MSc); Ghanbarpour, R. (PhD); Dolatshah, L. (MSc); Alizade, H. (MSc)

    2014-01-01

    Background and Objective: CTX-M type extended spectrum beta-lactamases is a rapidly expanding group of enzymes encountered with increasing fre‌quency, especially, in Escherichia coli (E. coli). There are a few reports on phylogenetic background of E. coli isolates from clinical sources of under five-year- old children in Iran. The purpose of this study was phylotyping of E. coli isolates having blaCTX-M and blaCTX-M-15 genes from under five-year- old children with diarrhea and urinary tract i...

  14. Potential environmental implications of nano-enabled medical applications: critical review.

    Science.gov (United States)

    Mahapatra, Indrani; Clark, J; Dobson, Peter J; Owen, Richard; Lead, Jamie R

    2013-01-01

    The application of nanotechnology and nanoscience for medical purposes is anticipated to make significant contributions to enhance human health in the coming decades. However, the possible future mass production and use of these medical innovations exhibiting novel and multifunctional properties will very likely lead to discharges into the environment giving rise to potentially new environmental hazards and risks. To date, the sources, the release form and environmental fate and exposure of nano-enabled medical products have not been investigated and little or no data exists, although there are a small number of currently approved medical applications and a number in clinical trials. This paper discusses the current technological and regulatory landscape and potential hazards and risks to the environment of nano-enabled medical products, data gaps and gives tentative suggestions relating to possible environmental hotspots. PMID:24592432

  15. Impact of appropriate pharmaceutical therapy for chronic conditions on direct medical costs and workplace productivity: a review of the literature.

    Science.gov (United States)

    Goldfarb, Neil; Weston, Christine; Hartmann, Christine W; Sikirica, Mirko; Crawford, Albert; He, Hope; Howell, Jamie; Maio, Vittorio; Clarke, Janice; Nuthulaganti, Bhaskar; Cobb, Nicole

    2004-01-01

    This paper presents the findings of a literature review investigating the economic impact of appropriate pharmaceutical therapy in treating four prevalent chronic conditions - asthma, diabetes, heart failure, and migraine. The goal of the review was to identify high-quality studies examining the extent to which appropriate pharmaceutical therapy impacts overall medical expenditure (direct costs) and workplace productivity (indirect costs). The working hypothesis in conducting the review was that the costs of pharmaceuticals for the selected chronic conditions are offset by savings in direct and indirect costs in other areas. The literature provides evidence that appropriate drug therapy improves the health status and quality of life of individuals with chronic illnesses while reducing costs associated with utilization of emergency room, inpatient, and other medical services. A growing body of evidence also suggests that workers whose chronic conditions are effectively controlled with medications are more productive. For employers, the evidence translates into potential direct and indirect cost savings. The findings also confirm the importance of pharmaceutical management as a cornerstone of disease management. PMID:15035834

  16. Virulence of Klebsiella pneumoniae isolates harboring bla KPC-2 carbapenemase gene in a Caenorhabditis elegans model.

    Directory of Open Access Journals (Sweden)

    Jean-Philippe Lavigne

    Full Text Available Klebsiella pneumoniae carbapenemase (KPC is a carbapenemase increasingly reported worldwide in Enterobacteriaceae. The aim of this study was to analyze the virulence of several KPC-2-producing K. pneumoniae isolates. The studied strains were (i five KPC-2 clinical strains from different geographical origins, belonging to different ST-types and possessing plasmids of different incompatibility groups; (ii seven transformants obtained after electroporation of either these natural KPC plasmids or a recombinant plasmid harboring only the bla KPC-2 gene into reference strains K. pneumoniae ATCC10031/CIP53153; and (iii five clinical strains cured of plasmids. The virulence of K. pneumoniae isolates was evaluated in the Caenorhabditis elegans model. The clinical KPC producers and transformants were significantly less virulent (LT50: 5.5 days than K. pneumoniae reference strain (LT50: 4.3 days (p<0.01. However, the worldwide spread KPC-2 positive K. pneumoniae ST258 strains and reference strains containing plasmids extracted from K. pneumoniae ST258 strains had a higher virulence than KPC-2 strains belonging to other ST types (LT50: 5 days vs. 6 days, p<0.01. The increased virulence observed in cured strains confirmed this trend. The bla KPC-2 gene itself was not associated to increased virulence.

  17. Clonal and horizontal spread of the blaOXA-232 gene among Enterobacteriaceae in a Korean hospital.

    Science.gov (United States)

    Jeong, Seok Hoon; Lee, Kyu Man; Lee, Jacob; Bae, Il Kwon; Kim, Jae-Seok; Kim, Han-Sung; Song, Wonkeun

    2015-05-01

    All 16 Klebsiella pneumoniae isolates and both Escherichia coli isolates harbored the bla(OXA-232) and bla(CTX-M-15) genes. Furthermore, all 16 K. pneumoniae isolates belonged to a unique pulsed-field gel electrophoresis clone and were assigned to an identical sequence type (ST14). The 2 E. coli isolates were identified as ST131 and ST457. The bla(OXA-232) gene underwent horizontal transfer to E. coli isolates via a conjugative ColE-type plasmid. The introduction of this K. pneumoniae ST14 strain to the Korean hospital was attributed to an index patient who was likely colonized during a prior hospitalization in India. PMID:25702524

  18. Intensive medical student involvement in short-term surgical trips provides safe and effective patient care: a case review

    Directory of Open Access Journals (Sweden)

    Macleod Jana B

    2011-09-01

    Full Text Available Abstract Background The hierarchical nature of medical education has been thought necessary for the safe care of patients. In this setting, medical students in particular have limited opportunities for experiential learning. We report on a student-faculty collaboration that has successfully operated an annual, short-term surgical intervention in Haiti for the last three years. Medical students were responsible for logistics and were overseen by faculty members for patient care. Substantial planning with local partners ensured that trip activities supplemented existing surgical services. A case review was performed hypothesizing that such trips could provide effective surgical care while also providing a suitable educational experience. Findings Over three week-long trips, 64 cases were performed without any reported complications, and no immediate perioperative morbidity or mortality. A plurality of cases were complex urological procedures that required surgical skills that were locally unavailable (43%. Surgical productivity was twice that of comparable peer institutions in the region. Student roles in patient care were greatly expanded in comparison to those at U.S. academic medical centers and appropriate supervision was maintained. Discussion This demonstration project suggests that a properly designed surgical trip model can effectively balance the surgical needs of the community with an opportunity to expose young trainees to a clinical and cross-cultural experience rarely provided at this early stage of medical education. Few formalized programs currently exist although the experience above suggests the rewarding potential for broad-based adoption.

  19. TH-D-16A-01: Medical Physics Workshop: Editorial Vision and Guidance On Writing and Reviewing Papers

    Energy Technology Data Exchange (ETDEWEB)

    Williamson, J [Virginia Commonwealth University, Richmond, VA (United States); Das, S [Duke University Medical Center, Durham, NC (United States); Goodsitt, M [University Michigan, Ann Arbor, MI (United States)

    2014-06-15

    On January 1, 2014, editorial leadership of Medical Physics passed from esteemed long-time Editor Bill Hendee to a collective editorial group composed of the three presenters listed above. In this presentation, we would like to outline our vision for the future of Medical Physics and review recent work-in-progress initiatives to implement this vision. Finally, we will close with guidance to authors on how to write a good Medical Physics paper. Vision for Medical Physics and current initiatives: Jeff Williamson, Editor-in-Chief We cannot improve on Dr. Hendee's succinct vision statement “to continue the Journal's tradition of publishing the very best science that propels our discipline forward and improves our contribution to patient care.” More concretely, the Journal should be s the preeminent forum for electronic exchange of cutting edge medical physics science. We seek to identify the best contributions in (a) high impact clinical physics innovations; (b) clinical translation and validation of basic science innovations; or (c) cutting edge basic science developments with potential for patient care improvements. Among the challenges and opportunities we face are: are electronic-only and open access publishing; trends towards more interactive, social-media based scientific communities; and diversification of the medical physics research, authorship, and readership domains, including clinical applications quite foreign to core ABR clinical competencies. To address these issues over the next 3 years, we have reduced the size of our Editorial Board and focused its efforts on improving the Journal's impact through 4 working groups (WGs): WG-1: Review process quality and selectivity Creation of 120 member Board of Associate Editors to improve review uniformity by placing Ms. management in fewer hands New reviewer guidelines and templates Answer: “what is the scope of medical physics research?” Recursive taxonomy for tagging review expertise and

  20. TH-D-16A-01: Medical Physics Workshop: Editorial Vision and Guidance On Writing and Reviewing Papers

    International Nuclear Information System (INIS)

    On January 1, 2014, editorial leadership of Medical Physics passed from esteemed long-time Editor Bill Hendee to a collective editorial group composed of the three presenters listed above. In this presentation, we would like to outline our vision for the future of Medical Physics and review recent work-in-progress initiatives to implement this vision. Finally, we will close with guidance to authors on how to write a good Medical Physics paper. Vision for Medical Physics and current initiatives: Jeff Williamson, Editor-in-Chief We cannot improve on Dr. Hendee's succinct vision statement “to continue the Journal's tradition of publishing the very best science that propels our discipline forward and improves our contribution to patient care.” More concretely, the Journal should be s the preeminent forum for electronic exchange of cutting edge medical physics science. We seek to identify the best contributions in (a) high impact clinical physics innovations; (b) clinical translation and validation of basic science innovations; or (c) cutting edge basic science developments with potential for patient care improvements. Among the challenges and opportunities we face are: are electronic-only and open access publishing; trends towards more interactive, social-media based scientific communities; and diversification of the medical physics research, authorship, and readership domains, including clinical applications quite foreign to core ABR clinical competencies. To address these issues over the next 3 years, we have reduced the size of our Editorial Board and focused its efforts on improving the Journal's impact through 4 working groups (WGs): WG-1: Review process quality and selectivity Creation of 120 member Board of Associate Editors to improve review uniformity by placing Ms. management in fewer hands New reviewer guidelines and templates Answer: “what is the scope of medical physics research?” Recursive taxonomy for tagging review expertise and

  1. Further Spread of blaNDM-5 in Enterobacteriaceae via IncX3 Plasmids in Shanghai, China

    Science.gov (United States)

    Zhang, Fangfang; Xie, Lianyan; Wang, Xiaoli; Han, Lizhong; Guo, Xiaokui; Ni, Yuxing; Qu, Hongping; Sun, Jingyong

    2016-01-01

    One hundred and two carbapenem-resistant Enterobacteriaceae (CRE) strains were isolated in a teaching hospital in Shanghai, China from 2012 to 2015. In a follow-up study, four New Delhi metallo-β-lactamase-5 (NDM-5)-producing strains were identified after screening these CRE strains, including 1 Klebsiella pneumoniae strain (RJ01), 1 Proteus mirabilis strain (RJ02), and 2 Escherichia coli strains (RJ03 and RJ04). All K. pneumoniae and E. coli isolates were resistant to carbapenems, third-generation cephalosporins, and piperacillin-tazobactam, but were susceptible to amikacin. No epidemiological links for either E. coli isolate were found by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). However, MLST revealed a novel sequence type, ST2250, of the K. pneumoniae RJ01 strain. Inc types and sizes of blaNDM-5-carrying plasmids differed among the four isolates, although in P. mirabilis RJ02 and E. coli RJ03, blaNDM-5 was carried by conjugative IncX3 plasmids of nearly the same size (∼40 kb). Investigation of the genetic background of sequences flanking the blaNDM-5 gene showed that all four isolates shared the same genetic content (IS3000-ΔISAba125-IS5-blaNDM-5-ble-trpF-dsbC-IS26-ΔumuD), which was identical to that of the pNDM_MGR194 plasmid circulating in India. This is the first identification of blaNDM-5 in P. mirabilis, which suggests its further spread to Enterobacteriaceae, and indicates that IncX3 plasmids may play an important role in potentiating the spread of blaNDM. PMID:27065982

  2. Further Spread of bla NDM-5 in Enterobacteriaceae via IncX3 Plasmids in Shanghai, China.

    Science.gov (United States)

    Zhang, Fangfang; Xie, Lianyan; Wang, Xiaoli; Han, Lizhong; Guo, Xiaokui; Ni, Yuxing; Qu, Hongping; Sun, Jingyong

    2016-01-01

    One hundred and two carbapenem-resistant Enterobacteriaceae (CRE) strains were isolated in a teaching hospital in Shanghai, China from 2012 to 2015. In a follow-up study, four New Delhi metallo-β-lactamase-5 (NDM-5)-producing strains were identified after screening these CRE strains, including 1 Klebsiella pneumoniae strain (RJ01), 1 Proteus mirabilis strain (RJ02), and 2 Escherichia coli strains (RJ03 and RJ04). All K. pneumoniae and E. coli isolates were resistant to carbapenems, third-generation cephalosporins, and piperacillin-tazobactam, but were susceptible to amikacin. No epidemiological links for either E. coli isolate were found by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). However, MLST revealed a novel sequence type, ST2250, of the K. pneumoniae RJ01 strain. Inc types and sizes of bla NDM-5-carrying plasmids differed among the four isolates, although in P. mirabilis RJ02 and E. coli RJ03, bla NDM-5 was carried by conjugative IncX3 plasmids of nearly the same size (∼40 kb). Investigation of the genetic background of sequences flanking the bla NDM-5 gene showed that all four isolates shared the same genetic content (IS3000-ΔISAba125-IS5-bla NDM-5-ble-trpF-dsbC-IS26-ΔumuD), which was identical to that of the pNDM_MGR194 plasmid circulating in India. This is the first identification of bla NDM-5 in P. mirabilis, which suggests its further spread to Enterobacteriaceae, and indicates that IncX3 plasmids may play an important role in potentiating the spread of bla NDM. PMID:27065982

  3. Molecular typing and genetic environment of the blaKPC gene in Chilean isolates of Klebsiella pneumoniae.

    Science.gov (United States)

    Barría-Loaiza, Carla; Pincheira, Andrea; Quezada, Mario; Vera, Alejandra; Valenzuela, Pedro; Domínguez, Mariana; Lima, Celia A; Araya, Ingrid; Araya, Pamela; Prat, Soledad; Aguayo, Carolina; Fernández, Jorge; Hormazábal, Juan Carlos; Bello-Toledo, Helia; González-Rocha, Gerardo

    2016-03-01

    The aim of this work was to determine the genetic environment and transferability of blaKPC as well as the pulsotypes of KPC-producing Klebsiella pneumoniae strains isolated from clinical samples in Chilean hospitals. Seventeen strains, principally isolated in Santiago (the capital of Chile) during the years 2012 and 2013, were included. The genetic environment of blaKPC was elucidated by PCR mapping and sequencing. Molecular typing was performed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Curing and conjugation experiments were performed with six strains of different sequence types (STs) and pulsotypes. Thirteen pulsotypes and six STs, mainly belonging to clonal complex 258, were found. In addition, seven strains belonged to a new ST assigned ST1161. The blaKPC sequence indicated that 16 strains had the KPC-2 variant; in only one strain (UC331) an amino acid change (R6P) was detected, corresponding to a new KPC variant designated KPC-24. Molecular characterisation of the blaKPC genetic environment revealed two distinct platforms, namely variant 1a and the Tn4401a isoform, with the first being the most common (11/17 strains). Mating experiments failed to produce transconjugants; however, loss of blaKPC was achieved by plasmid curing in all assayed strains. In conclusion, in Chilean strains of K. pneumoniae, blaKPC is primarily found associated with the variant 1a and is located in non-transferable plasmids. In addition, this study highlights the description of the new ST1161 and the new KPC-24 variant. PMID:27436389

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

    Science.gov (United States)

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

    2016-08-01

    A Systematic Tool to Reduce Inappropriate Prescribing (STRIP), which includes the Screening Tool to Alert doctors to Right Treatment (START) and the Screening Tool of Older Peoples' Prescriptions (STOPP), has recently been developed in the Netherlands for older patients with polypharmacy in the general population. Active involvement of the patient is part of this systematic multidisciplinary medication review. Although annual review of pharmacotherapy is recommended for people with an intellectual disability (ID), a specific tool for this population is not yet available. Besides, active involvement can be compromised by ID. Therefore, the objective of this observational pilot study was to evaluate the process of medication review using STRIP in adults with an ID living in a centralized or dependent setting and the identification of drug-related problems using this tool. The study was performed in three residential care organizations for ID. In each organization nine clients with polypharmacy were selected by an investigator (a physician in training to become a specialized physician for individuals with an ID) for a review using STRIP. Clients as well as their legal representatives (usually a family member) and professional caregivers were invited to participate. Reviews were performed by an investigator together with a pharmacist. First, to evaluate the process time-investments of the investigator and the pharmacist were described. Besides, the proportion of reviews in which a client and/or his legal representative participated was calculated as well as the proportion of professional caregivers that participated. Second, to evaluate the identification of drug-related problems using STRIP, the proportion of clients with at least one drug-related problem was calculated. Mean time investment was 130minutes for the investigator and 90minutes for the pharmacist. The client and/or a legal representatives were present during 25 of 27 reviews (93%). All 27 professional

  5. Quality of medication use in primary care - mapping the problem, working to a solution: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Willson Alan

    2009-09-01

    Full Text Available Abstract Background The UK, USA and the World Health Organization have identified improved patient safety in healthcare as a priority. Medication error has been identified as one of the most frequent forms of medical error and is associated with significant medical harm. Errors are the result of the systems that produce them. In industrial settings, a range of systematic techniques have been designed to reduce error and waste. The first stage of these processes is to map out the whole system and its reliability at each stage. However, to date, studies of medication error and solutions have concentrated on individual parts of the whole system. In this paper we wished to conduct a systematic review of the literature, in order to map out the medication system with its associated errors and failures in quality, to assess the strength of the evidence and to use approaches from quality management to identify ways in which the system could be made safer. Methods We mapped out the medicines management system in primary care in the UK. We conducted a systematic literature review in order to refine our map of the system and to establish the quality of the research and reliability of the system. Results The map demonstrated that the proportion of errors in the management system for medicines in primary care is very high. Several stages of the process had error rates of 50% or more: repeat prescribing reviews, interface prescribing and communication and patient adherence. When including the efficacy of the medicine in the system, the available evidence suggested that only between 4% and 21% of patients achieved the optimum benefit from their medication. Whilst there were some limitations in the evidence base, including the error rate measurement and the sampling strategies employed, there was sufficient information to indicate the ways in which the system could be improved, using management approaches. The first step to improving the overall quality would

  6. Dissemination of IncI2 Plasmids That Harbor the blaCTX-M Element among Clinical Salmonella Isolates.

    Science.gov (United States)

    Wong, Marcus Ho-Yin; Liu, Lizhang; Yan, Meiying; Chan, Edward Wai-Chi; Chen, Sheng

    2015-08-01

    The extended-spectrum-β-lactamase (ESBL) determinant CTX-M-55 is increasingly prevalent in Escherichia coli but remains extremely rare in Salmonella. This study reports the isolation of a plasmid harboring the blaCTX-M-55 element in a clinical Salmonella enterica serotype Typhimurium strain resistant to multiple antibiotics. This plasmid is genetically identical to several known IncI2-type elements harbored by E. coli strains recovered from animals. This finding indicates that IncI2 plasmids harboring the blaCTX-M genes may undergo cross-species migration among potential bacterial pathogens, with E. coli as the major source of such elements. PMID:26014934

  7. First Human Isolate of Salmonella enterica Serotype Enteritidis Harboring blaCTX-M-14 in South America

    OpenAIRE

    Bado, I; Garcia-Fulgueiras, V.; Cordeiro, N F; Betancor, L.; Caiata, L.; Seija, V.; Robino, L.; Algorta, G.; Chabalgoity, J. A.; Ayala, J. A.; Gutkind, G. O.; Vignoli, R

    2012-01-01

    We studied a clinical isolate of Salmonella enterica serotype Enteritidis showing resistance to oxyiminocephalosporins. PCR analysis confirmed the presence of bla CTX-M-14 linked to IS903 in a 95-kb IncI1 conjugative plasmid. Such a plasmid is maintained on account of the presence of a pndAC addiction system. Multilocus sequence typing (MLST) analysis indicated that the strain belongs to ST11. This is the first report of bla CTX-M-14 in Salmonella Enteritidis of human origin in South America....

  8. Recent Emergence of Escherichia coli with Cephalosporin Resistance Conferred by blaCTX-M on Washington State Dairy Farms

    OpenAIRE

    Davis, Margaret A.; Sischo, William M.; Jones, Lisa P.; Moore, Dale A; Ahmed, Sara; Short, Diana M.; Besser, Thomas E.

    2015-01-01

    Enterobacteriaceae-associated blaCTX-M genes have become globally widespread within the past 30 years. Among isolates from Washington State cattle, Escherichia coli strains carrying blaCTX-M (CTX-M E. coli strains) were absent from a set of 2008 isolates but present in a set of isolates from 2011. On 30 Washington State dairy farms sampled in 2012, CTX-M E. coli prevalence was significantly higher on eastern than on northwestern Washington farms, on farms with more than 3,000 adult cows, and ...

  9. Results-Based Financing in Mozambique’s Central Medical Store: A Review After 1 Year

    Science.gov (United States)

    Spisak, Cary; Morgan, Lindsay; Eichler, Rena; Rosen, James; Serumaga, Brian; Wang, Angela

    2016-01-01

    ABSTRACT Background: Public health commodity supply chains are typically weak in low-income countries, partly because they have many disparate yet interdependent functions and components. Approaches to strengthening supply chains in such settings have often fallen short—they address technical weaknesses, but not the incentives that motivate staff to perform better. Methods: We reviewed the first year of a results-based financing (RBF) program in Mozambique, which began in January 2013. The program aimed to improve the performance of the central medical store—Central de Medicamentos e Artigos Medicos (CMAM)—by realigning incentives. We completed in-depth interviews and focus group discussions with 33 key informants, including representatives from CMAM and donor agencies, and collected quantitative data on performance measures and use of funds. Implementation: The RBF agreement linked CMAM performance payments to quarterly results on 5 performance indicators related to supply planning, distribution planning, and warehouse management. RBF is predicated on the theory that a combination of carrot and stick—i.e., shared financial incentives, plus increased accountability for results—will spur changes in behavior. Important design elements: (1) indicators were measured against quarterly targets, and payments were made only for indicators that met those targets; (2) targets were set based on documented performance, at levels that could be reasonably attained, yet pushed for improvement; (3) payment was shared with and dependent on all staff, encouraging teamwork and collaboration; (4) results were validated by verifiable data sources; and (5) CMAM had discretion over how to use the funds. Findings: We found that CMAM’s performance continually improved over baseline and that CMAM achieved many of its performance targets, for example, timely submission of quarterly supply and distribution planning reports. Warehouse indicators, such as inventory management and

  10. Validation of the CoRE Questionnaire for a Medical Journal Peer Review.

    Science.gov (United States)

    Doi, Suhail A R; Salzman-Scott, Sherry A; Onitilo, Adedayo A

    2016-01-01

    If a peer review instrument asks concrete questions (defined as items that can only generate disagreement if reviewers have different degrees of expertise), then questionnaires could become more meaningful in terms of resolving subjectivity thus leading to more reviewer agreement. A concrete item questionnaire with well-chosen questions can also help resolve disagreement when reviewers have the same level of expertise. We have recently created the core-item reviewer evaluation (CoRE) questionnaire for which decision-threshold score levels have been created, but which have not been validated. This prospective validation of these thresholds for the CoRE questionnaire demonstrated strong agreement between reviewer recommendations and their reported score levels when tested prospectively at Clinical Medicine and Research. We conclude that using the CoRE questionnaire will help reduce peer reviewer disagreement. More importantly, when reviewer expertise varies, editors can more easily detect this and decide which opinion reflects the greater expertise. PMID:26192007

  11. Assessing Communication Skills of Medical Students in Objective Structured Clinical Examinations (OSCE) - A Systematic Review of Rating Scales

    Science.gov (United States)

    Cömert, Musa; Zill, Jördis Maria; Christalle, Eva; Dirmaier, Jörg; Härter, Martin; Scholl, Isabelle

    2016-01-01

    Background Teaching and assessment of communication skills have become essential in medical education. The Objective Structured Clinical Examination (OSCE) has been found as an appropriate means to assess communication skills within medical education. Studies have demonstrated the importance of a valid assessment of medical students’ communication skills. Yet, the validity of the performance scores depends fundamentally on the quality of the rating scales used in an OSCE. Thus, this systematic review aimed at providing an overview of existing rating scales, describing their underlying definition of communication skills, determining the methodological quality of psychometric studies and the quality of psychometric properties of the identified rating scales. Methods We conducted a systematic review to identify psychometrically tested rating scales, which have been applied in OSCE settings to assess communication skills of medical students. Our search strategy comprised three databases (EMBASE, PsycINFO, and PubMed), reference tracking and consultation of experts. We included studies that reported psychometric properties of communication skills assessment rating scales used in OSCEs by examiners only. The methodological quality of included studies was assessed using the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. The quality of psychometric properties was evaluated using the quality criteria of Terwee and colleagues. Results Data of twelve studies reporting on eight rating scales on communication skills assessment in OSCEs were included. Five of eight rating scales were explicitly developed based on a specific definition of communication skills. The methodological quality of studies was mainly poor. The psychometric quality of the eight rating scales was mainly intermediate. Discussion Our results reveal that future psychometric evaluation studies focusing on improving the methodological quality are needed

  12. A Review of Semantic Network based System Architecture for Remote Medical Applications: Efficacy & Applicability

    Directory of Open Access Journals (Sweden)

    Onkar S Kemkar

    2012-07-01

    Full Text Available Nowadays, the evolution of wireless communication and network technologies enables remote medical services to be available everywhere in the world. In this paper, a semantic network-based system architecture adopting wireless personal area network, body area network (BAN protocol and 3G communication networks for remote medical applications is proposed. In the proposed system, the number and type of medical sensors are scalable depending on individual needs. This feature allows the system to be flexibly applied in several medical applications. Furthermore, a differentiated service using priority scheduling and data compression is introduced. This scheme can not only reduce transmission delay for critical physiological signals and enhance bandwidth utilization at the same time, but also decrease power consumption of the hand-held personal server. Our research combines ubiquitous computing with mobile health technology. We use wireless sensors and smart phones to monitor the wellbeing of high risk patients.

  13. Doctors charged with manslaughter in the course of medical practice, 1795-2005: a literature review

    OpenAIRE

    Ferner, R E; McDowell, Sarah E

    2006-01-01

    Objectives: To quantify the number of doctors charged with manslaughter in the course of legitimate medical practice and to classify cases, as mistakes, slips (or lapses), and violations, using a recognized classification of human error system.

  14. Undergraduate medical education in substance use in Ireland: a review of the literature and discussion paper.

    LENUS (Irish Health Repository)

    O'Brien, S

    2011-12-01

    Medical complications of substance use are a considerable cause of morbidity and the role of the physician in the care of such problems has consistently been demonstrated. Appropriate knowledge and skills are necessary to carry out this role.

  15. A critical review and meta-analysis of the unconscious thought effect in medical decision making

    OpenAIRE

    Vadillo, Miguel A.; Kostopoulou, Olga; David R. Shanks

    2015-01-01

    Based on research on the increasingly popular unconscious thought effect (UTE), it has been suggested that physicians might make better diagnostic decisions after a period of distraction than after an equivalent amount of time of conscious deliberation. However, published attempts to demonstrate the UTE in medical decision making have yielded inconsistent results. In the present study, we report the results of a meta-analysis of all the available evidence on the UTE in medical decisions made ...

  16. The Evolution and Role Changes of The Australian Military Medic: A Review of The Literature

    OpenAIRE

    Kristina Griffin

    2014-01-01

    Many ancient armies tried to reduce morbidity and mortality on the battlefield through the provision of first aid, the objective of this aid being to prevent further injury and relieve pain until medical help arrived, with the foundation of organised and trained first aid having its origins in this military environment (1). The most successful were the Romans, under Emperor Augustus (63BC-18AD), who developed advanced military medical services to support their legions (2). Included in these ...

  17. Factors affecting the attractiveness of medical tourism destination: an empirical study on India- review article.

    Directory of Open Access Journals (Sweden)

    Seyama Sultana

    2014-07-01

    Full Text Available In this edge, medical tourism is not a new idea. Medical treatment is one of the essential demands of human beings and it requires high quality and intensive care. Beside western world, few developing countries are playing key roles as medical tourism destinations. India is one of the leading names among these countries. The purpose of the paper is to find the factors influencing the attractiveness of India as a health tourism destination.The study has found the major contributing factors and their relative importance in the attractiveness of the health tourism destination that is India from consumers' perspectives by conducting survey with an application of structural equation modelling approach.In Indian context, medical tourists consider service quality and cost mostly to select any medical destination. In addition they also give value to the destination competitiveness but tourist attitude is less important in comparison with other factors affecting their destination choice. Since the study has used structural equation modelling approach to test the hypothesis and figure out the relative importance of the factors, the fundamental indices such as Normed Chi square(less than 3, RMSEA (less than 0.08 and CFI (more than 0.90 values show the overall model fit of the proposed model.In order to transform a country such as India as an attractive and competitive medical tourist destination in this time of globalization, a step should be taken to control cost ensuring the quality of services.

  18. Medical tourism: between entrepreneurship opportunities and bioethics boundaries: narrative review article.

    Directory of Open Access Journals (Sweden)

    Daniel Badulescu

    2015-04-01

    Full Text Available Nowadays, medical tourism reports impressive growth in terms of number of persons, income and number of countries involved in cross-border flows. So this study was undertaken to clarify entrepreneurship opportunities and bio-ethics boundaries in medical tourism. For tourism entrepreneurs, these outgoing flows related to medical procedures and tourism become an opportunity that cannot be ignored, so a wide range of tourist services related to health care are provided on a private, entrepreneurial basis. However, social and economic boundaries are omnipresent (impaired health services in receiving (incoming countries, the crisis of the health care systems in emitting (outgoing countries, over-consumption of medical and tourism services, and, not least, ethical considerations. Transforming medical care in a market tool, reducing human attributes to the status of commodity that can be bought, sold or negotiated, seriously challenges contemporary bioethics principles. It is a significant entering in the area (which is essentially un-ethic of market transactions, where libertarianism and consumer-oriented attitudes dominates the spectrum of rational choice. So tourism comes to provide an organized and comfortable framework for all these choices, but many issues still re-main controversial and may worsen if national health systems and national and international regulations would not identify their problems and would continue to leave medical tourism to market mechanisms. Market will efficiently allocate the resources, but not always in an ethical manner.

  19. Medical tourism: between entrepreneurship opportunities and bioethics boundaries: narrative review article.

    Science.gov (United States)

    Badulescu, Daniel; Badulescu, Alina

    2014-04-01

    Nowadays, medical tourism reports impressive growth in terms of number of persons, income and number of countries involved in cross-border flows. So this study was undertaken to clarify entrepreneurship opportunities and bio-ethics boundaries in medical tourism. For tourism entrepreneurs, these outgoing flows related to medical procedures and tourism become an opportunity that cannot be ignored, so a wide range of tourist services related to health care are provided on a private, entrepreneurial basis. However, social and economic boundaries are omnipresent (impaired health services in receiving (incoming) countries, the crisis of the health care systems in emitting (outgoing) countries, over-consumption of medical and tourism services), and, not least, ethical considerations. Transforming medical care in a market tool, reducing human attributes to the status of commodity that can be bought, sold or negotiated, seriously challenges contemporary bioethics principles. It is a significant entering in the area (which is essentially un-ethic) of market transactions, where libertarianism and consumer-oriented attitudes dominates the spectrum of rational choice. So tourism comes to provide an organized and comfortable framework for all these choices, but many issues still re-main controversial and may worsen if national health systems and national and international regulations would not identify their problems and would continue to leave medical tourism to market mechanisms. Market will efficiently allocate the resources, but not always in an ethical manner. PMID:26005650

  20. Medical Tourism: Between Entrepreneurship Opportunities and Bioethics Boundaries: Narrative Review Article

    Science.gov (United States)

    BADULESCU, Daniel; BADULESCU, Alina

    2014-01-01

    Abstract Nowadays, medical tourism reports impressive growth in terms of number of persons, income and number of countries involved in cross-border flows. So this study was undertaken to clarify entrepreneurship opportunities and bio-ethics boundaries in medical tourism. For tourism entrepreneurs, these outgoing flows related to medical procedures and tourism become an opportunity that cannot be ignored, so a wide range of tourist services related to health care are provided on a private, entrepreneurial basis. However, social and economic boundaries are omnipresent (impaired health services in receiving (incoming) countries, the crisis of the health care systems in emitting (outgoing) countries, over-consumption of medical and tourism services), and, not least, ethical considerations. Transforming medical care in a market tool, reducing human attributes to the status of commodity that can be bought, sold or negotiated, seriously challenges contemporary bioethics principles. It is a significant entering in the area (which is essentially un-ethic) of market transactions, where libertarianism and consumer-oriented attitudes dominates the spectrum of rational choice. So tourism comes to provide an organized and comfortable framework for all these choices, but many issues still re-main controversial and may worsen if national health systems and national and international regulations would not identify their problems and would continue to leave medical tourism to market mechanisms. Market will efficiently allocate the resources, but not always in an ethical manner. PMID:26005650

  1. Ambiente genético del Gen blaCTX-M-12 en aislamientos hospitalarios de Klebsiella pneumoniae

    Directory of Open Access Journals (Sweden)

    Yamile Adriana Celis Bustos

    2009-06-01

    Full Text Available The blaCTX-M-12 gene’s genetic environmnt in Klebsiella pneumoniae hospital isolates Resumen: En Colombia se han detectado genes del grupo CTX-M-1 con alta frecuencia en aislamientos de Klebsiella pneumoniae causantes de infección intrahospitalaria. El conocimiento de los factores genéticos que pueden favorecer la diseminación de estos genes entre especies bacterianas es un aspecto importante para el control de la resistencia. En este estudio se identificaron los plásmidos portadores del gen blaCTX-M-12 en 21 aislamientos clínicos de K. pneumoniae. Se evaluó por conjugación la transferencia de resistencia a antibióticos. Integrones, secuencias de inserción y otros elementos genéticos fueron detectados por amplificación del ADN plasmídico con la reacción en cadena de la polimerasa (PCR. Mediante análisis por PCR se determinó la relación entre el gen blaCTX-M-12 y los elementos genéticos detectados. En todos los aislamientos, el gen blaCTX-M-12 se encontró en plásmidos conjugativos de tamaños entre 65 y 106 kpb. La transferencia por conjugación de estos elementos móviles puede explicar la amplia diseminación de este gen entre enterobacterias causantes de infección nosocomial en hospitales de Bogotá, Colombia. El gen blaCTX-M-12 se encontró corriente abajo de ISEcp1, secuencia de inserción que se ha asociado con la movilización de determinantes genéticos de resistencia. Los promotores de ISEcp1, detectados por análisis de secuencia, pueden facilitar la expresión de la cefotaximasa codificada por este gen.Palabras clave: resistencia a antibióticos; elementos genéticos móviles; gen blaCTX-M-12; plásmidos conjugativos;  Klebsiella pneumoniae. Abstract: Genes from CTX-M-1 group have been detected with great frequency in Colombia in intrahospital infection-causing Klebsiella pneumoniae isolates. Knowledge regarding the genetic factors favouring such genes’ dissemination amongst bacterial species is an

  2. Patients’ perspectives on the medical primary–secondary care interface: systematic review and synthesis of qualitative research

    Science.gov (United States)

    Sampson, Rod; Cooper, Jamie; Barbour, Rosaline; Polson, Rob; Wilson, Philip

    2015-01-01

    Objectives To synthesise the published literature on the patient experience of the medical primary–secondary care interface and to determine priorities for future work in this field aimed at improving clinical outcomes. Design Systematic review and metaethnographic synthesis of primary studies that used qualitative methods to explore patients’ perspectives of the medical primary–secondary care interface. Setting International primary–secondary care interface. Data sources EMBASE, MEDLINE, CINAHL Plus with Full text, PsycINFO, Psychology and Behavioural Sciences Collection, Health Business Elite, Biomedica Reference Collection: Comprehensive Library, Information Science & Technology Abstracts, eBook Collection, Web of Science Core Collection: Citation Indexes and Social Sciences Citation Index, and grey literature. Eligibility criteria for selecting studies Studies were eligible for inclusion if they were full research papers employing qualitative methodology to explore patients’ perspectives of the medical primary–secondary care interface. Review methods The 7-step metaethnographic approach described by Noblit and Hare, which involves cross-interpretation between studies while preserving the context of the primary data. Results The search identified 690 articles, of which 39 were selected for full-text review. 20 articles were included in the systematic review that encompassed a total of 689 patients from 10 countries. 4 important areas specific to the primary–secondary care interface from the patients’ perspective emerged: barriers to care, communication, coordination, and ‘relationships and personal value’. Conclusions and implications of key findings Patients should be the focus of any transfer of care between primary and secondary systems. From their perspective, areas for improvement may be classified into four domains that should usefully guide future work aimed at improving quality at this important interface. Trial registration number

  3. Dissemination and characterization of plasmids carrying oqxAB-bla CTX-M genes in Escherichia coli isolates from food-producing animals.

    Directory of Open Access Journals (Sweden)

    Bao-Tao Liu

    Full Text Available BACKGROUND: The association of PMQR and ESBLs in negative-bacteria isolates has been of great concern. The present study was performed to investigate the prevalence of co-transferability of oqxAB and bla CTX-M genes among the 696 Escherichia coli (E. coli isolates from food-producing animals in South China, and to characterize these plasmids. METHODS: The ESBL-encoding genes (bla(CTX-M, bla(TEM and bla(SHV, and PMQR (qnrA, qnrB, qnrS, qnrC, qnrD, aac(6'-Ib-cr, qepA, and oqxAB of these 696 isolates were determined by PCR and sequenced directionally. Conjugation, S1 nuclease pulsed-field gel electrophoresis (PFGE and Southern blotting experiments were performed to investigate the co-transferability and location of oqxAB and bla(CTX-M. The EcoRI digestion profiles of the plasmids with oqxAB-bla(CTX-M were also analyzed. The clonal relatedness was investigated by PFGE. RESULTS: Of the 696 isolates, 429 harbored at least one PMQR gene, with oqxAB (328 being the most common type; 191 carried bla(CTX-M, with bla(CTX-M-14 the most common. We observed a significant higher prevalence of bla(CTX-M among the oqxAB-positive isolates (38.7% than that (17.4% in the oqxAB-negative isolates. Co-transferability of oqxAB and bla(CTX-M was found in 18 of the 127 isolates carrying oqxAB-bla(CTX-M. These two genes were located on the same plasmid in all the 18 isolates, with floR being on these plasmids in 13 isolates. The co-dissemination of these genes was mainly mediated by F33:A-: B- and HI2 plasmids with highly similar EcoRI digestion profiles. Diverse PFGE patterns indicated the high prevalence of oqxAB was not caused by clonal dissemination. CONCLUSION: bla(CTX-M was highly prevalent among the oqxAB-positive isolates. The co-dissemination of oqxAB-bla(CTX-M genes in E. coli isolates from food-producing animals is mediated mainly by similar F33:A-: B- and HI2 plasmids. This is the first report of the co-existence of oqxAB, bla(CTX-M, and floR on the same

  4. Constitutional limits on federal legislation practically compelling medical employment: Wong v Commonwealth; Selim v Professional Services Review Committee.

    Science.gov (United States)

    Faunce, Thomas

    2009-10-01

    A recent decision by the High Court of Australia (Wong v Commonwealth; Selim v Professional Services Review Committee (2009) 236 CLR 573) (the PSR case) has not only clarified the scope of the Australian constitutional prohibition on "any form of civil conscription" in relation to federal legislation concerning medical or dental services (s 51xxiiiA), but has highlighted its importance as a great constitutional guarantee ensuring the mixed State-federal and public-private nature of medical service delivery in Australia. Previous decisions of the High Court have clarified that the prohibition does not prevent federal laws regulating the manner in which medical services are provided. The PSR case determined that the anti-overservicing provisions directed at bulk-billing general practitioners under Pt VAA of the Health Insurance Act 1973 (Cth) did not offend the prohibition. Importantly, the High Court also indicated that the s 51(xxiiiA) civil conscription guarantee should be construed widely and that it would invalidate federal laws requiring providers of medical and dental services (either expressly or by practical compulsion) to work for the federal government or any specified State, agency or private industrial employer. This decision is likely to restrict the capacity of any future federal government to restructure the Australian health care system, eg by implementing recommendations from the National Health and Hospitals Reform Commission for either federal government or private corporate control of presently State-run public hospitals. PMID:19998589

  5. The role of peer review on the improvement of the articles published in the Journal of Birjand University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Hossein Beydokhti

    2014-11-01

    Conclusion: Peer review improved the quality of articles, particularly in the titles, editing and findings. Since accurate medical research reports in the correct information transfer to professionals and researchers, what JBUMS has done can be useful and valuable.

  6. Narrative review of the safety and efficacy of marijuana for the treatment of commonly state-approved medical and psychiatric disorders

    OpenAIRE

    Belendiuk, Katherine A.; Baldini, Lisa L; Bonn-Miller, Marcel O.

    2015-01-01

    The present investigation aimed to provide an objective narrative review of the existing literature pertaining to the benefits and harms of marijuana use for the treatment of the most common medical and psychological conditions for which it has been allowed at the state level. Common medical conditions for which marijuana is allowed (i.e., those conditions shared by at least 80 percent of medical marijuana states) were identified as: Alzheimer’s disease, amyotrophic lateral sclerosis, cachexi...

  7. Efficacy of Atypical Antipsychotic Medication in the Management of Behaviour Problems in Children with Intellectual Disabilities and Borderline Intelligence: A Systematic Review

    Science.gov (United States)

    Unwin, Gemma L.; Deb, Shoumitro

    2011-01-01

    The use of medications to manage problem behaviours is widespread. However, robust evidence to support their use seems to be lacking. The aim was to review research evidence into the efficacy of atypical antipsychotic medication in managing problem behaviour in children with intellectual disabilities and borderline intelligence. A systematic…

  8. A critical review of glove and hand research with regard to medical glove design.

    Science.gov (United States)

    Mylon, Peter; Lewis, Roger; Carré, Matt J; Martin, Nicolas

    2014-01-01

    Research from a number of areas was surveyed, including hand function; skin friction; manual performance testing; glove comfort, fit and durability; and user perception. The relevance of the research to medical glove design was discussed. It was concluded that, while an understanding has been gained of the factors that affect glove performance in general, specific application to thin rubber gloves has not been well explored. The focus in glove performance testing has also been on simple tasks such as pegboards, which do not necessarily assess the fine dexterity required in many surgical tasks. Recommendations were made for the development of a new battery of tests specific to medical gloves that would simulate real medical tasks and could produce repeatable results and have sufficient resolution to differentiate between glove types. PMID:24219777

  9. Social Media Etiquette for the Modern Medical Student: A Narrative Review

    Directory of Open Access Journals (Sweden)

    Brittany Harrison

    2014-06-01

    Full Text Available Most medical students worldwide are using some form of social media platform to supplement their learning via file sharing and to stay up-to-date on medical events. Often, social media may blur the line between socialization and educational use, so it is important to be aware of how one is utilizing social media and how to remain professional. Research has yielded some troublesome themes of misconduct: drunken behaviour, violations of confidentiality and defamation of institutions. Because there is no universal policy to monitor online professionalism, there exists the potential for indiscretions to occur. It has been reported that misdemeanours can affect future residency placements and employment for medical students. Accordingly, studies suggest that educators need to recognize this new era of professionalism and adapt policies and reprimands to meet modern outlets where professionalism may be violated.

  10. A narrative review on the management of medication overuse headache: the steep road from experience to evidence

    DEFF Research Database (Denmark)

    Rossi, Paolo; Jensen, Rigmor; Nappi, Giuseppe; Allena, Marta; COMOESTAS Consortium

    2009-01-01

    The management of medication overuse headache (MOH) is based essentially on the withdrawal of the overused drug(s). Drug withdrawal is performed according to widely differing protocols, both within and across countries; therefore, therapeutic recommendations for the acute phase of detoxification...... vary considerably among studies. Basically, the aims of MOH management are: (a) to withdraw the overused drug(s); (b) to alleviate withdrawal symptoms by means of a bridge therapy, which includes pharmacological and non-pharmacological support, designed to help the patient to tolerate the withdrawal...... process; (c) to prevent relapse. Today, there is extensive debate over the best strategies for achieving these goals and the different aspects of this debate are discussed in this review. The authors searched for the best available evidence relating to the following questions: should medication withdrawal...

  11. A systematic review of the factors associated with delays in medical and psychological help-seeking among men.

    Science.gov (United States)

    Yousaf, Omar; Grunfeld, Elizabeth A; Hunter, Myra S

    2015-01-01

    Despite a growing literature on the factors associated with men's low rates of medical and psychological help-seeking, a systematic review of these is missing. Such an overview can help to inform health psychologists of the barriers to the performance of adaptive health behaviours, such as prompt help-seeking, and could inform theoretical advancements and the development of targeted interventions to facilitate prompt help-seeking among men. We systematically reviewed quantitative and qualitative empirical papers on factors associated with delays in men's medical and psychological help-seeking. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and we used the databases PsycINFO, Medline, Embase and PsycARTICLES (with keywords: men/male*/gender*, help*/seek* and health*/service*/utili*[sation]) for papers in English. 41 citations (amounting to 21,787 participants aged 15-80 + ) met the inclusion criteria. Approximately half of these used qualitative methodologies (i.e., semi-structured interviews and focus groups), while half used quantitative methodologies (i.e., questionnaires). We identify a number of recurring cognitive, emotional, health-service related and socio-demographic help-seeking factors/predictors from the 41 papers. Of these, the most prominent barriers to help-seeking were disinclination to express emotions/concerns about health, embarrassment, anxiety and fear, and poor communication with health-care professionals. PMID:26209212

  12. Medical emergency provisions in case of large-scale radiation accidents (literature review)

    International Nuclear Information System (INIS)

    Problems of planning population protection in case of severe radiation accidents are considered. Attention is paid to the state of these problems in the USSR and other contries as well as to IAEA directives. The Three Mile Island and Chernobyl accidents are used for illustration purposes. Organization of medical help during radiation accidents, provided for in national regulations and experience gained during Chernobyl NPP accident are considered. Conclusion is made on the necessity of forcasting accident consequences with regard to local, social, economical, geographic and other conditions. Availability of medical provision plans, related to elimination of accident aftereffects and skill training, is obligatory

  13. Reporting of various methodological and statistical parameters in negative studies published in prominent Indian Medical Journals: A systematic review

    Directory of Open Access Journals (Sweden)

    J Charan

    2014-01-01

    Full Text Available Objectives: Biased negative studies not only reflect poor research effort but also have an impact on ′patient care′ as they prevent further research with similar objectives, leading to potential research areas remaining unexplored. Hence, published ′negative studies′ should be methodologically strong. All parameters that may help a reader to judge validity of results and conclusions should be reported in published negative studies. There is a paucity of data on reporting of statistical and methodological parameters in negative studies published in Indian Medical Journals. The present systematic review was designed with an aim to critically evaluate negative studies published in prominent Indian Medical Journals for reporting of statistical and methodological parameters. Design: Systematic review. Materials and Methods: All negative studies published in 15 Science Citation Indexed (SCI medical journals published from India were included in present study. Investigators involved in the study evaluated all negative studies for the reporting of various parameters. Primary endpoints were reporting of "power" and "confidence interval." Results: Power was reported in 11.8% studies. Confidence interval was reported in 15.7% studies. Majority of parameters like sample size calculation (13.2%, type of sampling method (50.8%, name of statistical tests (49.1%, adjustment of multiple endpoints (1%, post hoc power calculation (2.1% were reported poorly. Frequency of reporting was more in clinical trials as compared to other study designs and in journals having impact factor more than 1 as compared to journals having impact factor less than 1. Conclusion: Negative studies published in prominent Indian medical journals do not report statistical and methodological parameters adequately and this may create problems in the critical appraisal of findings reported in these journals by its readers.

  14. Researchers' experience with project management in health and medical research: Results from a post-project review

    Directory of Open Access Journals (Sweden)

    Elliott Elizabeth J

    2011-06-01

    Full Text Available Abstract Background Project management is widely used to deliver projects on time, within budget and of defined quality. However, there is little published information describing its use in managing health and medical research projects. We used project management in the Alcohol and Pregnancy Project (2006-2008 http://www.ichr.uwa.edu.au/alcoholandpregnancy and in this paper report researchers' opinions on project management and whether it made a difference to the project. Methods A national interdisciplinary group of 20 researchers, one of whom was the project manager, formed the Steering Committee for the project. We used project management to ensure project outputs and outcomes were achieved and all aspects of the project were planned, implemented, monitored and controlled. Sixteen of the researchers were asked to complete a self administered questionnaire for a post-project review. Results The project was delivered according to the project protocol within the allocated budget and time frame. Fifteen researchers (93.8% completed a questionnaire. They reported that project management increased the effectiveness of the project, communication, teamwork, and application of the interdisciplinary group of researchers' expertise. They would recommend this type of project management for future projects. Conclusions Our post-project review showed that researchers comprehensively endorsed project management in the Alcohol and Pregnancy Project and agreed that project management had contributed substantially to the research. In future, we will project manage new projects and conduct post-project reviews. The results will be used to encourage continuous learning and continuous improvement of project management, and provide greater transparency and accountability of health and medical research. The use of project management can benefit both management and scientific outcomes of health and medical research projects.

  15. A Systematic Review of the Level of Evidence in Economic Evaluations of Medical Devices: The Example of Vertebroplasty and Kyphoplasty.

    Directory of Open Access Journals (Sweden)

    Nicolas Martelli

    Full Text Available Economic evaluations are far less frequently reported for medical devices than for drugs. In addition, little is known about the quality of existing economic evaluations, particularly for innovative devices, such as those used in vertebroplasty and kyphoplasty.To assess the level of evidence provided by the available economic evaluations for vertebroplasty and kyphoplasty.A systematic review of articles in English or French listed in the MEDLINE, PASCAL, COCHRANE and National Health Service Economic Evaluation databases, with limits on publication date (up to the date of the review, March 2014.We included only economic evaluations of vertebroplasty or kyphoplasty. Editorial and methodological articles were excluded.Data were extracted from articles by two authors working independently and using two analysis grids to measure the quality of economic evaluations.Twenty-one studies met our inclusion criteria. All were published between 2008 and 2014. Eighteen (86% were full economic evaluations. Cost-effectiveness analysis (CEA was the most frequent type of economic evaluation, and was present in 11 (52% studies. Only three CEAs complied fully with the British Medical Journal checklist. The quality of the data sources used in the 21 studies was high, but the CEAs conforming to methodological guidelines did not use high-quality data sources for all components of the analysis.This systematic review shows that the level of evidence in economic evaluations of vertebroplasty and kyphoplasty is low, despite the recent publication of a large number of studies. This finding highlights the challenges to be faced to improve the quality of economic evaluations of medical devices.

  16. Medical Utilization of Kiosks in the Delivery of Patient Education: A Systematic Review

    Science.gov (United States)

    Yvonne Chan, Yu-Feng; Nagurka, Roxanne; Bentley, Suzanne; Ordonez, Edgardo; Sproule, William

    2014-01-01

    Background: The utilization of kiosks has previously been shown to be effective for collecting information, delivering educational modules, and providing access to health information. We discuss a review of current literature for the utilization of kiosks for the delivery of patient education. Methods: The criteria for inclusion in this literature review were: (1) study discusses the utilization of kiosks for patient health education; (2) study discusses the use of touch screens for patient health information; (3) published in English. Our review includes searches via MEDLINE databases and Google Scholar for the years 1996-2014. Results: Overall, 167 articles were screened for final eligibility, and after discarding duplicates and non-eligible studies with abstract. Full-text review of 28 articles was included in the final analysis. Conclusion: The review of available literature demonstrates the effectiveness of touch screen kiosks to educate patients and to improve healthcare, both at a performance and cost advantage over other modes of patient education. PMID:25097831

  17. A critical review and meta-analysis of the unconscious thought effect in medical decision making

    Directory of Open Access Journals (Sweden)

    Miguel A. Vadillo

    2015-05-01

    Full Text Available Based on research on the increasingly popular unconscious thought effect (UTE, it has been suggested that physicians might make better diagnostic decisions after a period of distraction than after an equivalent amount of time of conscious deliberation. However, published attempts to demonstrate the UTE in medical decision making have yielded inconsistent results. In the present study, we report the results of a meta-analysis of all the available evidence on the UTE in medical decisions made by expert and novice clinicians. The meta-analysis failed to find a significant contribution of unconscious thought to the accuracy of medical decisions. This result cannot be easily attributed to any of the potential moderators of the UTE that have been discussed in the literature. Furthermore, a Bayes Factor analysis shows that most experimental conditions provide positive support for the null hypothesis, suggesting that these null results do not reflect a simple lack of statistical power. We suggest ways in which new studies could usefully provide further evidence on the UTE. Unless future research shows otherwise, the recommendation of using unconscious thought to improve medical decisions lacks empirical support.

  18. A critical review and meta-analysis of the unconscious thought effect in medical decision making.

    Science.gov (United States)

    Vadillo, Miguel A; Kostopoulou, Olga; Shanks, David R

    2015-01-01

    Based on research on the increasingly popular unconscious thought effect (UTE), it has been suggested that physicians might make better diagnostic decisions after a period of distraction than after an equivalent amount of time of conscious deliberation. However, published attempts to demonstrate the UTE in medical decision making have yielded inconsistent results. In the present study, we report the results of a meta-analysis of all the available evidence on the UTE in medical decisions made by expert and novice clinicians. The meta-analysis failed to find a significant contribution of unconscious thought (UT) to the accuracy of medical decisions. This result cannot be easily attributed to any of the potential moderators of the UTE that have been discussed in the literature. Furthermore, a Bayes factor analysis shows that most experimental conditions provide positive support for the null hypothesis, suggesting that these null results do not reflect a simple lack of statistical power. We suggest ways in which new studies could usefully provide further evidence on the UTE. Unless future research shows otherwise, the recommendation of using UT to improve medical decisions lacks empirical support. PMID:26042068

  19. Review of interdisciplinary online-image-databases and their usability in medical education

    Directory of Open Access Journals (Sweden)

    Kammerer, Ferdinand J.

    2006-11-01

    Full Text Available Images play a significant role in medical teaching. They can get prospective physicians acquainted with specific pathological changes as early as possible and they support training their diagnostic eye. The latest improvements in Web-Based-Training offer extensive features for cost-effective studying adjustable to the individual student's requirements. However, many web-sites provide only qualitatively heterogeneous data and a limited inventory of images. This generally complicates any systematic access to the information the student requires.During the last years, several projects were initiated trying to overcome these difficulties. Web-Portals should provide access to large sets of images in a centralized manner while encompassing several medical subjects. For five of these portals their applicability for medical education was investigated considering structure, navigation and search mechanisms. Some notable approaches to implementing the various search functions were observed. However, some sites have room for improvement concerning quality of content as well as clarity of presentation and navigation. Based on the problems discovered and the approaches found, a catalogue of requirements was compiled for creating a Web-Portal to optimally support medical education.

  20. Program review of the USDA Center for Medical, Agricultural and Veterinary Entomology

    Science.gov (United States)

    The USDA-ARS Center for Medical, Agricultural and Veterinary Entomology (CMAVE) has a history that starts in 1932 in Orlando to develop methods to control mosquitoes, including malaria vectors under conditions simulating those of the south Pacific jungles, and other insects affecting man and animals...

  1. Mentoring programs for medical students - a review of the PubMed literature 2000 - 2008

    Directory of Open Access Journals (Sweden)

    Buddeberg-Fischer Barbara

    2010-04-01

    Full Text Available Abstract Background Although mentoring is acknowledged as a key to successful and satisfying careers in medicine, formal mentoring programs for medical students are lacking in most countries. Within the framework of planning a mentoring program for medical students at Zurich University, an investigation was carried out into what types of programs exist, what the objectives pursued by such programs are, and what effects are reported. Methods A PubMed literature search was conducted for 2000 - 2008 using the following keywords or their combinations: mentoring, mentoring program, medical student, mentor, mentee, protégé, mentorship. Although a total of 438 publications were identified, only 25 papers met the selection criteria for structured programs and student mentoring surveys. Results The mentoring programs reported in 14 papers aim to provide career counseling, develop professionalism, increase students' interest in research, and support them in their personal growth. There are both one-to-one and group mentorships, established in the first two years of medical school and continuing through graduation. The personal student-faculty relationship is important in that it helps students to feel that they are benefiting from individual advice and encourages them to give more thought to their career choices. Other benefits are an increase in research productivity and improved medical school performance in general. Mentored students also rate their overall well-being as higher. - The 11 surveys address the requirements for being an effective mentor as well as a successful mentee. A mentor should empower and encourage the mentee, be a role model, build a professional network, and assist in the mentee's personal development. A mentee should set agendas, follow through, accept criticism, and be able to assess performance and the benefits derived from the mentoring relationship. Conclusion Mentoring is obviously an important career advancement tool for

  2. Learning without Borders: A Review of the Implementation of Medical Error Reporting in Medecins Sans Frontieres.

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    Leslie Shanks

    Full Text Available To analyse the results from the first 3 years of implementation of a medical error reporting system in Médecins Sans Frontières-Operational Centre Amsterdam (MSF programs.A medical error reporting policy was developed with input from frontline workers and introduced to the organisation in June 2010. The definition of medical error used was "the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim." All confirmed error reports were entered into a database without the use of personal identifiers.179 errors were reported from 38 projects in 18 countries over the period of June 2010 to May 2013. The rate of reporting was 31, 42, and 106 incidents/year for reporting year 1, 2 and 3 respectively. The majority of errors were categorized as dispensing errors (62 cases or 34.6%, errors or delays in diagnosis (24 cases or 13.4% and inappropriate treatment (19 cases or 10.6%. The impact of the error was categorized as no harm (58, 32.4%, harm (70, 39.1%, death (42, 23.5% and unknown in 9 (5.0% reports. Disclosure to the patient took place in 34 cases (19.0%, did not take place in 46 (25.7%, was not applicable for 5 (2.8% cases and not reported for 94 (52.5%. Remedial actions introduced at headquarters level included guideline revisions and changes to medical supply procedures. At field level improvements included increased training and supervision, adjustments in staffing levels, and adaptations to the organization of the pharmacy.It was feasible to implement a voluntary reporting system for medical errors despite the complex contexts in which MSF intervenes. The reporting policy led to system changes that improved patient safety and accountability to patients. Challenges remain in achieving widespread acceptance of the policy as evidenced by the low reporting and disclosure rates.

  3. Pregnancy-Related Acute Myocardial Infarction: A Review of Epidemiology, Diagnosis, Medical And Surgical Management

    OpenAIRE

    Mohammad Reza Taban Sadeghi; Naser Aslanabadi; Naser Khezerlou Aghdam; Razieh Parizad; Hossein Namdar

    2014-01-01

    Although acute myocardial infarction (AMI) in pregnancy is rare, can result in maternal and/or fetal death and should be carefully managed. The aim of this study is to collect and review the data on the management from numerous articles published since 2000. For literature review we performed a literature search on PubMed that were based on diagnoses and management of myocardial infarction on pregnancy. Atherosclerosis appears to be the most common cause of AMI. Although there are some differ...

  4. Intercultural Usage of Mori Folium: Comparison Review from a Korean Medical Perspective

    OpenAIRE

    Byungjin Joh; Eun Sang Jeon; Su Hye Lim; Yu Lee Park; Wansu Park; Han Chae

    2015-01-01

    Objectives. A review on studies related to the use of Mori folium, the leaves of Morus alba, was conducted with the goal of identifying new clinical applications in Korean medicine. Methods. Global literature search was conducted using three electronic databases up to January 2015 with the term Morus alba and its Korean terms. KM literatures including textbooks and standard pharmacopoeia were separately hand-searched and reviewed to provide comparison. Data were extracted according to predete...

  5. Designing medical and educational intervention studies. A review of some alternatives to conventional randomized controlled trials

    OpenAIRE

    Bradley, Clare

    1993-01-01

    The advantages and limitations of RCT designs are discussed, and a range of alternative designs for medical and educational intervention studies considered. Designs selected are those that address the much neglected psychological issues involved in the recruitment of patients and allocation of patients to treatments within trials. Designs include Zelen's (18) randomized consent design, Brewin and Bradley's (20) partially randomized patient-centered design, and Korn and Baumrind's (21) partial...

  6. Manipulating measurement scales in medical statistical analysis and data mining: A review of methodologies

    OpenAIRE

    Hamid Reza Marateb; Marjan Mansourian; Peyman Adibi; Dario Farina

    2014-01-01

    Background: selecting the correct statistical test and data mining method depends highly on the measurement scale of data, type of variables, and purpose of the analysis. Different measurement scales are studied in details and statistical comparison, modeling, and data mining methods are studied based upon using several medical examples. We have presented two ordinal-variables clustering examples, as more challenging variable in analysis, using Wisconsin Breast Cancer Data (WBCD). Ordinal-to-...

  7. Twenty-year review of medical findings in a Marshallese population accidentally exposed to radioactive fallout

    International Nuclear Information System (INIS)

    A summary is presented of results of medical examinations of inhabitants of the Marshall Islands during the 20-year period following the exposure of Rongelap people to radioactive fallout in 1954. The initial effect observed was β burns of the skin of some individuals. Few significant findings were observed during the subsequent 9-year period, although an increase in miscarriages and stillbirths among the exposed women was noted. In 1963 some thyroid abnormalities and growth retardation of some children were noted. (177 references)

  8. Towards Web 3.0: Taxonomies and ontologies for medical education - a systematic review

    OpenAIRE

    Blaum, Wolf E.; Jarczweski, Anne; Balzer, Felix; Stötzner, Philip; Ahlers, Olaf

    2013-01-01

    Introduction: Both for curricular development and mapping, as well as for orientation within the mounting supply of learning resources in medical education, the Semantic Web ("Web 3.0") poses a low-threshold, effective tool that enables identification of content related items across system boundaries. Replacement of the currently required manual with an automatically generated link, which is based on content and semantics, requires the use of a suitably structured vocabulary for a machine-rea...

  9. Music as Medicine: A Literature Review and Project Proposal for "Ethnomusic Therapy" and Medical Ethnomusicology

    OpenAIRE

    Phan, Christopher

    2016-01-01

    “Ethnomusic therapy” and medical ethnomusicology are emerging subdisciplines in the field of ethnomusicology that explore issues of music, health, medicine, education, and culture. Drawing from methodologies in the arts, humanities, and sciences, researchers in the field come from a variety of disciplines and examine different aspects of music and health research. While clinicians such as music therapists, nurses, and doctors tend to focus on improving patient care and treating diseases, fiel...

  10. First Description of the Extended Spectrum-Beta-Lactamase Gene blaCTX-M-109 in Salmonella Grumpensis Strains Isolated from Neonatal Nosocomial Infections in Dakar, Senegal.

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    Amadou Diop

    Full Text Available Nosocomial infections are very common in African hospitals, particularly in neonatal units. These infections are most often caused by bacteria such as Escherichia coli, Klebsiella spp and Staphylococcus spp. Salmonella strains are rarely involved in nosocomial infections. Here, we report the first description of S. Grumpensis in neonatal infections in Senegal. Seventeen Salmonella strains were isolated from hospitalized infants' stool samples. The following resistance phenotype was described in strains: AMXRTICRCFR FOXRCFXRCTXRCAZRIMPSATMRNARNORRCIPRTMRGMRTERSXTR. All isolates were susceptible to imipenem, 15 out of 17 produced an extended spectrum ß-lactamase (ESBL. blaOXA-1, blaSHV-1, blaTEM-1, blaCTX-M1 genes were detected in strains 8, 13, 5 and 8, respectively. blaCTX-M1 sequencing revealed the presence of blaCTX-M-109. Thirteen of the 17 Salmonella Grumpensis strains were analyzed by PFGE. These 13 isolates belonged to a single pulsotype and were genotypically identical. This is the first report of neonatal S. Grumpensis infections in Senegal, and the first report of blaCTX-M-109 in the genus Salmonella.

  11. Local envenoming by the Western hognose snake (Heterodon nasicus): a case report and review of medically significant Heterodon bites.

    Science.gov (United States)

    Weinstein, Scott A; Keyler, Daniel E

    2009-09-01

    A case of clinically significant local envenoming resulting from a bite inflicted by a Western hognose snake, Heterodon nasicus, is described. The patient was bitten while offering a juvenile mouse to a captive snake. The snake maintained a grip on the patient's arm (left anticubital fossa) for several minutes. The bite resulted in marked edema, ecchymoses, lymphadenopathy, cutaneous signs suggestive of mild cellulitis and blister formation. There were no systemic effects. Recovery was complete after approximately five months. Several documented Heterodon sp. bites with significant clinical effects are reviewed. This common xenodontine colubrid must be considered capable of inflicting medically significant bites. It is currently unclear whether the pathological changes associated with these bites are due to specific Duvernoy's secretion components, Type I hypersensitivity or a combination of these. The influence of the feeding response on the severity of clinical effects is considered as is the discrepancy between experimentally verified pharmacological activities of Duvernoy's secretions from Heterodon sp. and medical sequelae of documented bites. Although hognose snakes may uncommonly produce medically significant bites, they should not be considered dangerous or venomous. Captive specimens should be handled carefully, particularly when offered food. PMID:19393681

  12. Children with Attention Deficit/Hyperactivity Disorder and Reading Disability: A Review of the Efficacy of Medication Treatments.

    Science.gov (United States)

    Gray, Christina; Climie, Emma A

    2016-01-01

    Reading is a multifaceted skillset that has the potential to profoundly impact a child's academic performance and achievement. Mastery of reading skills is often an area of difficulty for children during their academic journey, particularly for children with Attention Deficit/Hyperactivity Disorder (ADHD), Specific Learning Disorder with Impairment in Reading (SLD-R), or children with a comorbid diagnosis of both ADHD and SLD-R. ADHD is characterized by executive functioning and impulse control deficits, as well as inattention and impulsivity. Among the academic struggles experienced by children with ADHD are challenges with word reading, decoding, or reading comprehension. Similarly, children with SLD-R frequently encounter difficulties in the development of appropriate reading skills. SLD-R incorporates dysfunctions in basic visual and auditory processes that result in difficulties with decoding and spelling words. There have been limited empirical studies investigating the efficacy of interventions to improve the reading ability of children with both ADHD and SLD-R. Research studies that have focused on reading interventions for children from this population have predominantly included the use of medication treatments with stimulants (e.g., methylphenidate) and non-stimulants (e.g., atomoxetine). This review paper will present and integrate findings from empirical studies on successful medication treatments for children with comorbid ADHD and SLD-R. Furthermore, this paper will extend findings from empirically successful medication treatments to provide directions for future research. PMID:27458398

  13. Children with Attention Deficit/Hyperactivity Disorder and Reading Disability: A Review of the Efficacy of Medication Treatments

    Science.gov (United States)

    Gray, Christina; Climie, Emma A.

    2016-01-01

    Reading is a multifaceted skillset that has the potential to profoundly impact a child’s academic performance and achievement. Mastery of reading skills is often an area of difficulty for children during their academic journey, particularly for children with Attention Deficit/Hyperactivity Disorder (ADHD), Specific Learning Disorder with Impairment in Reading (SLD-R), or children with a comorbid diagnosis of both ADHD and SLD-R. ADHD is characterized by executive functioning and impulse control deficits, as well as inattention and impulsivity. Among the academic struggles experienced by children with ADHD are challenges with word reading, decoding, or reading comprehension. Similarly, children with SLD-R frequently encounter difficulties in the development of appropriate reading skills. SLD-R incorporates dysfunctions in basic visual and auditory processes that result in difficulties with decoding and spelling words. There have been limited empirical studies investigating the efficacy of interventions to improve the reading ability of children with both ADHD and SLD-R. Research studies that have focused on reading interventions for children from this population have predominantly included the use of medication treatments with stimulants (e.g., methylphenidate) and non-stimulants (e.g., atomoxetine). This review paper will present and integrate findings from empirical studies on successful medication treatments for children with comorbid ADHD and SLD-R. Furthermore, this paper will extend findings from empirically successful medication treatments to provide directions for future research. PMID:27458398

  14. A Systematic Review of Statistical Methods Used to Test for Reliability of Medical Instruments Measuring Continuous Variables

    Directory of Open Access Journals (Sweden)

    Rafdzah Zaki

    2013-06-01

    Full Text Available   Objective(s: Reliability measures precision or the extent to which test results can be replicated. This is the first ever systematic review to identify statistical methods used to measure reliability of equipment measuring continuous variables. This studyalso aims to highlight the inappropriate statistical method used in the reliability analysis and its implication in the medical practice.   Materials and Methods: In 2010, five electronic databases were searched between 2007 and 2009 to look for reliability studies. A total of 5,795 titles were initially identified. Only 282 titles were potentially related, and finally 42 fitted the inclusion criteria. Results: The Intra-class Correlation Coefficient (ICC is the most popular method with 25 (60% studies having used this method followed by the comparing means (8 or 19%. Out of 25 studies using the ICC, only 7 (28% reported the confidence intervals and types of ICC used. Most studies (71% also tested the agreement of instruments. Conclusion: This study finds that the Intra-class Correlation Coefficient is the most popular method used to assess the reliability of medical instruments measuring continuous outcomes. There are also inappropriate applications and interpretations of statistical methods in some studies. It is important for medical researchers to be aware of this issue, and be able to correctly perform analysis in reliability studies.

  15. Peer review comments on drug trials submitted to medical journals differ depending on sponsorship, results and acceptance: a retrospective cohort study

    NARCIS (Netherlands)

    Lent, M. van; Hout, J. in't; Out, H.J.

    2015-01-01

    OBJECTIVE: During peer review, submitted manuscripts are scrutinised by independent experts to assist journal editors in their decision-making and to help improve the quality of articles. In this retrospective cohort study, peer review comments for drug trials submitted to medical journals were anal

  16. Feature engineering and a proposed decision-support system for systematic reviewers of medical evidence.

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    Tanja Bekhuis

    Full Text Available OBJECTIVES: Evidence-based medicine depends on the timely synthesis of research findings. An important source of synthesized evidence resides in systematic reviews. However, a bottleneck in review production involves dual screening of citations with titles and abstracts to find eligible studies. For this research, we tested the effect of various kinds of textual information (features on performance of a machine learning classifier. Based on our findings, we propose an automated system to reduce screeing burden, as well as offer quality assurance. METHODS: We built a database of citations from 5 systematic reviews that varied with respect to domain, topic, and sponsor. Consensus judgments regarding eligibility were inferred from published reports. We extracted 5 feature sets from citations: alphabetic, alphanumeric(+, indexing, features mapped to concepts in systematic reviews, and topic models. To simulate a two-person team, we divided the data into random halves. We optimized the parameters of a Bayesian classifier, then trained and tested models on alternate data halves. Overall, we conducted 50 independent tests. RESULTS: All tests of summary performance (mean F3 surpassed the corresponding baseline, P<0.0001. The ranks for mean F3, precision, and classification error were statistically different across feature sets averaged over reviews; P-values for Friedman's test were .045, .002, and .002, respectively. Differences in ranks for mean recall were not statistically significant. Alphanumeric(+ features were associated with best performance; mean reduction in screening burden for this feature type ranged from 88% to 98% for the second pass through citations and from 38% to 48% overall. CONCLUSIONS: A computer-assisted, decision support system based on our methods could substantially reduce the burden of screening citations for systematic review teams and solo reviewers. Additionally, such a system could deliver quality assurance both by

  17. Internet-based medical education: a realist review of what works, for whom and in what circumstances

    Directory of Open Access Journals (Sweden)

    Greenhalgh Trisha

    2010-02-01

    Full Text Available Abstract Background Educational courses for doctors and medical students are increasingly offered via the Internet. Despite much research, course developers remain unsure about what (if anything to offer online and how. Prospective learners lack evidence-based guidance on how to choose between the options on offer. We aimed to produce theory driven criteria to guide the development and evaluation of Internet-based medical courses. Methods Realist review - a qualitative systematic review method whose goal is to identify and explain the interaction between context, mechanism and outcome. We searched 15 electronic databases and references of included articles, seeking to identify theoretical models of how the Internet might support learning from empirical studies which (a used the Internet to support learning, (b involved doctors or medical students; and (c reported a formal evaluation. All study designs and outcomes were considered. Using immersion and interpretation, we tested theories by considering how well they explained the different outcomes achieved in different educational contexts. Results 249 papers met our inclusion criteria. We identified two main theories of the course-in-context that explained variation in learners' satisfaction and outcomes: Davis's Technology Acceptance Model and Laurillard's model of interactive dialogue. Learners were more likely to accept a course if it offered a perceived advantage over available non-Internet alternatives, was easy to use technically, and compatible with their values and norms. 'Interactivity' led to effective learning only if learners were able to enter into a dialogue - with a tutor, fellow students or virtual tutorials - and gain formative feedback. Conclusions Different modes of course delivery suit different learners in different contexts. When designing or choosing an Internet-based course, attention must be given to the fit between its technical attributes and learners' needs and

  18. Medical Utilization of Kiosks in the Delivery of Patient Education: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Roxanne Nagurka

    2014-07-01

    Full Text Available Background: The utilization of kiosks has previously been shown to be effective for collecting information, delivering educational modules, and providing access to health information. We discuss a review of current literature for the utilization of kiosks for the delivery of patient education. Methods: The criteria for inclusion in this literature review were: (1 study dis-cusses the utilization of kiosks for patient health education; (2 study discusses the use of touch screens for patient health information; (3 published in English. Our review includes searches via MEDLINE databases and Google Scholar for the years 1996-2014. Results: Overall, 167 articles were screened for final eligibility, and after discarding duplicates and non-eligible studies with abstract. Full-text review of 28 articles was included in the final analysis. Conclusion: The review of available literature demonstrates the effectiveness of touch screen kiosks to educate patients and to improve healthcare, both at a performance and cost advantage over other modes of patient education.

  19. Ethico-legal aspects of hospital-based blood transfusion practice; implications of professional negligence to medical practitioners: a review

    Directory of Open Access Journals (Sweden)

    Orkuma J.A

    2014-12-01

    Full Text Available Background: Blood transfusion is predominantly a hospital-based practice in many resourceconstrained economies like Nigeria, wherein the sourcing, storage, processing and clinical use of blood and blood products resides in the often financial and manpower constrained hospitals. Aim: To identify the ethical and legal issues related to hospital-based blood transfusion practice for medical practitioner. Methods: Relevant articles retrieved via PubMed/MEDLINE and Google scholar search engines were used. Results: This review found that, medical practitioners are directly or vicariously liable in professional negligence in hospital-based transfusion injuries. The potential weaknesses in hospital-based blood transfusion practice as ethically identified include; transfusion transmissible infections, blood group incompatibility, haemolytic transfusion reaction, failure to obtain informed consent and challenges of haemovigillance. However from the cases considered, medical practitioners are more professionally liable where they withhold a transfusion or transfuse blood group incompatible transfusion or fail to obtain an informed consent for blood transfusion especially amongst Jehovah’s Witness adherents. Conclusion: Medical practitioners at hospital-based transfusion centres are professionally liable for negligence due to blood transfusion injuries by their clinical, laboratory or general administrative oversight at different levels of hospital management. It is recommended that, they carry out this duty cautiously. While error reporting should be encouraged, litigations against them should be pursued cautiously in order not to encourage defensive blood transfusion practices in fear of claims or litigations to the disadvantage of the patients. Mediation or arbitration systems which are faster, less expensive and often less punitive but help strengthen the blood transfusion services should be encouraged.

  20. Beta-lactam induction of ISEcp1B-mediated mobilization of the naturally occurring bla(CTX-M) beta-lactamase gene of Kluyvera ascorbata

    OpenAIRE

    Nordmann, Patrice; Lartigue, Marie-Frédérique; Poirel, Laurent

    2008-01-01

    ISEcp1B is an insertion element associated with the emerging expanded-spectrum β-lactamase blaCTX-M genes in Enterobacteriaceae. Because ISEcp1B-blaCTX-M positive strains may be identified from humans and animals, the ability of this insertion sequence to mobilize the blaCTX-M-2 gene was tested from its progenitor Kluyvera ascorbata to study the effects of amoxicillin/clavulanic and cefquinome as enhancers of transposition. These β-lactam molecules are administered parenterally to treat infec...

  1. Beta-lactam induction of ISEcp1B-mediated mobilization of the naturally occurring bla(CTX-M) beta-lactamase gene of Kluyvera ascorbata.

    OpenAIRE

    Nordmann, Patrice; Lartigue, Marie-Frédérique; Poirel, Laurent

    2008-01-01

    ISEcp1B is an insertion element associated with the emerging expanded-spectrum beta-lactamase bla(CTX-M) genes in Enterobacteriaceae. Because ISEcp1B-bla(CTX-M)positive strains may be identified from humans and animals, the ability of this insertion sequence to mobilize the bla(CTX-M-2) gene was tested from its progenitor Kluyvera ascorbata to study the effects of amoxicillin/clavulanic and cefquinome as enhancers of transposition. These beta-lactam molecules are administered parenterally to ...

  2. Prevalence of blaZ Gene Types and the Inoculum Effect with Cefazolin among Bloodstream Isolates of Methicillin-Susceptible Staphylococcus aureus

    OpenAIRE

    Livorsi, D. J.; Crispell, E.; Satola, S. W.; Burd, E. M.; Jerris, R.; Wang, Y.F.(Institute of High Energy Physics, Beijing, 100049, People's Republic of China); Farley, M M

    2012-01-01

    We sought to define the prevalence of blaZ gene types and the inoculum effect to cefazolin among methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections. The blaZ gene was present in 142/185 (77%) isolates. A total of 50 (27%) isolates had a ≥4-fold increase in the cefazolin MIC from a standard to a high inoculum, and 8 (4%) demonstrated a nonsusceptible cefazolin MIC, all type A blaZ strains. The efficacy of cefazolin in the presence of the inoculum effect requires furthe...

  3. Prevalence of blaCTX-M gene in multi-resistant Escherichia coli isolated from Urinary Tract Infections, Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Mehdi Goudarzi

    2014-11-01

    Full Text Available Background:The emergence and increase in the incidence of Extended-spectrum beta lactamase (ESBL producing Escherichia coli has become an emerging challenge especially in hospitalized patients with UTI. The aim of the present study was to survey the frequency of bla CTX-M genotype in ESBL producing E. coli isolated from hospitalized patients with UTI and determination of their antibiotic resistance pattern.Material and methodsA total of 135 E. coli isolates were collected from isolated from patients with UTI. The isolates were subjected to confirmatory phenotype tests for the presence of ESBL. 75 E. coli isolates were confirmed as ESBL-positive by means of the Double disc synergy test. In vitro susceptibility of ESBL isolates to 15 antimicrobial agents amoxicillin, penicillin, ceftazidime, cefotaxime, cefoxitin, ceftriaxone, cefixime, cephalexin, co-trimoxazole, gentamicin, nalidixic acid, ciprofloxacin, nitrofourantoin, amikacin and imipenem was performed by Kirby-Bauer’s Disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI, 2012 guideline. PCR method was used to identify bla CTX-M gene in 75 ESBL positive strains.Results:PCR and sequence analysis showed that 75 (55.5% isolates produced bla CTX-M genes. In vitro susceptibility of ESBL producing E. coli showed that all of them were resistant to amoxicillin and penicillin and The rates of resistance to the majority of tested antibiotics varied between 61% to 100 %, with the exception of amikacin (14.7% and imipenem (2.7%. Our results showed that the frequency of bla CTX-M was strikingly high (93.3%.Conclusion:These data confirmed that the frequency of bla CTX-M genes were high among E. coli isolated from patients with UTI. The trend of multidrug-resistant profile has been associated with bla CTX-M gene is alarming. Therefore, it is very important to establish a routine screening of ESBL in clinical isolates to prevent dissemination of resistant isolates in health

  4. A review of objective structured practical examination (OSPE in pharmacology at a rural medical college

    Directory of Open Access Journals (Sweden)

    Rushikesh P. Deshpande

    2013-10-01

    Full Text Available Background: 1. To evaluate the attitudes of undergraduate medical students towards objectively structured practical examination (OSPE component of Pharmacology practical examination. 2. To investigate any gender differences and any influence of medium of instruction in school on these attitudes. Methods: The scores of 40 undergraduate medical students were analysed at S R T R Government Medical College, Ambajogai, Maharashtra, India. A Likert scale containing 9 items was used to assess the attitudes of students towards OSPE in Pharmacology. Student perspectives regarding the OSPE were obtained by asking them to respond to a questionnaire. Results: The study revealed that the OSPE was an acceptable tool in Pharmacology practical examination. The overall mean attitude score was 3.99. The response of male students towards OSPE (4.2 was more favourable as compared to that of female students (3.9 Students strongly agreed that OPSE covers wide range of skills and it is a good form of examination and learning experience. Majority of students were in favour of continuing OSPE as a method for examination in Pharmacology. Conclusions: OSPE was found to be a valuable tool to check the depth of understanding of undergraduate students. OSPE can be used as an index of the learning attitude of students. The present study is a small step in a direction of changing the traditional patterns of practical examination to a more objective and reliable way of evaluation in Pharmacology. It will help in modifying teaching-learning strategies so that both, the teachers as well as the students can gain maximum advantage. [Int J Basic Clin Pharmacol 2013; 2(5.000: 629-633

  5. Title and Abstract Screening and Evaluation in Systematic Reviews (TASER): a pilot randomised controlled trial of title and abstract screening by medical students

    OpenAIRE

    Ng, Lauren; Pitt, Veronica; Huckvale, Kit; Clavisi, Ornella; Turner, Tari; Gruen, Russell; Elliott, Julian H.

    2014-01-01

    Background The production of high quality systematic reviews requires rigorous methods that are time-consuming and resource intensive. Citation screening is a key step in the systematic review process. An opportunity to improve the efficiency of systematic review production involves the use of non-expert groups and new technologies for citation screening. We performed a pilot study of citation screening by medical students using four screening methods and compared students’ performance to exp...

  6. Citrus (Rutaceae): a review of recent advances in etymology, systematics and medical applications

    OpenAIRE

    Mabberley, D.J.

    2004-01-01

    The naming, introduction and classification of citrus crops and their allies is outlined. Traditional medicinal use and ‘Western’ applications in the treatment of scurvy and obesity, the prevention of AIDS, and in contraception is reviewed. Names for the commercially significant citrangequat (Citrus × georgiana) and the ‘sunrise lime’ or ‘faustrimedin’ (C. × oliveri) are provided.

  7. Issues in Business and Medical Education: Brief Literature Review on Strategic Management of Health Care Institutions.

    Science.gov (United States)

    Smith, Alan D.

    The literature on the use of strategic management principles by health care organizations is reviewed. After considering basic concepts of strategic management and managerial problems in nonprofit organizations, strategic planning and management of health care organizations are covered. Attention is directed to the health care environment,…

  8. Mesenteric desmoid tumours in Gardner's syndrome--review of medical treatments.

    OpenAIRE

    Eagel, B. A.; Zentler-Munro, P.; Smith, I. E.

    1989-01-01

    Gardner's syndrome comprises a triad of polyposis coli, osteomata and soft tissue tumours including desmoid tumours which can often present difficult problems in management. We report a patient with Gardner's syndrome treated with tamoxifen and medroxyprogesterone acetate. The literature on this rare syndrome and its management is reviewed.

  9. THE NEGATIVE EFFECTS OF SOME COSMETIC PROCEDURES: PROTECTION POSSIBILITIES, MEDICAL AND PREVENTIVE AGENTS (REVIEW

    Directory of Open Access Journals (Sweden)

    A. V. Majorova

    2016-01-01

    Full Text Available The article describes the possible side responses on cosmetic procedures. There is a review of pharmaceutical and cosmeceutical agents for external use to treat and prevent the complications. We have described the reasonability of the external dosage forms use of anti-histaminic action.

  10. Molecular characterisation of acquired and overproduced chromosomal blaAmpC in Escherichia coli clinical isolates.

    Science.gov (United States)

    Alonso, Noemí; Miró, Elisenda; Pascual, Vanesa; Rivera, Alba; Simó, Maria; Garcia, Maria Consol; Xercavins, Mariona; Morera, Maria Antonia; Espejo, Elena; Gurguí, Mercè; Pérez, Josefa; Rodríguez-Carballeira, Mònica; Garau, Javier; Calbo, Esther; Navarro, Ferran; Mirelis, Beatriz; Coll, Pere

    2016-01-01

    Escherichia coli recovered from three hospitals in Barcelona (Spain) were studied to determine the prevalence of isolates with acquired AmpC (ac-AmpC) and/or overproduced chromosomal AmpC (c-AmpC). Mechanisms involved in blac-AmpC overexpression, blaac-AmpC and the plasmids associated with their distribution as well as the prevalence of plasmid-mediated quinolone resistance (PMQR) in AmpC-producing isolates were also determined. Isolates were selected according to their resistance phenotype. blaac-AmpC, alterations in the blac-AmpC promoter/attenuator, and PMQR genes [qnrA, qnrB, qnrS, aac(6')-Ib-cr and qepA] were characterised by PCR and sequencing. blac-AmpC expression was determined by qRT-PCR. Population structure analysis was performed using PFGE, MLST and phylogenetic group PCR. Plasmids carrying blaac-AmpC were characterised by PCR-based replicon typing and S1-PFGE. IncI1 and IncF plasmids were also analysed by plasmid MLST and replicon sequence typing, respectively. Among 21563 E. coli isolates, 240 (1.1%) overproduced AmpC β-lactamases, including 180 (75.0%) harbouring ac-AmpC (132 CMY-2 variants and 48 DHA-1) and 60 (25.0%) c-AmpC enzymes. Three mutation profiles in the blac-AmpC promoter/attenuator were associated with a 72.5-, 19.9- and 5.8-fold increased expression, respectively. Moreover, 63.3% of ac-AmpC and 43.3% of c-AmpC isolates belonged to B2, D, E or F phylogenetic groups. PMQR was found in 31% of ac-AmpC isolates [38 qnrB4, 8 aac(6')-Ib-cr, 6 qnrS1 and 3 qnrB19] and in 10% of c-AmpC isolates [5 aac(6')-Ib-cr and 1 qnrS1]. IncI1-ST12 and IncF were associated with blaCMY-2 and blaDHA-1, respectively. These results suggest that ac-AmpC β-lactamases were the main mechanism of AmpC production. Isolates and plasmids both showed high genetic diversity. PMID:26607336

  11. High prevalence of blaOXA-23 in Acinetobacter spp. and detection of blaNDM-1 in A. soli in Cuba: report from National Surveillance Program (2010–2012

    Directory of Open Access Journals (Sweden)

    D. Quiñones

    2015-09-01

    Full Text Available As a first national surveillance of Acinetobacter in Cuba, a total of 500 Acinetobacter spp. isolates recovered from 30 hospitals between 2010 and 2012 were studied. Acinetobacter baumannii–calcoaceticus complex accounted for 96.4% of all the Acinetobacter isolates, while other species were detected at low frequency (A. junii 1.6%, A. lwoffii 1%, A. haemolyticus 0.8%, A. soli 0.2%. Resistance rates of isolates were 34–61% to third-generation cephalosporins, 49–50% to β-lactams/inhibitor combinations, 42–47% to aminoglycosides, 42–44% to carbapenems and 55% to ciprofloxacin. However, resistance rates to colistin, doxycycline, tetracycline and rifampin were less than 5%. Among carbapenem-resistant isolates, 75% harboured different blaOXA genes (OXA-23, 73%; OXA-24, 18%; OXA-58, 3%. The blaNDM-1 gene was identified in an A. soli strain, of which the species was confirmed by sequence analysis of 16S rRNA gene, rpoB, rpoB–rpoC and rpoL–rpoB intergenic spacer regions and gyrB. The sequences of blaNDM-1 and its surrounding genes were identical to those reported for plasmids of A. baumannii and A. lwoffi strains. This is the first report of blaNDM-1 in A. soli, together with a high prevalence of OXA-23 carbapenemase for carbapenem resistance in Acinetobacter spp. in Cuba.

  12. Reducing the time-lag between onset of chest pain and seeking professional medical help: a theory-based review

    Directory of Open Access Journals (Sweden)

    Baxter Susan K

    2013-02-01

    Full Text Available Abstract Background Research suggests that there are a number of factors which can be associated with delay in a patient seeking professional help following chest pain, including demographic and social factors. These factors may have an adverse impact on the efficacy of interventions which to date have had limited success in improving patient action times. Theory-based methods of review are becoming increasingly recognised as important additions to conventional systematic review methods. They can be useful to gain additional insights into the characteristics of effective interventions by uncovering complex underlying mechanisms. Methods This paper describes the further analysis of research papers identified in a conventional systematic review of published evidence. The aim of this work was to investigate the theoretical frameworks underpinning studies exploring the issue of why people having a heart attack delay seeking professional medical help. The study used standard review methods to identify papers meeting the inclusion criterion, and carried out a synthesis of data relating to theoretical underpinnings. Results Thirty six papers from the 53 in the original systematic review referred to a particular theoretical perspective, or contained data which related to theoretical assumptions. The most frequently mentioned theory was the self-regulatory model of illness behaviour. Papers reported the potential significance of aspects of this model including different coping mechanisms, strategies of denial and varying models of treatment seeking. Studies also drew attention to the potential role of belief systems, applied elements of attachment theory, and referred to models of maintaining integrity, ways of knowing, and the influence of gender. Conclusions The review highlights the need to examine an individual’s subjective experience of and response to health threats, and confirms the gap between knowledge and changed behaviour. Interventions face

  13. Bibliographic reviews in Cuban medical journals. Las revisiones bibliográficas en revistas médicas cubanas.

    Directory of Open Access Journals (Sweden)

    Lucitere Rodríguez González

    2008-04-01

    Full Text Available Background: Bibliographic reviews acquire great importance in the specific context of medical publications; however, some editorial facts can affect their scientific value. Objective: To characterize the bibliographic reviews published by some Cuban medical journals. Methods: The most recent reviews (10 were analyzed by means of an exploratory, retrospective and descriptive study. Selected from 5 electronic medical journals, summing up 50 articles. The following variables were studied: article's length, statement of objective and characteristics of bibliographic references. Results: In 20 reviews the objective was not stated, only in 23 (46% the objective was correctly declared. More than 50% of the article had between 4 and 9 screens; 16 structural variables were found with a predominance of blocks and block plus discussion. Only 20 (40% gathered between 25 and 50 references and 24 had more than 50% of their references not updated. Conclusion: There is a misapprehension regarding the review article among Cuban medical journals, which could somehow affect its pertinence and scientific rigor to the eyes of the international scientific community.

    Fundamento: Por diversas razones, las revisiones bibliográficas adquieren gran importancia en el contexto de las publicaciones médicas; sin embargo, algunos elementos de carácter editorial pueden afectar su valor científico. Objetivo: Caracterizar las revisiones bibliográficas publicadas por algunas revistas médicas cubanas. Métodos: Mediante un estudio exploratorio, descriptivo y retrospectivo, se analizaron las 10 revisiones bibliográficas más recientes, de 5 revistas médicas en formato electrónico, para un total de 50 artículos de revisión, en los cuales se analizaron las variables siguientes: extensión del artículo, estructura, declaración de

  14. A review of cardiopulmonary research in Brazilian medical journals: clinical, surgical and epidemiological data

    OpenAIRE

    Carlos Serrano; Mauricio Rocha e Silva

    2010-01-01

    Research in the field of cardiopulmonary disease in Brazil has been very active in recent decades. The combination of PUBMED, SCieLO, open access and online searching has provided a significant increase in the visibility of Brazilian journals. This newly acquired international visibility has in turn resulted in the appearance of more original research reports in the Brazilian scientific press. This review is intended to highlight part of this work for the benefit of the readers of "Clinics." ...

  15. Drug interactions among commonly used medications. Chart simplifies data from critical literature review.

    OpenAIRE

    Crowther, N. R.; Holbrook, A. M.; Kenwright, R.; Kenwright, M.

    1997-01-01

    OBJECTIVE: To simplify risk assessment, we have developed a way to present critically appraised drug interaction information through a chart. DATA SOURCES: Fifty drugs most frequently prescribed by Canadian family physicians and 16 drugs and substances that frequently interact with these drugs were the basis for a literature review. Drug interaction textbooks and MEDLINE (from 1966 to 1994) were searched for documented interactions. Reports of additive effects and animal or in vitro studies w...

  16. Medical applications of Terahertz Imaging: a Review of Current Technology and Potential Applications in Biomedical Engineering

    OpenAIRE

    Humphries, K.; Loughran, J.P.; Gradziel, M; Lanigan, W.; Ward, T.; Murphy, J. A.; O'Sullivan, C.

    2004-01-01

    Terahertz (THz) imaging is in its early stages of development but already the potential clinical impact of this new imaging modality is clear. From cancer research to DNA analysis THz technology is improving or even making possible imaging of hitherto inaccessible phenomena. In this paper we present a short review of THz imaging from the point of view of biomedical engineering. We discuss the current state of the art in terms of THz imaging systems; describe current ap...

  17. Hyperprolactinemia and medications for bipolar disorder: systematic review of a neglected issue in clinical practice.

    Science.gov (United States)

    Pacchiarotti, Isabella; Murru, Andrea; Kotzalidis, Georgios D; Bonnin, C Mar; Mazzarini, Lorenzo; Colom, Francesc; Vieta, Eduard

    2015-08-01

    Drug-induced changes in serum prolactin (sPrl) levels constitute a relevant issue due to the potentially severe consequences on physical health of psychiatric patients such as sexual dysfunctions, osteoporosis and Prl-sensitive tumors. Several drugs have been associated to sPrl changes. Only antipsychotics have been extensively studied as sPrl-elevating agents in schizophrenia, but the extent to which bipolar disorder (BD) treatments affect sPrl levels is much less known. The objective of this systematic review is to summarize the evidence of the effects of drugs used in BD on Prl. This review followed the PRISMA statement. The MEDLINE/PubMed/Index Medicus, EMBASE, and Cochrane Library databases were systematically searched for articles in English appearing from any time to May 30, 2014. Twenty-six studies were included. These suggest that treatments for BD are less likely to be associated with Prl elevations, with valproate, quetiapine, lurasidone, mirtazapine, and bupropion reported not to change PRL levels significantly and lithium and aripiprazole to lower them in some studies. Taking into account the effects of the different classes of drugs on Prl may improve the care of BD patients requiring long-term pharmacotherapy. Based on the results of this review, lithium and valproate appear to be safer due to their low potential to elevate sPrL; among antipsychotics, quetiapine, lurasidone and aripiprazole appear to be similarly safe. PMID:25937241

  18. Review on toxicology of aerosols produced during medical laser treatment or electrosurgery

    Science.gov (United States)

    Weber, Lothar W.; Meier, Thomas H.

    1994-02-01

    Medical laser treatment enlarged its application in recent years in an explosive way. By a given distance to the patient the laser surgeon can cut, coagulate, or evaporate human tissue in a very distinct manner. Due to the mainly thermal interaction of the laser light with the irradiated tissue it may be heated up to pyrolysis conditions. By pyrolysis of human tissue degradation products are generated, which may be harmful. Chemical substances and particles formed of tissue could be toxic, cancerogenic or irritant to skin and airways or after uptake. Special hazards of human laser plume in the health care environment may result from infectious viruses, bacterias, parasites, spread tumor cells and DNA fragments.

  19. Dupuytren’s contracture of hand and its medical and social review

    Directory of Open Access Journals (Sweden)

    V. O. Vishnevskiy

    2014-02-01

    Full Text Available Introduction Dupuytren's contracture is a disease of connective tissue with the affection of palmar aponeurosis, frequently with chronic recurrent course, the flexion deformities of fingers and dysfunction of the hand. It composed 11,8 % among of all types of the hand pathology. The mostly it develops in men of middle-aged and elderly. At young age it occurs more rarely, but with fast progressing current, which in 67 % of cases leads to impaired ability to perform professional hand-work and in 3 % patients to physical inability. Predisposing factors for this fibromatosis are numerous, but one of the popular opinion among of authors is a hereditary character of disease. In clinical practice, the most frequently used fourth degree’s classification of Dupuytren's contracture includes severity of deformation and function disorders of the hand. It is correspond to the normative standards of medical and social expertise The aim of research: to specify the most optimal methods of surgical treatment, the criteria of medical and social examination and rehabilitation, clinical and labor prognosis, indications to establishment of disability after operations concerning of Dupuytren’s contracture. In our clinic was performed three methods of operation: aponeurotomia “open hand”, partial aponeuroectomia, total aponeuroectomia. Errors in the treatment of palmar fibromatosis we shared on: preoperated, intraoperated and associated with violations of the mode of rehabilitation. The next clinical observation of 68 patients (up to 3 years after surgery with Dupuytren’s contracture of hand showed the recurrence rate amounted to 31,7%, and physical inability level is 5,9% of cases. In our opinion the most optimal operative methodic is total aponeuroectomia with rational surgical approaches. Clinical and labour prognosis depends on the manifestations of disease which can develop regardless of the stage, methods of treatment and patient's age. Disadvantageous

  20. The sudden dominance of blaCTX-M harbouring plasmids in Shigella spp. Circulating in Southern Vietnam.

    Directory of Open Access Journals (Sweden)

    Nhu Thi Khanh Nguyen

    Full Text Available BACKGROUND: Plasmid mediated antimicrobial resistance in the Enterobacteriaceae is a global problem. The rise of CTX-M class extended spectrum beta lactamases (ESBLs has been well documented in industrialized countries. Vietnam is representative of a typical transitional middle income country where the spectrum of infectious diseases combined with the spread of drug resistance is shifting and bringing new healthcare challenges. METHODOLOGY: We collected hospital admission data from the pediatric population attending the hospital for tropical diseases in Ho Chi Minh City with Shigella infections. Organisms were cultured from all enrolled patients and subjected to antimicrobial susceptibility testing. Those that were ESBL positive were subjected to further investigation. These investigations included PCR amplification for common ESBL genes, plasmid investigation, conjugation, microarray hybridization and DNA sequencing of a bla(CTX-M encoding plasmid. PRINCIPAL FINDINGS: We show that two different bla(CTX-M genes are circulating in this bacterial population in this location. Sequence of one of the ESBL plasmids shows that rather than the gene being integrated into a preexisting MDR plasmid, the bla(CTX-M gene is located on relatively simple conjugative plasmid. The sequenced plasmid (pEG356 carried the bla(CTX-M-24 gene on an ISEcp1 element and demonstrated considerable sequence homology with other IncFI plasmids. SIGNIFICANCE: The rapid dissemination, spread of antimicrobial resistance and changing population of Shigella spp. concurrent with economic growth are pertinent to many other countries undergoing similar development. Third generation cephalosporins are commonly used empiric antibiotics in Ho Chi Minh City. We recommend that these agents should not be considered for therapy of dysentery in this setting.

  1. Dissemination of IncI2 Plasmids That Harbor the blaCTX-M Element among Clinical Salmonella Isolates

    OpenAIRE

    Wong, Marcus Ho-yin; Liu, Lizhang; Yan, Meiying; Chan, Edward Wai-chi; Chen, Sheng

    2015-01-01

    The extended-spectrum-β-lactamase (ESBL) determinant CTX-M-55 is increasingly prevalent in Escherichia coli but remains extremely rare in Salmonella. This study reports the isolation of a plasmid harboring the blaCTX-M-55 element in a clinical Salmonella enterica serotype Typhimurium strain resistant to multiple antibiotics. This plasmid is genetically identical to several known IncI2-type elements harbored by E. coli strains recovered from animals. This finding indicates that IncI2 plasmids ...

  2. Land Use and Land Cover - CEMETERIES_USGS_BLA_IN: Cemetery Locations in Indiana (United States Geological Survey, 1:24000, Point Shapefile)

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — Cemeteries_USGSs__BLA_IN is a point shapefile showing the locations and attribute values of cemeteries extracted from the Geographic Names Information System (GNIS)...

  3. Association between β-Lactamase-Encoding blaOXA-51 Variants and DiversiLab Rep-PCR-Based Typing of Acinetobacter baumannii Isolates

    Science.gov (United States)

    Zander, Esther; Nemec, Alexandr; Seifert, Harald

    2012-01-01

    This study investigated the correlation between blaOXA-51 variants and Acinetobacter baumannii worldwide clonal lineages 1 to 8 (WW1 to -8). The blaOXA-51-like genes of 102 A. baumannii isolates were sequenced. Using DiversiLab repetitive-sequence-based PCR (rep-PCR) typing, 92 of these isolates had previously been assigned to WW1 to -8 and 10 were unclustered. Clustering of DNA sequences was performed using the neighbor-joining method and the Jukes-Cantor phylogenetic correction. blaOXA-51 variants were in good correlation with DiversiLab-defined clonal lineages. Sequence-based typing of blaOXA-51 variants has the potential to be applied for epidemiologic characterization of A. baumannii and to identify worldwide clonal lineages 1 to 8. PMID:22422849

  4. Molecular Evolution of a Klebsiella pneumoniae ST278 Isolate Harboring blaNDM-7 and Involved in Nosocomial Transmission.

    Science.gov (United States)

    Lynch, Tarah; Chen, Liang; Peirano, Gisele; Gregson, Dan B; Church, Deirdre L; Conly, John; Kreiswirth, Barry N; Pitout, Johann D

    2016-09-01

    During 2013, ST278 Klebsiella pneumoniae with blaNDM-7 was isolated from the urine (KpN01) and rectum (KpN02) of a patient in Calgary, Canada. The same strain (KpN04) was subsequently isolated from another patient in the same unit. Interestingly, a carbapenem-susceptible K. pneumoniae ST278 (KpN06) was obtained 1 month later from the blood of the second patient. Next-generation sequencing (NGS) revealed that the loss of carbapenem-resistance in KpN06 was due to a 5-kb deletion on the blaNDM-7-harboring IncX3 plasmid. In addition, an IncFIB plasmid in KpN06 had a 27-kb deletion that removed genes encoding for heavy metal resistance. Phylogenetic analysis showed that the K. pneumoniae ST278 from patient 2 was likely a descendant of KpN02 and that KpN06 was a close progenitor of an environmental ST278. It is unclear whether KpN06 lost the blaNDM-7 gene in vivo. This study detailed the remarkable plasticity and speed of evolutionary changes in multidrug-resistant K. pneumoniae, demonstrating the highly recombinant nature of this species. It also highlights the ability of NGS to clarify molecular microevolutionary events within antibiotic-resistant organisms. PMID:27284091

  5. Considerations on the Improved Integration of Medical Guidelines into Routine Clinical Practice – a Review and Concept Proposal

    Science.gov (United States)

    Beckmann, M. W.; Schlieter, H.; Richter, P.; Wesselmann, S.

    2016-01-01

    Medical guidelines have become established as the standard for the comprehensive synopsis of all available information (scientific trials, expert opinion) on diagnosis and treatment recommendations. The transfer of guidelines to clinical practice and subsequent monitoring has however proven difficult. In particular the potential interaction between guideline developers and guideline users has not been fully utilised. This review article analyses the status quo and existing methodological and technical information solutions supporting the guideline life cycle. It is shown that there are numerous innovative developments that in isolation do not provide comprehensive support. The vision of the “Living Guidelines 2.0” is therefore presented. This outlines the merging of guideline development and implementation on the basis of clinical pathways and guideline-based quality control, and building on this, the generation of information for guideline development and research. PMID:27134291

  6. BILATERAL MENIERE’S DISEASE IN THE YOUNG, DILEMMA’S IN MEDICAL MANAGEMENT: A CRITICAL REVIEW OF LITERATURE

    Directory of Open Access Journals (Sweden)

    Sahoo Kumar Anjan

    2015-04-01

    Full Text Available It is not very unusual for the ENT personnel to encounter cases of Meniere’s disease with bilateral ear involvement. As compared to unilateral cases the patient with bilateral involvement has more significant morbidity and emotional disturbance, particularly in young individuals. The present ambiguity in aetiology of the disease process has leaked to the management too and no definitive treatment options are described till date. The medical management at present is successful in controlling vertigo in the majority of the patients. But the symptoms of hearing loss and tinnitus are relatively less rehabilitated. The options of management like Aminoglycoside infusion and surgery have a limited role in cases with bilateral involvement and this drastically cripples the management protocol. The present review aims to evaluate the efficacy of individual agents and suggest a beneficial protocol based on the current literature.

  7. A review of countries' pharmacist-patient communication legal requirements on prescription medications and alignment with practice

    DEFF Research Database (Denmark)

    Svensberg, Karin; Sporrong, Sofia Kälvemark; Björnsdottir, Ingunn

    2015-01-01

    their requirements for pharmacy staff to communicate on the use of medicines during dispensing. The Nordic countries all require such communication, which aligns with professional visions. Regardless of the pharmacy system, the states let the employer and pharmacy professions carry out it in practice...... countries of Denmark, Finland, Iceland, Norway and Sweden provide the legislative examples and can be used as a platform to discuss how society's expectations, professional visions, and practice are aligning. OBJECTIVE: The overall aim of this study was to describe society's expectations of pharmacist......-patient communication around medications as expressed by the state in Nordic legislation, economic incentives and authority control. Additionally, this study describes how the states govern Nordic pharmacists in different pharmacy systems. METHOD: A legal review was performed using online legislative databases...

  8. a retrospective review of medical records of patients in Park-Klinik Weißensee from April 1997 to September 2003

    OpenAIRE

    Gerhardt, Ulrike

    2010-01-01

    Pancreatic pseudocysts are fluid collections that frequently occur as complications of an acute or chronic pancreatitis. Acute pseudocysts in particular do have an intense tendency to involution, the necessity of a therapy only arises in symptomatic pseudocysts. The percutaneous catheter drainage has become an alternative to a surgical treatment of pancreatic pseudocysts. With the help of a retrospective review of medical records of all patients, that were medicated due to symptomatic pse...

  9. Doses to patients from medical X-ray examinations in the UK. 2000 review

    International Nuclear Information System (INIS)

    In 1992 NRPB established a National Collation Centre for measurements of doses to patients made by x-ray departments throughout the UK. This report is the second in a series of five-yearly reviews of the national patient dose database and analyses the information collected during the period January 1996 to December 2000. It includes the results of 28,000 entrance surface dose (ESD) measurements and 13,000 dose-area product (DAP) measurements for single radiographs, and 140,000 DAP measurements and 128,000 records of the fluoroscopy time for complete examinations, collected from 371 hospitals throughout the UK. Information on the patient dose distributions and exposure conditions for over 30 types of examination and radiograph is presented. National reference doses based on the rounded third quartile values of these dose distributions are recommended and are seen to be about 20% lower than corresponding values in the previous (1995) review. They have approximately halved since the original UK national reference doses were derived from a survey in the mid-1980s. In this review reference doses have been derived for a larger number of examinations on adults than previously and, for the first time, for three examinations on children, with specific values for five standard-sized patients corresponding to new born babies, 1, 5, 10 and 15 year olds. NRPB gratefully acknowledges the co-operation of hospital physicists and radiology department staff in supplying patient dose data. The continued provision of data to the National Patient Dose Database will be essential in order to monitor the progress of patient dose reduction measures in the UK and to extend and revise national reference doses in the future. (author)

  10. Periodontal Systemic Connections-Novel Associations-A Review of the Evidence with Implications for Medical Practitioners

    Science.gov (United States)

    Kalakonda, Butchibabu; Koppolu, Pradeep; Baroudi, Kusai; Mishra, Ashank

    2016-01-01

    Periodontal diseases, considered as inflammatory diseases have proved to have a spectrum of systemic implications. Earliest research has associated periodontal disease with common systemic aliments such as hypertension, diabetes, osteoporosis, rheumatoid arthritis to name a few. The evolution of advanced diagnostic aids let researchers make vast inroads in linking periodontal diseases to systemic diseases like Alzheimer’s disease (AD) and even Schizophrenia. Our aim was to review and critically evaluate comprehensive literature and provide knowledge to medical practitioners on these associations so as to pave way for closer interactions between medical and dental practitioners in implementing better health care. Electronic databases such as PubMed, Google Scholar and Cochrane databases were used as source of the data for relevant studies published from 2005 up to 2015 with the following keywords, “‘Periodontal disease”, “systemic conditions”, “periodontal disease and Alzheimer’s”, “Periodontal disease and Schizophrenia”, “Periodontal disease and Psoriasis” and “Periodontal disease and erectile dysfunction”. The evidence presented ascertains that a reasonable and modest association does exist between Periodontal disease and Alzheimer’s, Schizophrenia, Erectile dysfunction, as well as Psoriasis and thus establishes periodontal disease as a potential risk factor. PMID:27103910

  11. Periodontal Systemic Connections-Novel Associations-A Review of the Evidence with Implications for Medical Practitioners.

    Science.gov (United States)

    Kalakonda, Butchibabu; Koppolu, Pradeep; Baroudi, Kusai; Mishra, Ashank

    2016-04-01

    Periodontal diseases, considered as inflammatory diseases have proved to have a spectrum of systemic implications. Earliest research has associated periodontal disease with common systemic aliments such as hypertension, diabetes, osteoporosis, rheumatoid arthritis to name a few. The evolution of advanced diagnostic aids let researchers make vast inroads in linking periodontal diseases to systemic diseases like Alzheimer's disease (AD) and even Schizophrenia. Our aim was to review and critically evaluate comprehensive literature and provide knowledge to medical practitioners on these associations so as to pave way for closer interactions between medical and dental practitioners in implementing better health care. Electronic databases such as PubMed, Google Scholar and Cochrane databases were used as source of the data for relevant studies published from 2005 up to 2015 with the following keywords, "'Periodontal disease", "systemic conditions", "periodontal disease and Alzheimer's", "Periodontal disease and Schizophrenia", "Periodontal disease and Psoriasis" and "Periodontal disease and erectile dysfunction". The evidence presented ascertains that a reasonable and modest association does exist between Periodontal disease and Alzheimer's, Schizophrenia, Erectile dysfunction, as well as Psoriasis and thus establishes periodontal disease as a potential risk factor. PMID:27103910

  12. Prevalence of intimate partner violence across medical and surgical health care settings: a systematic review.

    Science.gov (United States)

    Sprague, Sheila; Goslings, J Carel; Hogentoren, Celine; de Milliano, Simone; Simunovic, Nicole; Madden, Kim; Bhandari, Mohit

    2014-01-01

    Intimate partner violence (IPV) is a serious health problem and a leading cause of nonfatal injury in North American females. Prevalence of IPV has ranged from less than 20% to more than 50% across primary care, emergency medicine, and family medicine. We conducted a systematic review and meta-analysis of the literature to examine best estimates of IPV prevalence as opportunities for targeted interventions in health care specialties. We included 37 articles in this study. Based on our pooled data, best estimates of the lifetime prevalence of any type of IPV were 38% in family medicine and 40% in emergency medicine. PMID:24476759

  13. Adrenal lesions encountered in current medical practice − a review of their radiological imaging

    Directory of Open Access Journals (Sweden)

    Vanesha Naidu

    2013-11-01

    Full Text Available Modern radiological technology has transformed the way that adrenal lesions are currently investigated. The contemporary radiologist has been catapulted to the forefront in the management of adrenal disease. With the increasing use of cross-sectional imaging, adrenal lesions are being serendipitously discovered in radiological studies undertaken for non-adrenal-related conditions – the so-called adrenal ‘incidentaloma’. This review discusses the imaging modalities available for characterising these lesions, highlighting current concepts and controversies in differentiating benign from malignant pathology. The article also provides a brief overview of the spectrum of adrenal pathology commonly encountered in the adult population.

  14. Amphetamine poisoning in a dog: case report, literature review and veterinary medical perspectives.

    Science.gov (United States)

    Diniz, Pedro Paulo V P; Sousa, Marlos G; Gerardi, Daniel G; Tinucci-Costa, Mirela

    2003-12-01

    Amphetamine abuse in human beings has increased, resulting in many reports of toxicity and death. In the US over 4 million people have abused amphetamines at least once, thus small animals are exposed to increased accidental poisoning risk. This report describes an acute amphetamine poisoning in a dog due to ingestion of 15 mg/kg fenproporex, leading to typical signs of catecholamines release and effects in different organ systems. Similar clinical and laboratory findings observed in human beings are reviewed and physiopathogenic mechanisms discussed, as well as the therapeutic approaches available in veterinary medicine. PMID:14640484

  15. Novel Complex Class 1 Integron Bearing an ISCR1 Element in an Escherichia coli Isolate Carrying the blaCTX-M-14 Gene▿

    OpenAIRE

    Bae, Il Kwon; Lee, You-Nae; Lee, Wee Gyo; Lee, Sang Hee; Jeong, Seok Hoon

    2007-01-01

    This work identifies an ISCR1-related blaCTX-M-14 gene, which has never been reported before, from a clinical isolate of Escherichia coli. The blaCTX-M-14 gene was preceded by an ISCR1 element that was followed by a class 1 integron containing three different insert gene cassettes, i.e., dfrA12, orfF, and aadA2.

  16. A novel IS26 structure is surrounding blaCTX-M genes in different plasmids of German clinical isolates of Escherichia coli

    OpenAIRE

    Cullik, Angela; Pfeifer, Yvonne; Prager, Rita; von Baum, Heike; Witte, Wolfgang

    2010-01-01

    This report focuses on the molecular characterization of 22 extended-spectrum beta-lactamase (ESBL) producing E. coli isolates collected in a German university hospital, during a period of nine months in 2006. Relationship analysis of clinical isolates was done via pulsed-field gel-electrophoresis, mulit-locus sequence typing, plasmid profiling and additionally PCR for blaESBL detection and phylogroups. After conjugal transfer plasmid isolation and subsequent PCR for blaESBL detection and inc...

  17. Doses to patients from medical X-ray examinations in the UK. 2000 review

    CERN Document Server

    Hart, D; Wall, B F

    2002-01-01

    In 1992 NRPB established a National Collation Centre for measurements of doses to patients made by x-ray departments throughout the UK. This report is the second in a series of five-yearly reviews of the national patient dose database and analyses the information collected during the period January 1996 to December 2000. It includes the results of 28,000 entrance surface dose (ESD) measurements and 13,000 dose-area product (DAP) measurements for single radiographs, and 140,000 DAP measurements and 128,000 records of the fluoroscopy time for complete examinations, collected from 371 hospitals throughout the UK. Information on the patient dose distributions and exposure conditions for over 30 types of examination and radiograph is presented. National reference doses based on the rounded third quartile values of these dose distributions are recommended and are seen to be about 20% lower than corresponding values in the previous (1995) review. They have approximately halved since the original UK national referenc...

  18. Intercultural Usage of Mori Folium: Comparison Review from a Korean Medical Perspective

    Directory of Open Access Journals (Sweden)

    Byungjin Joh

    2015-01-01

    Full Text Available Objectives. A review on studies related to the use of Mori folium, the leaves of Morus alba, was conducted with the goal of identifying new clinical applications in Korean medicine. Methods. Global literature search was conducted using three electronic databases up to January 2015 with the term Morus alba and its Korean terms. KM literatures including textbooks and standard pharmacopoeia were separately hand-searched and reviewed to provide comparison. Data were extracted according to predetermined criteria, and clinical uses were standardized with ICD-10 categories. Results. 159 potentially relevant studies were identified, and 18 articles including 12 ethnopharmacologic and 6 clinical studies were finally included in this analysis. Ethnopharmacologic studies from 8 countries provided 17 clinical uses. We found that five out of six clinical trials were related to diabetes and suggested a moderate short-term to mild long-term effect. And 43 Korean texts also provided 156 clinical uses in 35 categories including ocular and respiratory disorders. Discussion and Conclusions. Though majority of the clinical uses were also found in Korean medicine literature, treatment of infertility, jaundice, cognitive disorder, and hyperpigmentation was found to be effective and diabetes with Morus alba was recognized to have clinical importance.

  19. Review and state of the art on radiation sterilization of medical devices

    Energy Technology Data Exchange (ETDEWEB)

    Dorpema, J.W. (National Inst. of Public Health and Environmental Protection, Bilthoven (Netherlands). National Control Laboratory)

    1990-01-01

    Radiation as a sterilization method was designed in the years 1950-1960. The decade afterwards the application for sterilization of medical products and devices was developed. Extensive studies performed on both the physical, chemical and (micro)biological aspects revealed the requirements for safety and efficacy. As a spin off it initiated new ideas and approaches towards sterilization in general. Consequently sterility was redefined in terms of a probabilistic concept and the bioburden determination method was introduced as a tool for both quality control and potential instrument for dose setting. However these refinements also created controversies, whereby the dose requirements became divided for Europe and North America. Moreover studies recently performed in Europe suggest even a further extension of this opinion gap. Detailed studies, on the clinical effects of low dose treated products (12.5-17.5 kGy) are needed to counterbalance the dose suggestions extracted from statistically based dose determinations (> 28 kGy) and the microbiological resistance determinations (> 28-30 kGy). Dose settings based on risk classification could be considered for distinct product categories. In the meantime a general acceptance of the originally, in the early seventies, established minimum dose of 25 kGy would seem a reasonable compromise. As the interest for radiation sterilization as the favourable, non polluting and simple method is increasing rapidly over the last five years, both gamma- and beta driven sterilization plants will be needed. Harmonization on sterilization dose therefore requires high priority. (author).

  20. Manipulating measurement scales in medical statistical analysis and data mining: A review of methodologies

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    Hamid Reza Marateb

    2014-01-01

    Full Text Available Background: selecting the correct statistical test and data mining method depends highly on the measurement scale of data, type of variables, and purpose of the analysis. Different measurement scales are studied in details and statistical comparison, modeling, and data mining methods are studied based upon using several medical examples. We have presented two ordinal-variables clustering examples, as more challenging variable in analysis, using Wisconsin Breast Cancer Data (WBCD. Ordinal-to-Interval scale conversion example: a breast cancer database of nine 10-level ordinal variables for 683 patients was analyzed by two ordinal-scale clustering methods. The performance of the clustering methods was assessed by comparison with the gold standard groups of malignant and benign cases that had been identified by clinical tests. Results: the sensitivity and accuracy of the two clustering methods were 98% and 96%, respectively. Their specificity was comparable. Conclusion: by using appropriate clustering algorithm based on the measurement scale of the variables in the study, high performance is granted. Moreover, descriptive and inferential statistics in addition to modeling approach must be selected based on the scale of the variables.

  1. Review of the Code of Practice for the Radiosterilization of Medical Products

    International Nuclear Information System (INIS)

    The background of the IAEA recommendations for a Code of Practice is outlined. The possibility of laying down broad safety margins based on scientific foresight and detailed advanced planning will serve to guide the rapidly accelerating acceptance of radiosterilization by industry, especially in those firms producing supplies for use in medicine and surgery. Production control should be attuned to the scientific and technological advances, and it is becoming clear that the focus of control should be moved away from sterility testing of the finished products to hygienic and sterile operations during the manufacturing operations themselves. The contamination of the product before sterilization should already have been kept to a minimum, and this pre-sterilization level of contamination should be regularly recorded using bacteriological tests. The choice of dosage should be based on average pre-sterilization counts and the inactivation factors found desirable for die intended use of the product. On commissioning, or whenever an existing process is altered, the efficiency of the irradiation facility must be tested using microbiological reference standards. The margin of safety should be checked by using deliberately contaminated articles. However, the backbone of the control procedures must still be dosimetry. The preparation of a Code of Practice for the Radiosterilization of Medical Products will constitute a challenge to operators working with other sterilizing procedures. (author)

  2. New cross section data and review of production routes of medically used $^{110m}$In

    CERN Document Server

    Tárkányi, F; Ditrói, F; Hermanne, A; Baba, M; Mohsena, B M A; Ignatyuk, A V

    2016-01-01

    Evaluation of nuclear data for production routes of $^{110m}$In is in progress in the frame of an IAEA Coordinated Research Project (CRP). New experimental cross section data for the indirect $^{nat}$In(p,x)$^{110}$Sn $\\longrightarrow$ $^{110m}$In and for the direct $^{107}$Ag($\\alpha$,n)$^{110m}$In and $^{109}$Ag($^{3}$He,2n)$^{110m}$In production routes and for the satellite impurity reactions $^{107}$Ag($\\alpha$,xn)$^{110g,109}$In and $^{109}$Ag($^{3}$He,xn)$^{110g,111,109}$In have been measured by using the activation method, stacked foil irradiation technique and gamma-ray spectrometry. Additional data are reported for production of the $^{111}$In diagnostic gamma-emitter via the $^{109}$Ag($\\alpha$,2n)$^{111}$In reaction. The earlier experimental data were critically reviewed in order to prepare recommended data and optimal production parameters for the different routes.

  3. Stereotactic body radiotherapy for the pancreas: a critical review for the medical oncologist

    Science.gov (United States)

    Kim, Samuel K.; Wu, Cheng-Chia

    2016-01-01

    With recent advances in imaging modalities and radiation therapy, stereotactic body radiotherapy (SBRT) has allowed for the delivery of high doses of radiation with accuracy and precision. As such, SBRT has generated favorable results in the treatment of several cancers. Although the role of radiation has been controversial for the treatment of pancreatic ductal adenocarcinoma (PDAC) due to rather lackluster results in clinical trials, SBRT may offer improved outcomes, enhance the quality of life, and aid in palliative care settings for PDAC patients. This review delineates the role of SBRT in the treatment of PDAC, presents the defining principles of radiation biology and the radiation oncology work flow, and discusses the prospects of new treatment regimens involving tumor immunology and radiation therapy. PMID:27284482

  4. Patient medical costs for tuberculosis treatment and impact on adherence in China: a systematic review

    Directory of Open Access Journals (Sweden)

    Zhang Tuohong

    2011-05-01

    Full Text Available Abstract Background Charging for tuberculosis (TB treatment could reduce completion rates, particularly in the poor. We identified and synthesised studies that measure costs of TB treatment, estimates of adherence and the potential impact of charging on treatment completion in China. Methods Inclusion criteria were primary research studies, including surveys and studies using qualitative methods, conducted in mainland China. We searched MEDLINE, PUBMED, EMBASE, Science Direct, HEED, CNKI to June 2010; and web pages of relevant Chinese and international organisations. Cost estimates were extracted, transformed, and expressed in absolute values and as a percentage of household income. Results Low income patients, defined at household or district level, pay a total of US$ 149 to 724 (RMB 1241 to 5228 for medical costs for a treatment course; as a percentage of annual household income, estimates range from 42% to 119%. One national survey showed 73% of TB patients at the time of the survey had interrupted or suspended treatment, and estimates from 9 smaller more recent studies showed that the proportion of patients at the time of the survey who had run out of drugs or were not taking them ranged from 3 to 25%. Synthesis of surveys and qualitative research indicate that cost is the most cited reason for default. Conclusions Despite a policy of free drug treatment for TB in China, health services charge all income groups, and costs are high. Adherence measured in cross sectional surveys is often low, and the cumulative failure to adhere is likely to be much higher. These findings may be relevant to those concerned with the development and spread of multi-drug resistant TB. New strategies need to take this into account and ensure patient adherence.

  5. Hidradenitis suppurativa: A practical review of possible medical treatments based on over 350 hidradenitis patients.

    Science.gov (United States)

    Scheinfeld, Noah

    2013-01-01

    Hidradenitis suppurativa (HS), a pathological follicular disease, impacts patients' lives profoundly. HS most commonly involves cutaneous intertriginous areas, such as the axilla, inner thighs, groin and buttocks, and pendulous breasts, but can appear on any follicular skin. Protean, HS manifests with variations of abscesses, folliculitis, pyogenic granulomas, scars (oval honeycombed), comedones, tracts, fistulas, and keloids. The pathophysiology might involve both defects of the innate follicular immunity and overreaction to coagulase negative Staphylococcus. Treatment depends on the morphology, extent, severity, and duration. Topical clindamycin and dapsone are often adequate for treating mild HS. For Stage 1 and 2 HS, first line treatment combines rifampin with either oral clindamycin or minocycline. Other HS treatments include: fluoroquinolones with metronidazole and rifampin, oral dapsone, zinc, acitretin, hormone blockers (oral contraceptive pills, spironolactone, finasteride, and dutasteride), and oral prednisone. For severe HS, cyclosporine, adalimumab, or infliximab (used at double psoriatic doses) and intravenous carbapenems or cephalosporins are often required. Isotretinoin, etanercept, isoniazid, lymecycline, sulfasalazine, methotrexate, metformin, colchicine, clarithromycin, IVIG, and thalidomide are less favored treatments. The role of botulinum toxin is uncertain. The most important life style modification is weight loss. De-roofing fluctuant nodules and injection of intralesional corticosteroids ameliorates the disease and perhaps, if done at regular intervals, improves HS more permanently. Surgical excision and CO2 laser ablation are more definitive treatments. The 1064 nm laser for hair removal aids in the treatment of HS. This article centers on medical therapies and will only passingly mention surgical and laser treatments. This article summarizes my treatment experience with over 350 HS patients. PMID:24021361

  6. The effect of new cooperative medical scheme on health outcomes and alleviating catastrophic health expenditure in China: a systematic review.

    Directory of Open Access Journals (Sweden)

    Xiaoyun Liang

    Full Text Available BACKGROUND: In 2002, the Chinese government launched a new rural health financing policy to provide health insurance (New Cooperative Medical Scheme, NCMS for its rural population. NCMS, jointly financed by governments and individual households, aims to protect households from impoverishment due to catastrophic health expenditure. In 2011, NCMS covered more than 96% of the rural population. We have systematically searched and reviewed available evidence to estimate the effects of NCMS on health outcomes and on alleviating catastrophic health expenditure. METHODS: PubMed, Web of Science with Conference Proceedings, ProQuest Digital Dissertations, CMCI, CNKI, and VIP were searched. We also obtained literature from colleague communications. Quasi-experimental studies regarding the effect of NCMS on health outcomes and catastrophic health expenditure were included. Two independent reviewers screened the literature, extracted the data, and assessed the study quality. RESULTS: Fifteen studies out of the 6123 studies in the literature fulfilled criteria and were included in this review. Twelve studies identified the relationship between NCMS and health outcomes, among which six studies measured sickness or injury in the past four weeks, four measured sickness or injury in the past two weeks, and five measured self-reported health status. Four studies focused on the relationship between NCMS and alleviating catastrophic health expenditure. However, the results from these studies were in conflict: individual studies indicated that NCMS had positive, negative, or no effect on health outcomes and/or the incidence of catastrophic health payments, respectively. CONCLUSIONS: We still have no clear evidence that NCMS improves the health outcomes and decreases the alleviating catastrophic health expenditure of the China's rural population. In addition, the heterogeneity among individual studies reminds us that provider payment method reforms, benefit package

  7. [Medications and financing of health systems in Third World countries. Cost recovery: a concept to review].

    Science.gov (United States)

    Velasquez, G

    1989-01-01

    During the 1960s most African countries declared that health care would be free in their newly independent countries. Unfortunately, the health care systems inherited from colonial days were hospital based and emphasized curative rather than preventive care, and were too expensive for most countries to maintain. As the quality and availability of health services have deteriorated, the concept of free care has been questioned. At the same time, the number of countries involved in programs of structural adjustment imposed by the International Monetary Fund has grown steadily since the early 1980s, and some countries have drastically restricted public expenditures for health care. IN the search for new sources of financing, the concept of recovery of costs has become prominent. Various attempts have been made to "recover costs" even before the costs have been assessed. Financing of health care by governments, besides being insufficient, has impeded analysis of health care costs in most African countries. The World Bank proposes that the price of each medical product or service should be equal to the cost of providing it. UNICEF proposals stress the need to rationalize expenses and to defend vulnerable population groups during application of adjustment measures. The World Health Organization approach is geared toward attaining the objective of health for all by the year 2000. The basic question is still how to finance quality health care with reasonable participation of users without impeding access of the population to needed health services. An objective of 100% cost recovery will seriously compromise access for the large number of persons without purchasing power to pay the real price of health care. The term "recovery of costs" is inappropriate; the problem is to achieve a balance between participation of the population and government resources for the health system. Health services are not completely self-financing in any developed country and it appears

  8. Controlling scabies in institutional settings: a review of medications, treatment models, and implementation.

    Science.gov (United States)

    Scheinfeld, Noah

    2004-01-01

    Scabies is a global problem and a significant source of morbidity in nursing home residents and workers because of its highly contagious nature. It is also a problem in hospitals that care for the elderly, the debilitated, and the immunocompromised. New outbreaks continue to occur, despite controlling the recurrent epidemics. Scabies manifests as papules, pustules, burrows, nodules, and occasionally urticarial papules and plaques. Most of the patients with scabies experience severe pruritus. A subset of patients have crusted or Norwegian scabies. These patients, who are usually debilitated or immunocompromised, do not experience the urge to scratch, and therefore do not scratch their own skin. Diagnosis of scabies is based on patient history, physical examination, and demonstration of mites, eggs, or scybala (black or brown football-shaped masses of feces of scabies) on microscopic examination. Scabies can be treated with topical or oral therapies. Topical treatments include 5% permethrin cream, 1% lindane (gamma benzene hexachloride) lotion, 6% precipitated sulfur in petrolatum, crotamiton, malathion, allethrin spray, and benzyl benzoate. Ivermectin, the only oral treatment, is not approved for scabies in the US. Most authorities advocate using a scabicide several times, specifically once a week over a period of 2-3 weeks. In an outbreak of scabies in a nursing home, residents, staff, and frequent visitors should all be treated even if they are not symptomatic. Ivermectin is useful in treating patients with Norwegian or crusted scabies, or who are debilitated. Ivermectin has no serious reported adverse effects. Model treatment plans to stop scabies epidemics have been developed. These plans coordinate treatment of all persons exposed (including ivermectin for debilitated patients), isolation of infected patients, disinfection of objects that patients have come into contact with, and education and reassurance of the medical staff. Failure to coordinate notification

  9. Priority Setting and Influential Factors on Acceptance of Pharmaceutical Recommendations in Collaborative Medication Reviews in an Ambulatory Care Setting – Analysis of a Cluster Randomized Controlled Trial (WestGem-Study)

    Science.gov (United States)

    Rose, Olaf; Mennemann, Hugo; John, Carina; Lautenschläger, Marcus; Mertens-Keller, Damaris; Richling, Katharina; Waltering, Isabel; Hamacher, Stefanie; Felsch, Moritz; Herich, Lena; Czarnecki, Kathrin; Schaffert, Corinna; Jaehde, Ulrich; Köberlein-Neu, Juliane

    2016-01-01

    Background Medication reviews are recognized services to increase quality of therapy and reduce medication risks. The selection of eligible patients with potential to receive a major benefit is based on assumptions rather than on factual data. Acceptance of interprofessional collaboration is crucial to increase the quality of medication therapy. Objective The research question was to identify and prioritize eligible patients for a medication review and to provide evidence-based criteria for patient selection. Acceptance of the prescribing general practitioner to implement pharmaceutical recommendations was measured and factors influencing physicians’ acceptance were explored to obtain an impression on the extent of collaboration in medication review in an ambulatory care setting. Methods Based on data of a cluster-randomized controlled study (WestGem-study), the correlation between patient parameters and the individual performance in a medication review was calculated in a multiple logistic regression model. Physician’s acceptance of the suggested intervention was assessed using feedback forms. Influential factors were analyzed. Results The number of drugs in use (p = 0.001), discrepancies between prescribed and used medicines (p = 0.014), the baseline Medication Appropriateness Index score (p0.05) and a low kidney function (p>0.05) do not predetermine the outcome. Longitudinal patient care with repeated reviews showed higher interprofessional acceptance and superior patient benefit. A total of 54.9% of the recommendations in a medication review on drug therapy were accepted for implementation. Conclusions The number of drugs in use and medication reconciliation could be a first rational step in patient selection for a medication review. Most elderly, multimorbid patients with polymedication experience a similar chance of receiving a benefit from a medication review. Longitudinal patient care should be preferred over confined medication reviews. The acceptance

  10. Scientometric analysis: A technical need for medical science researchers either as authors or as peer reviewers.

    Science.gov (United States)

    Masic, Izet

    2016-01-01

    The nature of performing a scientific research is a process that has several different components which consist of identifying the key research question(s), choices of scientific approach for the study and data collection, data analysis, and finally reporting on results. Generally, peer review is a series of procedures in the evaluation of a creative work or performance by other people, who work in the same or related field, with the aim of maintaining and improving the quality of work or performance in that field. The assessment of the achievement of every scientist, and thus indirectly determining his reputation in the scientific community of these publications, especially journals, is done through the so-called impact factor index. The impact factor predicts or estimates that how many annual citations article may receive after its publication. Evaluation of scientific productivity and assessment of the published articles of researchers and scientists can be made through the so-called H-index. The quality of published results of scientific work largely depends on knowledge sources that are used in the preparation, which means that it should be considered to serve the purpose and the very relevance of the information used. Scientometrics as a field of science covers all aforementioned issues, and scientometric analysis is obligatory for quality assessment of the scientific validity of published articles and other type of publications. PMID:26985429

  11. A Review on Recent Research and Implementation Methodologies on Medical Image Segmentation

    Directory of Open Access Journals (Sweden)

    S. K. Somasundaram

    2012-01-01

    Full Text Available Problem statement: Image segmentation plays a very important role in digital imaging applications for classifying the anatomical structures and other Regions of Interest. Segmentation refers to the process of identifying and isolating the surface and regions of the digital image which corresponds to the structural units. Approach: In the past few decades, many methods have been proposed to segment the digital image. Most of them were based on two basic properties of the pixels in relation to their local neighborhood: discontinuity and similarity. The approaches based on discontinuity partition of an image are performed by detecting isolated points, lines and edges, which were known as edge detection techniques. Results: A particular class of segmentation techniques is based on multi resolution analysis. The image segmentation process is includes various techniques like Threshold method, boundary tracking, Clustering, Region-Based. Conclusion: The objective of this study is to provide brief study on various segmentation methodologies for the researchers. This study presents the brief review on image segmentation and analyses the performance and improvement of various algorithms and fulfilled the objectives.

  12. Dispersal of carbapenemase blaVIM-1 gene associated with different Tn402 variants, mercury transposons, and conjugative plasmids in Enterobacteriaceae and Pseudomonas aeruginosa.

    Science.gov (United States)

    Tato, Marta; Coque, Teresa M; Baquero, Fernando; Cantón, Rafael

    2010-01-01

    The emergence of bla(VIM-1) within four different genetic platforms from distinct Enterobacteriaceae and Pseudomonas aeruginosa isolates in an area with a low prevalence of metallo-beta-lactamase producers is reported. Forty-three VIM-1-producing isolates (including 19 Enterobacter cloacae, 2 Escherichia coli, and 2 P. aeruginosa isolates, 18 Klebsiella pneumoniae isolate, and 2 Klebsiella oxytoca isolate) recovered from 2005 to 2007 and corresponding to 15 pulsed-field gel electrophoresis types were studied. The Enterobacteriaceae isolates corresponded to a hospital outbreak, and the P. aeruginosa isolates were sporadically recovered. The genetic context of the integrons carrying bla(VIM-1) (arbitrarily designated types A, B, C, and D) was characterized by PCR mapping based on known Tn402 and mercury transposons and further sequencing. Among Enterobacteriaceae isolates, bla(VIM-1) was part of integrons located either in an In2-Tn402 element linked to Tn21 (type A; In110-bla(VIM-1)-aacA4-aadA1) or in a Tn402 transposon lacking the whole tni module [type B; In113-bla(VIM-1)-aacA4-dhfrII (also called dfrB1)-aadA1-catB2] and the transposon was associated with an IncHI2 or IncI1 plasmid, respectively. Among P. aeruginosa isolates, bla(VIM-1) was part of a new gene cassette array located in a defective Tn402 transposon carrying either tniBDelta3 and tniA (type C; bla(VIM-1)-aadA1) or tniC and DeltatniQ (type D; bla(VIM-1)-aadB), and both Tn402 variants were associated with conjugative plasmids of 30 kb. The dissemination of bla(VIM-1) was associated with different genetic structures and bacterial hosts, depicting a complex emergence and evolutionary network scenario in our facility, Ramón y Cajal University Hospital, Madrid, Spain. Knowledge of the complex epidemiology of bla(VIM-1) is necessary to control this emerging threat. PMID:19901094

  13. Epidemiological characteristics of blaNDM-1 in Enterobacteriaceae and the Acinetobacter calcoaceticus-Acinetobacter baumannii complex in China from 2011 to 2012.

    Directory of Open Access Journals (Sweden)

    Weimei Ou

    Full Text Available OBJECTIVES: The study aimed to investigate the prevalence and epidemiological characteristics of blaNDM-1 (encoding New Delhi metallo-β-lactamase 1 in Enterobacteriaceae and the Acinetobacter calcoaceticus-Acinetobacter baumannii complex (ABC in China from July 2011 to June 2012. METHODS: PCR was used to screen for the presence of blaNDM-1 in all organisms studied. For blaNDM-1-positive strains, 16S rRNA analysis and Analytical Profile Index (API strips were used to identify the bacterial genus and species. The ABCs were reconfirmed by PCR detection of blaOXA-51-like. Antibiotic susceptibilities of the bacteria were assessed by determining minimum inhibitory concentration (MIC of them using two-fold agar dilution test, as recommended by the Clinical and Laboratory Standards Institute (CLSI. Molecular typing was performed using pulsed-field gel electrophoresis (PFGE. S1 nuclease-pulsed-field gel electrophoresis (S1-PFGE and Southern blot hybridization were conducted to ascertain the gene location of blaNDM-1. Conjugation experiments were conducted to determine the transmission of blaNDM-1-positive strains. RESULTS: Among 2,170 Enterobacteriaceae and 600 ABCs, seven Enterobacteriaceae strains and two A. calcoaceticus isolates from five different cities carried the blaNDM-1 gene. The seven Enterobacteriaceae strains comprised four Klebsiella pneumoniae, one Enterobacter cloacae, one Enterobacter aerogen and one Citrobacter freundii. All seven were non-susceptible to imipenem, meropenem or ertapenem. Two A. calcoaceticus species were resistant to imipenem and meropenem. Three K. pneumoniae showed the same PFGE profiles. The blaNDM-1 genes of eight strains were localized on plasmids, while one was chromosomal. CONCLUSIONS: Compared with previous reports, the numbers and species containing the blaNDM-1 in Enterobacteriaceae have significantly increased in China. Most of them are able to disseminate the gene, which is cause for concern. Consecutive

  14. Narrative review of the safety and efficacy of marijuana for the treatment of commonly state-approved medical and psychiatric disorders.

    Science.gov (United States)

    Belendiuk, Katherine A; Baldini, Lisa L; Bonn-Miller, Marcel O

    2015-01-01

    The present investigation aimed to provide an objective narrative review of the existing literature pertaining to the benefits and harms of marijuana use for the treatment of the most common medical and psychological conditions for which it has been allowed at the state level. Common medical conditions for which marijuana is allowed (i.e., those conditions shared by at least 80 percent of medical marijuana states) were identified as: Alzheimer's disease, amyotrophic lateral sclerosis, cachexia/wasting syndrome, cancer, Crohn's disease, epilepsy and seizures, glaucoma, hepatitis C virus, human immunodeficiency virus/acquired immunodeficiency syndrome, multiple sclerosis and muscle spasticity, severe and chronic pain, and severe nausea. Post-traumatic stress disorder was also included in the review, as it is the sole psychological disorder for which medical marijuana has been allowed. Studies for this narrative review were included based on a literature search in PsycINFO, MEDLINE, and Google Scholar. Findings indicate that, for the majority of these conditions, there is insufficient evidence to support the recommendation of medical marijuana at this time. A significant amount of rigorous research is needed to definitively ascertain the potential implications of marijuana for these conditions. It is important for such work to not only examine the effects of smoked marijuana preparations, but also to compare its safety, tolerability, and efficacy in relation to existing pharmacological treatments. PMID:25896576

  15. BIOCOMPATIBILITY OF MEDICAL DEVICES BASED ON METALS, CAUSES FORMATION OF PATHOLOGICAL REACTIVITY (A REVIEW OF FOREIGN LITERATURE

    Directory of Open Access Journals (Sweden)

    O. M. Rozhnova

    2015-01-01

    Full Text Available The objective of the research is a review of approaches to the evaluation of biocompatibility of medical devices on the basis of metals and alloys, and to find ways of overcoming the low engraftment of implanted structures. Implantation by artificial materials allows us to regain the use of human organs and tissues and to date has no rivals. The advantage of using metals and alloys for implanted structures is their high reliability in operation, long servicelife, and high functionality. The nature of the interaction between the human body and the implant has an impact on resource use and the durability of the structures. Manufacturers of scientific research into medical implants at the present stage are directed to obtain materials that will not adversely affect the human body, and to ensure the maximum survival rate when using them. At the same time, the data presented in the article suggests that attempts to make higher biocompatible material properties tend to reduce the development of new methods for the surface treatment and the chemical composition modulation implants. World literature demonstrates the lack of a systematic approach to the problem of increased sensitivity of patients to different metals and alloys (metal sensitization, resulting in the development of complications such as the development of aseptic inflammation and infectious complications of unstable structures, and loss of functionality. Consequently, there is a need to search for ways to improve the biocompatibility of materials used in medicine, based on an assessment of immune defense mechanisms, and the development of algorithms preoperative tactics. 

  16. Prevalence of somatoform disorders and medically unexplained symptoms in old age populations in comparison with younger age groups : A systematic review

    NARCIS (Netherlands)

    Hilderink, P. H.; Collard, R.; Rosmalen, J. G. M.; Voshaar, R. C. Oude

    2013-01-01

    Objective: To review current knowledge regarding the prevalence of somatization problems in later life by level of caseness (somatoform disorders and medically unexplained symptoms, MUS) and to compare these rates with those in middle-aged and younger age groups. Method: A systematic search of the l

  17. Responsible self-medication: review of the process of pharmaceutical attendance

    Directory of Open Access Journals (Sweden)

    Dayani Galato

    2009-12-01

    Full Text Available This article presents a review, based on a qualitative study, of pharmaceutical orientation in the management of minor illness. Action research methodology was used by a group of faculty members responsible for the community pharmacy internship and by postgraduates in clinical pharmacy, to carry out the study with the objective to present a standard service for this kind of procedure. The interaction with the individual starts with a welcoming reception, at which point the pharmacist should be receptive and show empathy. Subsequently, data from the history of the patient are collected to obtain relevant information. Based on this information, the pharmacist must develop a line of clinical reasoning and make a decision, taking the context of the patient into account. After this analysis, the most appropriate intervention is performed. This intervention could indicate the need for referral to another health professional, the use of a non-pharmacological therapy or the provision of sound advice on medicines available without prescription. The next step is monitoring the patient in order to identify the effectiveness and safety of treatment. The standardization process of pharmaceutical attendance in the management of minor disorders contributes to the rational use of medicines.A reflexão apresentada neste artigo representa um estudo de abordagem qualitativa baseada na pesquisa-ação da prática do atendimento farmacêutico no manejo de transtornos menores, realizada pelo grupo de professores do Estágio em Farmácia Comunitária e por farmacêuticos pós-graduados em Farmácia Clínica, com o objetivo de realizar uma proposta de atendimento padrão para este tipo de procedimento. A interação com o indivíduo é iniciada pelo acolhimento, momento no qual o farmacêutico deve ser receptivo e empático. A seguir, se executa a coleta de dados sobre a história do paciente, para obtenção de informações relevantes. Com base nas informações, o

  18. Medical leasing.

    Science.gov (United States)

    Holden, Elizabeth A

    2012-01-01

    Leases for medical space can have far-reaching (and sometimes unintentional) consequences for the future of the practice and the costs of the business. In order to prevent hardship and expense down the line, it is especially important to review the lease to make sure that it reflects the practice's goals, needs, and structure. This article provides a number of provisions that are especially crucial to review and negotiate when leasing medical space, including use restrictions, assignment and subleasing clauses, build-out terms, and legal compliance requirements. PMID:22594070

  19. Independent ethical review of studies involving personal medical records. Report of a working group to the Royal College of Physicians Committee on Ethical Issues in Medicine.

    Science.gov (United States)

    1994-01-01

    There is a duty to use available information for the general good where this can be done without detriment. It is, in principle, ethically acceptable to use personal medical records without approaching or involving the patients concerned, provided that confidentiality and anonymity are preserved; such use does not require independent ethical approval provided that confidentiality is assured and subject to safeguards described below. Epidemiologists have a special interest in the use of personal medical records in their work (in this context the use of health-related registers and existing biological samples may be included), though access to such data involves professional staff in all medical specialties, not only those in epidemiology. The following guidance is based on a report of a working group (which included non-medical members) to the Royal College of Physicians Committee on Ethical Issues in Medicine. Activities such as medical audit, epidemiological surveillance, inquiries designed to establish indices of morbidity and mortality and outbreak investigations all constitute medical practice and as such do not require independent ethical review. Research involving access to medical records, health-related registers, or existing biological samples only, without direct patient involvement, requires neither explicit individual patient consent nor independent ethical review provided that: a) explicit consent to access a person's records is obtained either from official custodians of the records (who have a duty to satisfy themselves as to the bona fides and competence of the investigator) or from the patient's clinician: the decision to access personal medical information should not be left to the sole discretion of the investigator.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7807434

  20. STS-3 medical report

    Science.gov (United States)

    Pool, S. L. (Editor); Johnson, P. C., Jr. (Editor); Mason, J. A. (Editor)

    1982-01-01

    The medical operations report for STS-3, which includes a review of the health of the crew before, during, and immediately after the third Shuttle orbital flight is presented. Areas reviewed include: health evaluation, medical debriefing of crewmembers, health stabilization program, medical training, medical 'kit' carried in flight, tests and countermeasures for space motion sickness, cardiovascular profile, biochemistry and endocrinology results, hematology and immunology analyses, medical microbiology, food and nutrition, potable water, shuttle toxicology, radiological health, and cabin acoustic noise. Environmental effects of shuttle launch and landing medical information management, and management, planning, and implementation of the medical program are also dicussed.