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Sample records for general medications utilization

  1. General medications utilization and cost patterns in hospitalized children

    Directory of Open Access Journals (Sweden)

    Kassis I

    2009-03-01

    Full Text Available Drug utilization in the in-patient setting can provide mechanisms to assess drug prescribing trends, efficiency and cost-effectiveness of hospital formularies and examine sub-populations such as children for which prescribing habits are different from adults. Objectives: The aim of this descriptive study was to analyze general medication utilization patterns and costs excluding antimicrobials prescriptions and to compare two pediatric admission units in a tertiary care university hospital. Methods: The total number of admitted children was 1,521 and 1,467 for the A and B admission units, respectively. The electronic data from 252 and 253 hospitalized children in the A and B admission unit were prospectively screened for general medication prescriptions, children on antimicrobials were excluded from the analysis. Their electronic charts were viewed once weekly from October 15, 2007 up to April 7, 2008 using the prescription-point prevalence method. One medication was considered to be one prescription. Results: The general medications prescription number was 790 for 94 children (8.4 prescription/patient in A and 959 for 88 children (10.9 prescription/patient in B (p=0.02. The general medications defined daily dose (DDD and drug utilization 90% (DU90% index were 2,509.63, 2,259 for A; and 6,110.35, 5,499 for B, respectively. The DU90% index placed salbutamol inhalation with 835 DDD and sodium heparin with 2,102 DDD in the first place for the A and B admission units, respectively. A net increment in medication cost was registered according to the calculated cost from the depicted DU90% when the A (20,263 NIS and B (6,269 NIS admission units were compared (p=0.04. Conclusions: A significant difference in the prescription utilization of general medications was shown between the A and B admission units. The A admission unit had lower prescriptions measured by the DU90% index with higher medication cost. Potential drug-drug interactions were depicted in

  2. General equilibrium without utility functions

    DEFF Research Database (Denmark)

    Balasko, Yves; Tvede, Mich

    2010-01-01

    How far can we go in weakening the assumptions of the general equilibrium model? Existence of equilibrium, structural stability and finiteness of equilibria of regular economies, genericity of regular economies and an index formula for the equilibria of regular economies have been known not to re......How far can we go in weakening the assumptions of the general equilibrium model? Existence of equilibrium, structural stability and finiteness of equilibria of regular economies, genericity of regular economies and an index formula for the equilibria of regular economies have been known...... and the diffeomorphism of the equilibrium manifold with a Euclidean space; (2) the diffeomorphism of the set of no-trade equilibria with a Euclidean space; (3) the openness and genericity of the set of regular equilibria as a subset of the equilibrium manifold; (4) for small trade vectors, the uniqueness, regularity...

  3. Characteristics, resource utilization and safety profile of patients prescribed with neuropathic pain treatments: a real-world evidence study on general practices in Europe - the role of the lidocaine 5% medicated plaster.

    Science.gov (United States)

    Katz, Pablo; Pegoraro, Valeria; Liedgens, Hiltrud

    2017-08-01

    To identify characteristics, resource utilization, and safety profile of patients prescribed with lidocaine 5% medicated plaster, pregabalin, gabapentin, amitriptyline and duloxetine when experiencing pain in the real-world setting of general practitioners (GPs) in Europe. Retrospective analysis on real world data from IMS Health Longitudinal Patient Database. Patients with at least one prescription of the drugs of interest during 2014 were selected and those with a non-neuropathic pain-related diagnosis were excluded. Patients' demographic and clinical characteristics, resource utilization data and adverse drug reactions (ADRs) as described in the leaflet were extracted. The association between treatments and ADR occurrence was evaluated applying multivariate logistic models. A total of 70,515 patients were selected from Italy, Germany, the UK, Spain and Belgium. Lidocaine 5% medicated plaster patients were the oldest in Italy, the UK and Spain and the most health impaired in Italy, Spain and Belgium. No relevant differences in the number of co-prescriptions, specialist visits, examinations and hospitalizations were found. Significantly less lidocaine 5% plasters patients experienced ADRs, with odds ratios in favor of lidocaine 5% medicated plasters ranging from 3.41 (p = .036) to 52.33 (p plaster patients showing a better safety profile, but also a comparable level of resource utilization. A possible re-evaluation of the scientific value coming from this retrospective study in building up a diagnostic as well as a therapeutic algorithm is suggested.

  4. Determinants related to gender differences in general practice utilization

    DEFF Research Database (Denmark)

    Jørgensen, Jeanette Therming; Andersen, John Sahl; Tjønneland, Anne

    2016-01-01

    OBJECTIVE: This study aims to describe the determinants related to gender differences in the GP utilization in Danish population aged 50-65 years. DESIGN: Cohort-based cross-sectional study. SETTING: Danish general practice. SUBJECTS: Totally, 54,849 participants of the Danish Diet, Cancer...... explain a large proportion, but not all of the gender difference in GP utilization. Medical conditions (somatic and mental) and unemployment are the main determinants of GP utilization in men and women, while lifestyle has minor effect. Key points: Female gender remained a dominant determinant of GP...... utilization, after adjustment for lifestyle, socio-demography, medical and gender specific factors, with females consulting their GP 18% more often than males. Female reproductive factors (use of postmenopausal hormone therapy and gravidity) explained a large proportion of the gender variation in use of GP...

  5. Addiction and the Utilization of Medical Care

    Directory of Open Access Journals (Sweden)

    Yen-Ju Lin

    2012-01-01

    Full Text Available We investigate the effect of different scales of addictive factors on the utilization of medical services in this paper using a two-part model. Data are from the 2005 National Health Interview Survey and the claims data in the National Health Insurance Research Database in Taiwan. The results show that personal addictive behavior is significantly associated with both outpatient and inpatient utilization. Moreover, our result implies that those who smoked at least 20 cigarettes per day might not visit a doctor until the illness was severe. It suggests that the government can accomplish these goals by promotion and education in order to increase public awareness of personal health.

  6. General Advice on Safe Medication Use

    Science.gov (United States)

    ... About Us Contact Us General Advice on Safe Medication Use Visit our new website for consumers The ... answers--it's your life and your health! Unfortunately, medication errors happen. They happen in hospitals, in pharmacies, ...

  7. Utilization of Dental General Anaesthesia for Children

    Science.gov (United States)

    Karim, Zarina Abdul; Musa, Normaizura; Noor, Siti Noor Fazliah Mohd

    2008-01-01

    Dental treatment under general anaesthesia may be needed for some children and adolescents due to medical or behaviour problem. The objective of the study is to identify the type of treatment that has been carried out under GA in Hospital Universiti Sains Malaysia (HUSM). A retrospective record review study from hospital records of dental patients (under 18 years old) receiving dental treatment under GA from 2003 until 2007 were retrieved from the database. Information such as the reason for GA, and the type of treatment provided was recorded in data sheet. The data were analyzed using SPSS 12.0.1 for Windows. It was checked and verified for errors. A total of 349 cases were treated of which 43.6% had medical problems. Patients were mostly diagnosed to have rampant caries (77.1%) and some of them have behavioural problems (34.4%). Treatment pattern in deciduous dentition revealed more extraction (97.8%) as compared to restoration (75.7%) whereas in permanent dentition more restoration was done (24.3%) as compared to extraction (2.2%). Majority of the restorations were done using Glass Ionomer Cements (47.5%). Biopsy (4.3%) contributed mainly to the surgery (24.1%) done during GA. General anesthesia is necessary when dental disease is interfering with health and general well-being of patient and it can facilitated dental treatment allowing dentists to benefit from improved treatment conditions and provide a higher quality of care. PMID:22570587

  8. Economic utilization of general aviation airport runways

    Science.gov (United States)

    Piper, R. R.

    1971-01-01

    The urban general aviation airport economics is studied in detail. The demand for airport services is discussed, and the different types of users are identified. The direct cost characteristics of the airport are summarized; costs to the airport owner are largely fixed, and, except at certain large airports, weight is not a significant factor in airport costs. The efficient use of an existing airport facility is explored, with the focus on the social cost of runway congestion as traffic density at the airport build up and queues form. The tradeoff between aircraft operating costs and airport costs is analyzed in terms of runway length. The transition from theory to practice is treated, and the policy of charging prices only on aircraft storage and fuel is felt likely to continue. Implications of the study from the standpoint of public policy include pricing that spreads traffic peaks to improve runway utilization, and pricing that discriminates against aircraft requiring long runways and causes owners to adopt V/STOL equipment.

  9. Determinants related to gender differences in general practice utilization

    DEFF Research Database (Denmark)

    Jørgensen, Jeanette Therming; Andersen, John Sahl; Tjønneland, Anne

    2016-01-01

    and Health cohort (50-65 years). MAIN OUTCOME MEASURES: The sum of cohort members' face-to-face consultations with general practitioner (GP) at the cohort baseline year (1993-1997). We obtained data on GP visits from the Danish National Health Service Register at the cohort baseline (1993-1997), when...... information on lifestyle (smoking, body mass index (BMI), alcohol use, physical activity), medical conditions (somatic and mental), employment, education, gravidity, and hormone therapy (HT) use was collected by questionnaire. RESULTS: Women had on average 4.1 and men 2.8 consultations per year. In a crude...... utilization, after adjustment for lifestyle, socio-demography, medical and gender specific factors, with females consulting their GP 18% more often than males. Female reproductive factors (use of postmenopausal hormone therapy and gravidity) explained a large proportion of the gender variation in use of GP...

  10. A general classification of silicon utilizing organisms

    Science.gov (United States)

    Das, P.; Das, S.

    2010-12-01

    Silicon utilizing organisms may be defined as organisms with high silicon content (≥ 1% dry weight) and they can metabolize silicon with or without demonstrable silicon transporter genes (SIT) in them(Das,2010). Silicon is the second most abundant element in the lithosphere (27.70%) and it is as important as phosphorus and magnesium (0.03%) in the biota. Hydrated silica represents the second most abundant biogenic mineral after carbonate minerals. Silicon is accumulated and metabolized by some prokaryotes, and Si compounds can stimulate the growth of a range of fungi. It is well known that Si is essential for diatoms. In mammals, Si is considered an essential trace element, required in bone, cartilage and connective tissue formation, enzymatic activities and other metabolic processes. Silicon was suggested to act as a phosphoprotein effector in bone. In mammals, Si is also reported to positively influence the immune system and to be required for lymphocyte proliferation. The aqueous chemistry of Si is dominated by silicic acid at biological pH ranges. Monosilicic acid can form stable complexes with organic hydroxy-containing molecules . Biosilica also has been identified associated with various biomolecules including proteins and carbohydrates. There are main seven groups of silicon utilizing organisms belonging to Gram positive bacteria, algae, protozoa, sponges, fungi, lichens, and monocotyledon plants. In each group again all the members are not silicon utilizing organisms, thus selective members in each group are further classified depending their degree of silicon utilization. Important silicon utilizing bacteria are Mycobacteria, Nocardia, Streptomyces, Staphylococcus, Bacillus, Lactobacillus spp. etc., Important silicon utilizing algae are Centrobacillariophyceae, Pennatibacillariophyceae and Chrysophyceae. Many protozoa belonging to Heterokonta, Choanoflagellida, Actinopoda are well known silicon utilizing microorganisms. Hexactinellida ( glass sponges

  11. Is expected utility theory normative for medical decision making?

    Science.gov (United States)

    Cohen, B J

    1996-01-01

    Expected utility theory is felt by its proponents to be a normative theory of decision making under uncertainty. The theory starts with some simple axioms that are held to be rules that any rational person would follow. It can be shown that if one adheres to these axioms, a numerical quantity, generally referred to as utility, can be assigned to each possible outcome, with the preferred course of action being that which has the highest expected utility. One of these axioms, the independence principle, is controversial, and is frequently violated in experimental situations. Proponents of the theory hold that these violations are irrational. The independence principle is simply an axiom dictating consistency among preferences, in that it dictates that a rational agent should hold a specified preference given another stated preference. When applied to preferences between lotteries, the independence principle can be demonstrated to be a rule that is followed only when preferences are formed in a particular way. The logic of expected utility theory is that this demonstration proves that preferences should be formed in this way. An alternative interpretation is that this demonstrates that the independence principle is not a valid general rule of consistency, but in particular, is a rule that must be followed if one is to consistently apply the decision rule "choose the lottery that has the highest expected utility." This decision rule must be justified on its own terms as a valid rule of rationality by demonstration that violation would lead to decisions that conflict with the decision maker's goals. This rule does not appear to be suitable for medical decisions because often these are one-time decisions in which expectation, a long-run property of a random variable, would not seem to be applicable. This is particularly true for those decisions involving a non-trivial risk of death.

  12. Do general medical practitioners examine injured runners?

    DEFF Research Database (Denmark)

    Andersen, Solvej Videbæk; Jensen, A V; Rasmussen, Sten

    2017-01-01

    BACKGROUND: General Medical Practitioners (GMP) in Denmark perform clinical examinations of patients with musculoskeletal pain. However, the prevalence proportion of examinations caused by running-related injuries remains unknown. PURPOSE: The primary purpose of the present study was to estimate...... the prevalence proportion of consultations in general medical practice caused by running-related injuries. The secondary purpose was to estimate the prevalence proportion of injured runners, who consult their GMP, that are referred to additional examinations or treatments. STUDY DESIGN: A survey-based study...

  13. National Institute of General Medical Sciences

    Science.gov (United States)

    ... CareerTrac Webinar for RISE and Bridges Program Directors Biomedical Beat : Science for the Public Fall 2017 Issue of Findings ... National Institutes of Health: NIH...Turning Discovery Into Health ® USA.gov National Institute of General Medical Sciences 45 Center Drive MSC 6200 Bethesda, MD 20892- ...

  14. General practitioners’ decisions about discontinuation of medication

    DEFF Research Database (Denmark)

    Nixon, Michael Simon; Vendelø, Morten Thanning

    2016-01-01

    Purpose – The purpose of this paper is to investigate how general practitioners’ (GPs) decisions about discontinuation of medication are influenced by their institutional context. Design/methodology/approach – In total, 24 GPs were interviewed, three practices were observed and documents were col...

  15. Remote Medical Diagnosis System (RMDS) Utilization Study.

    Science.gov (United States)

    1981-08-18

    able to determine that amputation of the finger at the third joint was 10. Telemedicine in Alaska, the ATS-6 Satellite Biomedical Demonstration, by D...physician then instructed the corpsman in the technique for performing the amputation . The physician stated in his report that the RMDS was beneficial to...involving ECGs, plastic surgery (burns), dermatology, physiotherapy , microscope slides, and dentistry. The use of the systems for the continuing medical

  16. Medical informed consent: general considerations for physicians.

    Science.gov (United States)

    Paterick, Timothy J; Carson, Geoff V; Allen, Marjorie C; Paterick, Timothy E

    2008-03-01

    Medical informed consent is essential to the physician's ability to diagnose and treat patients as well as the patient's right to accept or reject clinical evaluation, treatment, or both. Medical informed consent should be an exchange of ideas that buttresses the patient-physician relationship. The consent process should be the foundation of the fiduciary relationship between a patient and a physician. Physicians must recognize that informed medical choice is an educational process and has the potential to affect the patient-physician alliance to their mutual benefit. Physicians must give patients equality in the covenant by educating them to make informed choices. When physicians and patients take medical informed consent seriously, the patient-physician relationship becomes a true partnership with shared decision-making authority and responsibility for outcomes. Physicians need to understand informed medical consent from an ethical foundation, as codified by statutory law in many states, and from a generalized common-law perspective requiring medical practice consistent with the standard of care. It is fundamental to the patient-physician relationship that each partner understands and accepts the degree of autonomy the patient desires in the decision-making process.

  17. The Patient-Physician Relationship and Medical Utilization

    OpenAIRE

    Lynch, Denis J.; McGrady, Angele V.; Nagel, Rollin W.; Wahl, Elmer F.

    2007-01-01

    Objective: The goal of this study was to (1) explore the relationship between medical utilization and characteristics of the patient-physician relationship and (2) evaluate the relationship between physician perception of patient difficulty, chronic medical problems, and patient somatizing tendencies.

  18. [Death education for medical personnel utilizing cinema].

    Science.gov (United States)

    Jung, Hyun Chae

    2012-09-25

    Death and dying is an ultimate process that every human being must experience. However, in these days we do not like to think or discuss about death and dying. Actually, hatred and denial is the usual feeling when we encounter death and dying. Dying is more than a biological occurrence. It is a human, social, and spiritual event, but the spiritual dimension of patients is too often neglected. Whether death is viewed as a "wall" or as a "door" can have significantly important consequences for how we live our lives. Near death experience is one of the excellent evidences to prove that there should be spiritual component being separated from the human physical body when we experience death. People have called it soul, spirit, or nonlocal consciousness. Caregivers need to recognize and acknowledge the spiritual component of patient care. Learning about death and dying helps us encounter death in ways that are meaningful for our own lives. Among the several learning tools, utilizing cinema with its audio and visual components can be one of the most powerful learning tools in death education.

  19. Impact of a Value-based Formulary on Medication Utilization, Health Services Utilization, and Expenditures.

    Science.gov (United States)

    Yeung, Kai; Basu, Anirban; Hansen, Ryan N; Watkins, John B; Sullivan, Sean D

    2017-02-01

    Value-based benefit design has been suggested as an effective approach to managing the high cost of pharmaceuticals in health insurance markets. Premera Blue Cross, a large regional health plan, implemented a value-based formulary (VBF) for pharmaceuticals in 2010 that explicitly used cost-effectiveness analysis (CEA) to inform medication copayments. The objective of the study was to determine the impact of the VBF. Interrupted time series of employer-sponsored plans from 2006 to 2013. Intervention group: 5235 beneficiaries exposed to the VBF. 11,171 beneficiaries in plans without any changes in pharmacy benefits. The VBF-assigned medications with lower value (estimated by CEA) to higher copayment tiers and assigned medications with higher value to lower copayment tiers. Primary outcome was medication expenditures from member, health plan, and member plus health plan perspectives. Secondary outcomes were medication utilization, emergency department visits, hospitalizations, office visits, and nonmedication expenditures. In the intervention group after VBF implementation, member medication expenditures increased by $2 per member per month (PMPM) [95% confidence interval (CI), $1-$3] or 9%, whereas health plan medication expenditures decreased by $10 PMPM (CI, $18-$2) or 16%, resulting in a net decrease of $8 PMPM (CI, $15-$2) or 10%, which translates to a net savings of $1.1 million. Utilization of medications moved into lower copayment tiers increased by 1.95 days' supply (CI, 1.29-2.62) or 17%. Total medication utilization, health services utilization, and nonmedication expenditures did not change. Cost-sharing informed by CEA reduced overall medication expenditures without negatively impacting medication utilization, health services utilization, or nonmedication expenditures.

  20. Teaching exercise of drug utilization by medical students.

    Science.gov (United States)

    Das, B P; Sethi, A; Nutan, K; Gunjan

    2005-01-01

    The prescription is a vital written document communicating between the physician, the patient and the pharmacist. The audit of prescribing pattern is a component of medical audit, which seeks monitoring, evaluation and necessary modifications in the prescribing practices of prescribers to achieve rational and cost effective medical care for the patients, The present drug utilization study was conducted by fourth year MBBs students during their research posting in the department of Pharmacology at B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan. The prescriptions were randomly collected from BPKIHS pharmacy over a period of 3 weeks. The auditing was done in the form of a semi structured performa containing the patients particulars with regard to age, sex, and residence, the details of the illness and prescribed drug information. The data was analyzed at the end of the study. The study points out that the maximum (27.5%) prescriptions were from General Outpatient Department (GOPD) followed by ENT (16.5%), Internal medicine (15.5%) and General surgery (10%). This indicates the distribution of patient load in hospital and the dominant areas to be targeted for intervention. Further, the proportion of antimicrobial agents (AMAs) i.e. 26.03% use was low and was prescribed empirically in most of the cases. There was use of expensive AMAs and irrational prescribing of combinations of AMAs in some prescriptions. Other prevailing drugs which were prescribed were analgesics. The usage of nimesulide and rofecoxib. withdrawn by FDA were used recurrently in this setup. There was greater use of dubious drugs of unproven benefit like vitamins, calcium etc. The diagnosis of the disease were not mentioned in 32.5% of prescriptions, The dose, frequency and duration of drugs were unascertained in majority of prescriptions that might lead to health hazards. This exercise might change the behavior of existing prescribers and also of the future doctors.

  1. Trend of cost and utilization of COPD medication in Korea

    Science.gov (United States)

    Lee, Jongmin; Lee, Jae Ha; Kim, Jee-Ae; Rhee, Chin Kook

    2017-01-01

    Background There are only a few longitudinal studies regarding medical utilization and costs for patients with COPD. The purpose of this study was to analyze the trend of medical utilization and costs on a long-term basis. Methods Using the Korean Health Insurance Review and Assessment Service (HIRA) data from 2008 to 2013, COPD patients were identified. The trend of medical utilization and costs was also analyzed. Results The number of COPD patients increased by 13.9% from 2008 to 2013. During the same period, the cost of COPD medication increased by 78.2%. Methylxanthine and systemic beta agonists were most widely prescribed between 2008 and 2013. However, inhaled medications such as long-acting beta-2 agonist (LABA), long-acting muscarinic agonist, and inhaled corticosteroid plus LABA were dispensed to a relatively low proportion of patients with COPD. The number of patients who were prescribed inhaled medications increased gradually from 2008 to 2013, while the number of patients prescribed systemic beta agonist and methylxanthine has decreased since 2010. Conclusion This study shows that there is a large gap between the COPD guidelines and clinical practice in Korea. Training programs for primary care physicians on diagnosis and guideline-based treatment are needed to improve the management of COPD. PMID:28031708

  2. Factors Affecting Medical Services Utilization: A Behavioral Approach.

    Science.gov (United States)

    Kelly, Terence F.; Schieber, George J.

    This study describes behavioral response--both its theoretical specification and its estimation--which relates health service utilization and expenditures to a number of variables: demographic, psychological, economic, medical, and policy-related. By incorporating these behavioral relations into a recently developed microsimulation model, national…

  3. Aggregation Functions and Personal Utility Functions in General Insurance

    Directory of Open Access Journals (Sweden)

    Pavol Kráľ

    2010-11-01

    Full Text Available The modeling of a utility function’s forms is a very interesting part of moderndecision making theory. We apply a basic concept of the personal utility theory ondetermination of minimal net and maximal gross annual premium in general insurance. Weintroduce specific values of gross annual premium on the basis of a personal utilityfunction, which is determined empirically by a short personal interview. Moreover, weintroduce a new approach to the creation of a personal utility function by a fictive gameand an aggregation of specific values by mixture operators.

  4. Psychiatric disorders and general medical conditions: implications ...

    African Journals Online (AJOL)

    happening, medical practice is running the risk of becoming so compartmentalized that ... medical disorders also increase the risk of developing mental disorders. Mental illness and .... dysregulation, reduced heart rate variability, altered blood.

  5. Patterns of healthcare utilization in patients with generalized anxiety disorder in general practice in Germany

    Directory of Open Access Journals (Sweden)

    Ariel Berger

    2009-06-01

    Full Text Available Background and Objectives: To describe patterns of healthcare utilization among patients with generalized anxiety disorder (GAD in general practitioner (GP settings in Germany. Methods: Using a large computerized database with information from GP practices across Germany, we identified all patients, aged > 18 years, with diagnoses of, or prescriptions for, GAD (ICD-10 diagnosis code F41.1 between October 1, 2003 and September 30, 2004 ("GAD patients". We also constituted an age- and sex-matched comparison group, consisting of randomly selected patients without any GP encounters or prescriptions for anxiety or depression (a common comorbidity in GAD during the same period. GAD patients were then compared to those in the matched comparison group over the one-year study period. Results: The study sample consisted of 3340 GAD patients and an equal number of matched comparators. Mean age was 53.2 years; 66.3% were women. Over the 12-month study period, GAD patients were more likely than matched comparators to have encounters for various comorbidities, including sleep disorders (odds ratio [OR] = 6.75 [95% CI = 5.31, 8.57], substance abuse disorders (3.91 [2.89, 5.28], and digestive system disorders (2.62 [2.36, 2.91] (all p <0.01. GAD patients averaged 5.6 more GP encounters (10.5 [SD = 8.8] vs 4.9 [5.7] for comparison group and 1.4 more specialist referrals (2.3 [2.9] vs 0.9 [1.7] (both p <0.01. Only 58.3% of GAD patients received some type of psychotropic medication (i.e., benzodiazepines, antidepressants, and/or sedatives/hypnotics. Conclusions: Patients with GAD in GP practices in Germany have more clinically recognized comorbidities and higher levels of healthcare utilization than patients without anxiety or depression.

  6. Approximation solutions for indifference pricing under general utility functions

    NARCIS (Netherlands)

    Chen, An; Pelsser, Antoon; Vellekoop, M.H.

    2008-01-01

    With the aid of Taylor-based approximations, this paper presents results for pricing insurance contracts by using indifference pricing under general utility functions. We discuss the connection between the resulting "theoretical" indifference prices and the pricing rule-of-thumb that practitioners u

  7. Approximation solutions for indifference pricing under general utility functions

    NARCIS (Netherlands)

    Chen, An; Pelsser, Antoon; Vellekoop, M.H.

    2008-01-01

    With the aid of Taylor-based approximations, this paper presents results for pricing insurance contracts by using indifference pricing under general utility functions. We discuss the connection between the resulting "theoretical" indifference prices and the pricing rule-of-thumb that practitioners

  8. Approximation solutions for indifference pricing under general utility functions

    NARCIS (Netherlands)

    Chen, An; Pelsser, Antoon; Vellekoop, Michel

    2008-01-01

    With the aid of Taylor-based approximations, this paper presents results for pricing insurance contracts by using indifference pricing under general utility functions. We discuss the connection between the resulting "theoretical" indifference prices and the pricing rule-of-thumb that practitioners u

  9. Utility of Bispectral Index (BIS) monotoring during general anesthesia

    OpenAIRE

    Lindholm, Maj-Lis

    2009-01-01

    p>The possibility to objectively measure effects from anesthetics on the level of consciousness has since long been desired. General anesthetics cause changes in brain electrical activity, seen as changes in the electroencephalogram (EEG). Devices utilizing processed EEG for pseudo-quantification of anesthetic depth have been available for more than ten years. These monitors display the anesthetic, or rather, hypnotic depth as an index number. In this thesis, some aspects ...

  10. Emotional Distress, Medical Utilization, and Disability Claims in Adult Refugees.

    Science.gov (United States)

    Cronkright, Peter; Lupone, Christina D

    2017-07-06

    The refugee health screener-15 (RHS-15) is utilized as a diagnostic proxy for common mental disorders in refugees. Studies are needed to determine its clinical and social utility. A retrospective chart analysis of adult refugees compared RHS-15 scores to utilization of medical services and presence of disability claims. Refugees with negative, positive, and highly positive RHS-15 scores attended 3.1, 4.4, and 5.7 mean primary care visits and 1.6, 2.8, and 4.4 mean non-primary care visits, respectively (p < .000). The 11% (43/392) claiming disability were 5.1 times more likely to have a positive RHS-15 (OR 4.3, 95% CI 2.1-8.8). A positive RHS-15 was not predictive of a disability claim (19% PPV), and those with a negative RHS-15 were unlikely to claim disability (96% NPV). The RHS-15 score correlates with visit utilization. A positive score is not predictive of a subsequent disability claim.

  11. NASA technology utilization applications. [transfer of medical sciences

    Science.gov (United States)

    1973-01-01

    The work is reported from September 1972 through August 1973 by the Technology Applications Group of the Science Communication Division (SCD), formerly the Biological Sciences Communication Project (BSCP) in the Department of Medical and Public Affairs of the George Washington University. The work was supportive of many aspects of the NASA Technology Utilization program but in particular those dealing with Biomedical and Technology Application Teams, Applications Engineering projects, new technology reporting and documentation and transfer activities. Of particular interest are detailed reports on the progress of various hardware projects, and suggestions and criteria for the evaluation of candidate hardware projects. Finally some observations about the future expansion of the TU program are offered.

  12. Deep Learning in Medical Imaging: General Overview

    Science.gov (United States)

    Lee, June-Goo; Jun, Sanghoon; Cho, Young-Won; Lee, Hyunna; Kim, Guk Bae

    2017-01-01

    The artificial neural network (ANN)–a machine learning technique inspired by the human neuronal synapse system–was introduced in the 1950s. However, the ANN was previously limited in its ability to solve actual problems, due to the vanishing gradient and overfitting problems with training of deep architecture, lack of computing power, and primarily the absence of sufficient data to train the computer system. Interest in this concept has lately resurfaced, due to the availability of big data, enhanced computing power with the current graphics processing units, and novel algorithms to train the deep neural network. Recent studies on this technology suggest its potentially to perform better than humans in some visual and auditory recognition tasks, which may portend its applications in medicine and healthcare, especially in medical imaging, in the foreseeable future. This review article offers perspectives on the history, development, and applications of deep learning technology, particularly regarding its applications in medical imaging. PMID:28670152

  13. Deep Learning in Medical Imaging: General Overview.

    Science.gov (United States)

    Lee, June-Goo; Jun, Sanghoon; Cho, Young-Won; Lee, Hyunna; Kim, Guk Bae; Seo, Joon Beom; Kim, Namkug

    2017-01-01

    The artificial neural network (ANN)-a machine learning technique inspired by the human neuronal synapse system-was introduced in the 1950s. However, the ANN was previously limited in its ability to solve actual problems, due to the vanishing gradient and overfitting problems with training of deep architecture, lack of computing power, and primarily the absence of sufficient data to train the computer system. Interest in this concept has lately resurfaced, due to the availability of big data, enhanced computing power with the current graphics processing units, and novel algorithms to train the deep neural network. Recent studies on this technology suggest its potentially to perform better than humans in some visual and auditory recognition tasks, which may portend its applications in medicine and healthcare, especially in medical imaging, in the foreseeable future. This review article offers perspectives on the history, development, and applications of deep learning technology, particularly regarding its applications in medical imaging.

  14. Deep learning in medical imaging: General overview

    Energy Technology Data Exchange (ETDEWEB)

    Lee, June Goo; Jun, Sang Hoon; Cho, Young Won; Lee, Hyun Na; KIm, Guk Bae; Seo, Joon Beom; Kim, Nam Kug [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2017-08-01

    The artificial neural network (ANN)–a machine learning technique inspired by the human neuronal synapse system–was introduced in the 1950s. However, the ANN was previously limited in its ability to solve actual problems, due to the vanishing gradient and overfitting problems with training of deep architecture, lack of computing power, and primarily the absence of sufficient data to train the computer system. Interest in this concept has lately resurfaced, due to the availability of big data, enhanced computing power with the current graphics processing units, and novel algorithms to train the deep neural network. Recent studies on this technology suggest its potentially to perform better than humans in some visual and auditory recognition tasks, which may portend its applications in medicine and health care, especially in medical imaging, in the foreseeable future. This review article offers perspectives on the history, development, and applications of deep learning technology, particularly regarding its applications in medical imaging.

  15. Statewide tracking of crash victims' medical system utilization and outcomes.

    Science.gov (United States)

    Mango, Nicholas; Garthe, Elizabeth

    2007-02-01

    For the study year, the state of Massachusetts had the lowest fatal motor vehicle crash rate in the nation. The state was interested in exploring new approaches to save additional lives. The study goal was to determine the potential for Massachusetts's medical system to reduce fatalities through alternative utilization of existing transport methods, treatment hospital types, and victim pathways. This was a 1-year retrospective statewide population-based study of all persons involved in a trafficway motor vehicle crash in which at least one person died within 30 days. Database linkage was used to track the pathway and outcome of every involved victim from the crash scene, including air medical and ground ambulance utilization, community or trauma center treatment, and interhospital transfers; air and trauma center (TC) scene triage levels were computed retrospectively. All crash and hospital locations were geomapped and confounding factors were included. Air and ground scene transports to TCs were underutilized by 7:1 and 4.5:1, respectively. No request was the major reason for air underutilization. Underutilization was associated with reduced lived-to-died ratio (L/D) by pathway of up to 10:1. Statewide, air transport to Level I trauma centers had both the highest (1.0, scene) and lowest L/Ds (0.6, interfacility). A 4.5:1 difference in L/D was associated with fulfilled versus unfulfilled air requests. By emergency medical service region, L/D varied by nearly 3:1 and utilization of scene air and TC transports by 5:1 and 4:1. Victim helicopter emergency medical services transport to a TC with an Injury Severity Score > or =19 was identified as critical and was associated with L/D differences of 3.7:1. The paradox of lower L/D for scene air transports to TCs occurring simultaneously with higher overall system L/D was observed and explained. System-based L/D differences of 1.8:1 were observed associated with increases in appropriate triage. Results that explain the

  16. Generalized anxiety and mixed anxiety-depression: association with disability and health care utilization.

    Science.gov (United States)

    Roy-Byrne, P P

    1996-01-01

    Generalized anxiety and mixed anxiety-depression have received less attention than the major mood and anxiety disorders ith respect to their possible effects in increasing disability and health care utilization. A review of recent studies, however, indicates that these conditions are prevalent in primary care medical settings and are associated with significant social and occupational disability. Generalized anxiety disorder is also one of the most common diagnoses seen in patients presenting with medically unexplained somatic complaints such as chest pain, irritable bowel symptoms, and hyperventilation and in patients prone to overutilize health care services in general. It is poorly recognized by primary care physicians, possibly due to its chronicity, which may limit the ability of symptoms to "stand out" and be easily detected. However, it is disproportionately present in "high utilizer" samples found to be particularly "frustrating" to their physicians and is accompanied by a high rate of personality disorders, suggesting that maladaptive personality traits and styles of interaction in such patients may also contribute to underrecognition of symptoms by primary care physicians. These preliminary associations between generalized anxiety disorder/mixed anxiety-depression and both disability and increased health care utilization need to be confirmed with carefully designed and controlled studies.

  17. General practitioners' experiences as nursing home medical consultants

    OpenAIRE

    Kirsebom, Marie; Hedström, Mariann; Pöder, Ulrika; Wadensten, Barbro

    2017-01-01

    OBJECTIVE: To describe general practitioners' experiences of being the principal physician responsible for a nursing home. METHOD: Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation. RESULT: Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-li...

  18. Biocompatible yogurt carbon dots: evaluation of utilization for medical applications

    Science.gov (United States)

    Dinç, Saliha; Kara, Meryem; Demirel Kars, Meltem; Aykül, Fatmanur; Çiçekci, Hacer; Akkuş, Mehmet

    2017-09-01

    In this study, carbon dots (CDs) were produced from yogurt, a fermented milk product, via microwave-assisted process (800 W) in 30 min without using any additional chemical agents. Yogurt CDs had outstanding nitrogen and oxygen ratios. These dots were monodisperse and about 2 nm sized. The toxicological assessments of yogurt carbon dots in human cancer cells and normal epithelial cells and their fluorescence imaging in living cell system were carried out. Yogurt carbon dots had intense fluorescent signal under confocal microscopy and good fluorescence stability in living cell system. The resulting yogurt carbon dots exhibited high biocompatibility up to 7.1 mg/mL CD concentration which may find utilization in medical applications such as cellular tracking, imaging and drug delivery. Yogurt carbon dots have potential to be good diagnostic agents to visualize cancer cells which may be developed as a therapeutic carrier.

  19. Utility of a grief services program for medical examiners' offices.

    Science.gov (United States)

    Berry, Ryan S; Aurelius, Michelle B; Barickman, Nancy; Lathrop, Sarah L

    2013-03-01

    Medical examiner/coroner's (ME/C) offices investigate sudden, violent, and unexpected deaths, leaving those close to the deceased suffering traumatic loss with little in terms of support and counseling. We investigated a grief services program (GSP) at the New Mexico Office of the Medical Investigator (OMI) to better understand the needs of bereaved individuals, identify the services provided, and propose our findings as a model for others. A total of 1085 contacts occurred over 1 year, with the majority occurring at OMI (60.5%), followed by telephone (23.1%). Support was primarily provided to those suffering a loss due to homicide (28.8%) and suicide (26.1%). The roles grief counselors play in the setting of a GSP and ME/C office are multiple. Given the frequent utilization of OMI's GSP and diverse reasons for visits, it is apparent there is a need for GSPs at ME/C offices, particularly given the traumatic nature of deaths investigated by ME/Cs. © 2012 American Academy of Forensic Sciences.

  20. Perception of stroke symptoms and utilization of emergency medical services

    Directory of Open Access Journals (Sweden)

    Maximiliano A. Hawkes

    Full Text Available ABSTRACT Lack of stroke awareness and slow activation of emergency medical services (EMS are frequently reported reasons for delayed arrival to the hospital. We evaluated these variables in our population. Methods Review of hospital records and structured telephone interviews of 100 consecutive stroke patients. Forward stepwise logistic regression was used for the statistical analysis. Results Seventy patients (75% arrived at the hospital 4.5 hours after stroke symptoms onset. The use of EMS did not improve arrival times. Most patients who recognized their symptoms did not use EMS (p < 0.02. Nineteen patients (20% were initially misdiagnosed. Eighteen of them were first assessed by non-neurologist physicians (p < 0.001. Conclusions Our population showed a low level of stroke awareness. The use of EMS did not improve arrival times at the hospital and the non-utilization of the EMS was associated with the recognition of stroke symptoms. There was a concerning rate of misdiagnosis, mostly by non-neurologist medical providers.

  1. Chronicity of Voice-Related Health Care Utilization in the General Medicine Community.

    Science.gov (United States)

    Cohen, Seth M; Lee, Hui-Jie; Roy, Nelson; Misono, Stephanie

    2017-04-01

    Objectives To examine voice-related health care utilization of patients in the general medical community without otolaryngology evaluation and explore factors associated with prolonged voice-related health care. Study Design Retrospective cohort analysis. Setting Large, national administrative US claims database. Subjects and Methods Patients with voice disorders per International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD-9-CM) codes from January 1, 2010, to December 31, 2012, seen by a general medical physician, and who did not see an otolaryngologist in the subsequent year were included. Voice-related health care utilization, patient demographics, comorbid conditions, and index laryngeal diagnosis were collected. Logistic regression with variable selection was performed to evaluate the association between predictors and ≥30 days of voice-related health care use. Results In total, 46,205 unique voice-disordered patients met inclusion criteria. Of these patients, 8.5%, 10.0%, and 12.5% had voice-related health care use of ≥90, ≥60, and ≥30 days, respectively. Of the ≥30-day subset, 80.3% and 68.5%, respectively, had ≥60 and ≥90 days of voice-related health care utilization. The ≥30-day subset had more general medicine and nonotolaryngology specialty physician visits, more prescriptions and procedures, and 4 times the voice-related health care costs compared with those in the <30-day subset. Age, sex, employment status, initial voice disorder diagnosis, and comorbid conditions were related to ≥30 days of voice-related health care utilization. Conclusions Thirty days of nonotolaryngology-based care for a voice disorder may represent a threshold beyond which patients are more likely to experience prolonged voice-related health care utilization. Specific factors were associated with extended voice-related health care.

  2. Utilizing Electronic Medical Records to Discover Changing Trends of Medical Behaviors Over Time*

    Science.gov (United States)

    Yin, Liangying; Dong, Wei; He, Chunhua; Duan, Huilong

    2017-01-01

    Summary Objectives Medical behaviors are playing significant roles in the delivery of high quality and cost-effective health services. Timely discovery of changing frequencies of medical behaviors is beneficial for the improvement of health services. The main objective of this work is to discover the changing trends of medical behaviors over time. Methods This study proposes a two-steps approach to detect essential changing patterns of medical behaviors from Electronic Medical Records (EMRs). In detail, a probabilistic topic model, i.e., Latent Dirichlet allocation (LDA), is firstly applied to disclose yearly treatment patterns in regard to the risk stratification of patients from a large volume of EMRs. After that, the changing trends by comparing essential/critical medical behaviors in a specific time period are detected and analyzed, including changes of significant patient features with their values, and changes of critical treatment interventions with their occurring time stamps. Results We verify the effectiveness of the proposed approach on a clinical dataset containing 12,152 patient cases with a time range of 10 years. Totally, 135 patients features and 234 treatment interventions in three treatment patterns were selected to detect their changing trends. In particular, evolving trends of yearly occurring probabilities of the selected medical behaviors were categorized into six content changing patterns (i.e, 112 growing, 123 declining, 43 up-down, 16 down-up, 35 steady, and 40 jumping), using the proposed approach. Besides, changing trends of execution time of treatment interventions were classified into three occurring time changing patterns (i.e., 175 early-implemented, 50 steady-implemented and 9 delay-implemented). Conclusions Experimental results show that our approach has an ability to utilize EMRs to discover essential evolving trends of medical behaviors, and thus provide significant potential to be further explored for health services redesign and

  3. Utility of oral fluid in compliance monitoring of opioid medications.

    Science.gov (United States)

    Conermann, Till; Gosalia, Ankur R; Kabazie, Abraham Jack; Moore, Christina; Miller, Kathy; Fetsch, Madalene; Irvan, Dwain

    2014-01-01

    Prescription drug abuse is the fastest growing drug problem in the United States, and the increase in unintentional drug overdose deaths has been driven by the increase in opioid analgesic use. Given the epidemic of non-medical prescription pain reliever use and the current medico-legal climate, it is increasingly important for the prescriber to monitor for medication compliance. The purpose of this IRB approved study is to compare the results of oral fluid (OF) and routine urinalysis for monitoring compliance in a single academic pain management program in an urban setting in order to evaluate the utility of OF analysis in compliance monitoring when prescribing opioid medications. Outcomes analysis of prospective, consecutive, paired comparison study with clinical implications. Single academic interventional pain management center in the United States. Paired OF and urine specimens were collected for each patient with signed informed consent, at the Institute for Pain Medicine, Western Pennsylvania Hospital, from patients who routinely donated urine on a random basis for compliance testing. A total of 153 paired specimens were analyzed. Demographic and prescription data were made available. Specimens were screened using immunoassay and presumptive positive findings were confirmed with liquid-chromatography and mass spectrometry. Although both matrices were tested for a wider range of medications, the data presented here are representative of analgesic opioids and benzodiazepine drug classes only. Following exclusion criteria, of the 132 remaining specimen pairs that were positive for opioids or benzodiazepines in at least one matrix, 101 pairs showed exact drug class matches (76.5%). In an additional 21 pairs, at least one drug class was positive in both matrices (15.9%), giving an overall agreement of 92.4%. Overall, 191 positive results were found in urine averaging 1.4 drugs per specimen; 176 positives were detected using OF for an average of 1.3 drugs per

  4. Variation in spirometry utilization between trained general practitioners in practices equipped with a spirometer.

    NARCIS (Netherlands)

    Poels, P.J.E.; Schermer, T.R.J.; Jacobs, A.; Akkermans, R.P.; Hartman, J.; Bottema, B.J.A.M.; Weel, C. van

    2006-01-01

    OBJECTIVE: To explore spirometry utilization among general practitioners and identify practitioner and practice-related factors associated with spirometry utilization. DESIGN: Multivariate multilevel cross-sectional analysis of a questionnaire survey. SETTING: Some 61 general practices involved in a

  5. General practitioners' experiences as nursing home medical consultants.

    Science.gov (United States)

    Kirsebom, Marie; Hedström, Mariann; Pöder, Ulrika; Wadensten, Barbro

    2017-03-01

    To describe general practitioners' experiences of being the principal physician responsible for a nursing home. Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation. Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-life care. Registered Nurses' continuity and competence are perceived as crucial to the quality of care, but inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety. The study highlights the importance of advance care planning together with residents and family members in facilitating future decisions on medical treatment and end-of-life care. To meet the increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care, there would seem to be a need to increase Registered Nurses' staffing and acquire more advanced medical equipment, as well as to create better possibilities for Registered Nurses and general practitioners to access each other's healthcare record systems. © 2016 Nordic College of Caring Science.

  6. Comorbidity in patients with diabetes mellitus: impact on medical health care utilization

    Directory of Open Access Journals (Sweden)

    Westert Gert P

    2006-07-01

    Full Text Available Abstract Background Comorbidity has been shown to intensify health care utilization and to increase medical care costs for patients with diabetes. However, most studies have been focused on one health care service, mainly hospital care, or limited their analyses to one additional comorbid disease, or the data were based on self-reported questionnaires instead of health care registration data. The purpose of this study is to estimate the effects a broad spectrum of of comorbidities on the type and volume of medical health care utilization of patients with diabetes. Methods By linking general practice and hospital based registrations in the Netherlands, data on comorbidity and health care utilization of patients with diabetes (n = 7,499 were obtained. Comorbidity was defined as diabetes-related comorbiiabetes-related comorbidity. Multilevel regression analyses were applied to estimate the effects of comorbidity on health care utilization. Results Our results show that both diabetes-related and non diabetes-related comorbidity increase the use of medical care substantially in patients with diabetes. Having both diabeterelated and non diabetes-related comorbidity incrases the demand for health care even more. Differences in health care utilization patterns were observed between the comorbidities. Conclusion Non diabetes-related comorbidity increases the health care demand as much as diabetes-related comorbidity. Current single-disease approach of integrated diabetes care should be extended with additional care modules, which must be generic and include multiple diseases in order to meet the complex health care demands of patients with diabetes in the future.

  7. Comorbidity in patients with diabetes mellitus: impact on medical health care utilization

    Science.gov (United States)

    Struijs, Jeroen N; Baan, Caroline A; Schellevis, Francois G; Westert, Gert P; van den Bos, Geertrudis AM

    2006-01-01

    Background Comorbidity has been shown to intensify health care utilization and to increase medical care costs for patients with diabetes. However, most studies have been focused on one health care service, mainly hospital care, or limited their analyses to one additional comorbid disease, or the data were based on self-reported questionnaires instead of health care registration data. The purpose of this study is to estimate the effects a broad spectrum of of comorbidities on the type and volume of medical health care utilization of patients with diabetes. Methods By linking general practice and hospital based registrations in the Netherlands, data on comorbidity and health care utilization of patients with diabetes (n = 7,499) were obtained. Comorbidity was defined as diabetes-related comorbiiabetes-related comorbidity. Multilevel regression analyses were applied to estimate the effects of comorbidity on health care utilization. Results Our results show that both diabetes-related and non diabetes-related comorbidity increase the use of medical care substantially in patients with diabetes. Having both diabeterelated and non diabetes-related comorbidity incrases the demand for health care even more. Differences in health care utilization patterns were observed between the comorbidities. Conclusion Non diabetes-related comorbidity increases the health care demand as much as diabetes-related comorbidity. Current single-disease approach of integrated diabetes care should be extended with additional care modules, which must be generic and include multiple diseases in order to meet the complex health care demands of patients with diabetes in the future. PMID:16820048

  8. Nanomedicine concepts in the general medical curriculum: initiating a discussion.

    Science.gov (United States)

    Sweeney, Aldrin E

    2015-01-01

    Various applications of nanoscale science to the field of medicine have resulted in the ongoing development of the subfield of nanomedicine. Within the past several years, there has been a concurrent proliferation of academic journals, textbooks, and other professional literature addressing fundamental basic science research and seminal clinical developments in nanomedicine. Additionally, there is now broad consensus among medical researchers and practitioners that along with personalized medicine and regenerative medicine, nanomedicine is likely to revolutionize our definitions of what constitutes human disease and its treatment. In light of these developments, incorporation of key nanomedicine concepts into the general medical curriculum ought to be considered. Here, I offer for consideration five key nanomedicine concepts, along with suggestions regarding the manner in which they might be incorporated effectively into the general medical curriculum. Related curricular issues and implications for medical education also are presented.

  9. Teaching Medical Gerontology: Utilization of a Psychiatry Consultation Program.

    Science.gov (United States)

    Hall, Georgia G.; Starkman, Monica N.

    1979-01-01

    A pilot project to explore the feasibility of using the clinical Adult Service Psychiatry Consultation-Liaison Program at the University of Michigan as the locus for teaching medical gerontology to psychiatric and medical/surgical residents and medical students is described. The goals, techniques, content, and implementation procedures are…

  10. Distress syndromes, illness behavior, access to care and medical utilization in a defined population.

    Science.gov (United States)

    Mechanic, D; Cleary, P D; Greenley, J R

    1982-04-01

    This article examines the use of general medical services in a representative sample from a defined geographic area and in a sample of persons seeking psychiatric care from the same area. Psychiatric patients made 100 per cent more general medical care visits in the retrospective period and 83 per cent more in the prospective period than persons who did not seek mental health care. The analysis focuses on the determinants in general medical care use between those who sought mental health care and those who did not. The first hypothesis is that physical symptoms and dysfunction concomitant with psychologic disorder explain the difference. The second argues that the association is a product of help-seeking orientations and illness behavior. The third focuses on variations due to differences in access. The first two types of factors are the most important. Using sex, physical symptoms and illness behavior measures, we explain 50 per cent of the differences in retrospective utilization and 40 per cent of the differences in prospective data.

  11. Perception of medical students for utility of mobile technology use in medical education

    Directory of Open Access Journals (Sweden)

    Sushama Subhash Thakre

    2015-01-01

    Full Text Available Introduction: Mobile technology is changing the way we live, and it is beginning to change the way we learn. Current literature reviews have shown that research on mobile technology in medical education primarily focused on efficacy, of mobile devices as an educational tool and resource, infrastructure to support m-learning, benefits, challenges, and appropriate use. Objectives: To assess the perception of medical student for the utility of mobile technology in their learning experience and to find out different barriers in the application of mobile phone in medical education. Materials and Methods: The study was designed as a descriptive study to assess emerging patterns of mobile technology use by medical students across the academic year 2013-2014. Interview and focus group discussion was a method of data collection. Results: Mean age ± standard deviation of the current mobile was 3.45 ± 1.45 years. Mobile users were 302 (96.79% and Smartphone users were 261 (83.61%. In the present study, 176 (56.41% used for the academic purpose and 65 (20.83% of the students preferred the same for an entertainment purpose. Gender-wise significant difference was observed in regards to Smartphone availability and daily Internet use for education purpose by female was more than male. Conclusion: The lessons learned from this study are-majority of the students use Smartphone mainly for communication, learning, and entertainment purpose. With increasing use of portable devices by students, it is logical to expect the next step to incorporate these devices in the learning environment and should, therefore, be appropriately considered for curriculum.

  12. Persistent presentation of medically unexplained symptoms in general practice.

    NARCIS (Netherlands)

    Verhaak, P.F.M.; Meijer, S.A.; Visser, A.P.; Wolters, G.

    2006-01-01

    OBJECTIVES: To estimate the prevalence of persistent presentation of medically unexplained physical symptoms (MUPS) in general practice. To assess socio-demographic characteristics, health status and use of health services of patients who frequently present MUPS, compared with reference groups. DESI

  13. Medical Information Management System (MIMS): A Generalized Interactive Information System.

    Science.gov (United States)

    Alterescu,Sidney; And Others

    This report describes an interactive information system. It is a general purpose, free format system which can offer immediate assistance where manipulation of large data bases is required. The medical area is a prime area of application. The report is designed to serve as a manual for potential users--nontechnical personnel who will use the…

  14. Medical Information Management System (MIMS): A generalized interactive information system

    Science.gov (United States)

    Alterescu, S.; Friedman, C. A.; Hipkins, K. R.

    1975-01-01

    An interactive information system is described. It is a general purpose, free format system which offers immediate assistance where manipulation of large data bases is required. The medical area is a prime area of application. Examples of the system's operation, commentary on the examples, and a complete listing of the system program are included.

  15. 76 FR 30370 - National Institute of General Medical Sciences; Meeting

    Science.gov (United States)

    2011-05-25

    ... General Medical Sciences Initial Review Group; Biomedical Research and Research Training Review Subcommittee A. Date: June 28, 2011. Time: 8 a.m. to 5 p.m. Agenda: To review and evaluate grant applications... disclose confidential trade secrets or commercial property such as patentable material, and personal...

  16. Nanomedicine concepts in the general medical curriculum: initiating a discussion

    Directory of Open Access Journals (Sweden)

    Sweeney AE

    2015-12-01

    Full Text Available Aldrin E Sweeney Center for Teaching & Learning, Ross University School of Medicine, Roseau, Commonwealth of Dominica Abstract: Various applications of nanoscale science to the field of medicine have resulted in the ongoing development of the subfield of nanomedicine. Within the past several years, there has been a concurrent proliferation of academic journals, textbooks, and other professional literature addressing fundamental basic science research and seminal clinical developments in nanomedicine. Additionally, there is now broad consensus among medical researchers and practitioners that along with personalized medicine and regenerative medicine, nanomedicine is likely to revolutionize our definitions of what constitutes human disease and its treatment. In light of these developments, incorporation of key nanomedicine concepts into the general medical curriculum ought to be considered. Here, I offer for consideration five key nanomedicine concepts, along with suggestions regarding the manner in which they might be incorporated effectively into the general medical curriculum. Related curricular issues and implications for medical education also are presented. Keywords: medical education, basic science, teaching, learning, assessment, nanoscience curriculum, nanomedicine concepts

  17. General principles of medical interconsultation for hospitalised patients.

    Science.gov (United States)

    Monte-Secades, R; Montero-Ruiz, E; Gil-Díaz, A; Castiella-Herrero, J

    2016-01-01

    Medical interconsultation for hospitalised patients is a regular activity among internal medicine specialists. However, despite its growing impact and importance, a model that defines its characteristics, objectives and information has not been established. This study, conducted by the Shared Care and Interconsultations Group of the Spanish Society of Internal Medicine, proposes a number of general recommendations concerning the method for requesting and responding to hospital medical interconsultations, as well as a format for these interconsultations. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  18. Social network utilization (Facebook) & e-Professionalism among medical students

    OpenAIRE

    Jawaid, Masood; Khan, Muhammad Hassaan; Bhutto, Shahzadi Nisar

    2015-01-01

    Objective: To find out the frequency and contents of online social networking (Facebook) among medical students of Dow University of Health Sciences. Methods: The sample of the study comprised of final year students of two medical colleges of Dow University of Health Sciences – Karachi. Systematic search for the face book profiles of the students was carried out with a new Facebook account. In the initial phase of search, it was determined whether each student had a Facebook account and the s...

  19. Impact of teaching intensity and academic status on medical resource utilization by teaching hospitals in Japan.

    Science.gov (United States)

    Sato, Daisuke; Fushimi, Kiyohide

    2012-11-01

    Teaching hospitals require excess medical resources to maintain high-quality care and medical education. To evaluate the appropriateness of such surplus costs, we examined the impact of teaching intensity defined as activities for postgraduate training, and academic status as functions of medical research and undergraduate teaching on medical resource utilization. Administrative data for 47,397 discharges from 40 academic and 12 non-academic teaching hospitals in Japan were collected. Hospitals were classified into three groups according to intern/resident-to-bed (IRB) ratio. Resource utilization of medical services was estimated using fee-for-service charge schedules and normalized with case mix grouping. 15-24% more resource utilization for laboratory examinations, radiological imaging, and medications were observed in hospitals with higher IRB ratios. With multivariate adjustment for case mix and academic status, higher IRB ratios were associated with 10-15% more use of radiological imaging, injections, and medications; up to 5% shorter hospital stays; and not with total resource utilization. Conversely, academic status was associated with 21-33% more laboratory examinations, radiological imaging, and medications; 13% longer hospital stays; and 10% more total resource utilization. While differences in medical resource utilization by teaching intensity may not be associated with indirect educational costs, those by academic status may be. Therefore, academic hospitals may need efficiency improvement and financial compensation.

  20. General aviation design synthesis utilizing interactive computer graphics

    Science.gov (United States)

    Galloway, T. L.; Smith, M. R.

    1976-01-01

    Interactive computer graphics is a fast growing area of computer application, due to such factors as substantial cost reductions in hardware, general availability of software, and expanded data communication networks. In addition to allowing faster and more meaningful input/output, computer graphics permits the use of data in graphic form to carry out parametric studies for configuration selection and for assessing the impact of advanced technologies on general aviation designs. The incorporation of interactive computer graphics into a NASA developed general aviation synthesis program is described, and the potential uses of the synthesis program in preliminary design are demonstrated.

  1. [The General Military Medical Department during the Great Patriotic War].

    Science.gov (United States)

    Kryuchkov, O A; Kulnev, S V; Taranov, S P

    2015-08-01

    The article is devoted to the contribution of the General Military Medical Department of the Red Army (GMMD) to organisation of health care support during the Great Patriotic War of 1941-1945. In the summary you may follow the main ways of activity of the central governing body of medical (health) services of the Red. Army. The main focus of the article is made on conditions under which GMMD had to organize medical support of the Red. Army at the beginning of the war, the most difficult period of the Great Patriotic War. The authors payed attention to the forms and methods of the work of the head of GMMD and its subordinate departments under the conditions of rapidly changing environment of combat and rear situation, as well as interaction with GMMD People Commissariat of Health. The authors tried to highlight not well known but not less important moments in the activities of the Red Army GMMD.

  2. [Drug utilization in renal transplant patients: medication practices and representations].

    Science.gov (United States)

    de Arruda, Guilherme Oliveira; Renovato, Rogério Dias

    2012-12-01

    Qualitative research approach, descriptive and exploratory with objective of to know the practices and representations of medication on the use of drugs by people transplanted kidney. 18 people participated in the Dourados (MS), through semistructured interview. The theoretical contributions of medication practices were Peter Conrad and representation of Stuart Hall. The definition of the categories of theoretical analysis was Michel Foucault. Respondents had a mean age of 53.5 years, 13 males and 5 females, with median time to transplant eight years. The medications predominantly used were immunosuppresssive. We developed three categories of analysis: the drug as part of everyday life, the central role of the drug and correlation with rejection, and medicine and the autonomy of the transplanted kidney. The drugs are part of everyday life and the representations of autonomy and quality enhance your daily use.

  3. Learning styles of medical students, general surgery residents, and general surgeons: implications for surgical education

    Science.gov (United States)

    2010-01-01

    Background Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn. Methods The Kolb Learning Style Inventory, which divides individual learning styles into Accommodating, Diverging, Converging, and Assimilating categories, was administered to the second year undergraduate medical students, general surgery resident body, and general surgery faculty at the University of Alberta. Results A total of 241 faculty, residents, and students were surveyed with an overall response rate of 73%. The predominant learning style of the medical students was assimilating and this was statistically significant (p < 0.03) from the converging learning style found in the residents and faculty. The predominant learning styles of the residents and faculty were convergent and accommodative, with no statistically significant differences between the residents and the faculty. Conclusions We conclude that medical students have a significantly different learning style from general surgical trainees and general surgeons. This has important implications in the education of general surgery residents. PMID:20591159

  4. Learning styles of medical students, general surgery residents, and general surgeons: implications for surgical education.

    Science.gov (United States)

    Engels, Paul T; de Gara, Chris

    2010-06-30

    Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn. The Kolb Learning Style Inventory, which divides individual learning styles into Accommodating, Diverging, Converging, and Assimilating categories, was administered to the second year undergraduate medical students, general surgery resident body, and general surgery faculty at the University of Alberta. A total of 241 faculty, residents, and students were surveyed with an overall response rate of 73%. The predominant learning style of the medical students was assimilating and this was statistically significant (p learning style found in the residents and faculty. The predominant learning styles of the residents and faculty were convergent and accommodative, with no statistically significant differences between the residents and the faculty. We conclude that medical students have a significantly different learning style from general surgical trainees and general surgeons. This has important implications in the education of general surgery residents.

  5. Possibilities of utilizing blended-learning in the area of language education of medical staff

    Directory of Open Access Journals (Sweden)

    Radka Šulistová

    2014-11-01

    Full Text Available This contribution deals with the presentation of teaching materials created within the IMED-KOMM-EU "Intercultural medical communication inEurope" internet project, having taken place under the leadership of the Institute for Intercultural Communication inGermany(Ansbach,Berlin,Jena,Erfurt. Project target was creating, testing, valorisation and permanent extending of the mentioned teaching materials, testing and certification technologies (ECL for intercultural professional communication of foreign physicians and other medical staff. The target groups involving the already practising professionals, as well as students, should be able to utilize the existing possibilities of communication withinEuropeand to perform their professional activity or studies in the languages, in which the materials are elaborated. As a result, five complete courses of blended-learning were created, which are generally easily accessible at mutually connected web sites in Czech, Slovak, German, Bulgarian and Hungarian. Their core are modules orientated on practice with complex exercises online and offline focused on the medical communication, including the manuals for teachers.

  6. Comparative study on medical utilization and costs of chronic obstructive pulmonary disease with good lung function

    Directory of Open Access Journals (Sweden)

    Lim JU

    2017-09-01

    Full Text Available Jeong Uk Lim,1 Kyungjoo Kim,2 Sang Hyun Kim,3 Myung Goo Lee,4 Sang Yeub Lee,5 Kwang Ha Yoo,6 Sang Haak Lee,1 Ki-Suck Jung,7 Chin Kook Rhee,2 Yong Il Hwang7 1Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, St Paul’s Hospital, 2Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 3Big Data Division, Health Insurance Review and Assessment Service, Wonju, 4Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, 5Department of Internal Medicine, Korea University, Anam Hospital, 6Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, 7Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Republic of Korea Introduction: Patients with mild to moderate chronic obstructive pulmonary disease (COPD are underdiagnosed and undertreated due to the asymptomatic nature of the disease. Previous studies on patients with mild COPD have focused on symptomatic patients. Therefore, in this study, we evaluated the treatment status of patients with early COPD in Korea.Materials and methods: We compared hospital visits, medical costs per person, and COPD medication use by patients with COPD screened from the general population and COPD cohort patients. Patients with COPD aged ≥40 years with the value of forced expiratory volume in 1 s (FEV1 ≥60% were selected from the 2007 to 2012 Korea National Health and Nutrition Examination Survey (KNHANES data. Data including the number of outpatient clinic visits, admission to hospitals, COPD-related medications, and medical

  7. General Equilibrium without Utility Functions: How far to go?

    DEFF Research Database (Denmark)

    Balasko, Yves; Tvede, Mich

    How far can we go in weakening the assumptions of the general equilibrium model? Existence of equilibrium, structural stability and finiteness of equilibria of regular economies, genericity of regular economies and an index formula for the equilibria of regular economies have been known not to re......How far can we go in weakening the assumptions of the general equilibrium model? Existence of equilibrium, structural stability and finiteness of equilibria of regular economies, genericity of regular economies and an index formula for the equilibria of regular economies have been known...... and the diffeomorphism of the equilibrium manifold with a Euclidean space; 2) the diffeomorphism of the set of no-trade equilibria with a Euclidean space; 3) the openness and genericity of the set of regular equilibria as a subset of the equilibrium manifold; 4) for small trade vectors, the uniqueness, regularity...

  8. Utilization of a Marketing Strategy at Naval Regional Medical Center Great Lakes, Great Lakes, Illinois

    Science.gov (United States)

    1983-06-01

    UTILIZATION OF A MARKETING STRATEGY AToNAVAL REGIONAL MEDICAL CENTER GREAT LAKES NGREAT LAKES, ILLINOIS I DTIC S1 ELECTE I A Graduate Research...IWORK UNIT ELEMENT NO. NO. NO. rCCESSION NO. 11. TITLE (bw* u S.wufty asification) Utilization of A Marketing Strategy At Naval Regional Medical Center...Applied Research Question. ........ 37 Summary of the Steps of a Marketing Strategy .. ..... 38 Applicability to the Military Health Care System

  9. Utilization of smoking cessation medication benefits among medicaid fee-for-service enrollees 1999–2008

    Science.gov (United States)

    Kahende, Jennifer; England, Lucinda; Zhang, Lei; Mowery, Paul; Xu, Xin; Sevilimedu, Varadan; Rolle, Italia

    2017-01-01

    Objective To assess state coverage and utilization of Medicaid smoking cessation medication benefits among fee-for-service enrollees who smoked cigarettes. Methods We used the linked National Health Interview Survey (survey years 1995, 1997–2005) and the Medicaid Analytic eXtract files (1999–2008) to assess utilization of smoking cessation medication benefits among 5,982 cigarette smokers aged 18–64 years enrolled in Medicaid fee-for-service whose state Medicaid insurance covered at least one cessation medication. We excluded visits during pregnancy, and those covered by managed care or under dual enrollment (Medicaid and Medicare). Multivariate logistic regression was used to determine correlates of cessation medication benefit utilization among Medicaid fee-for-service enrollees, including measures of drug coverage (comprehensive cessation medication coverage, number of medications in state benefit, varenicline coverage), individual-level demographics at NHIS interview, age at Medicaid enrollment, and state-level cigarette excise taxes, statewide smoke-free laws, and per-capita tobacco control funding. Results In 1999, the percent of smokers with ≥1 medication claims was 5.7% in the 30 states that covered at least one Food and Drug Administration (FDA)-approved cessation medication; this increased to 9.9% in 2008 in the 44 states that covered at least one FDA-approved medication (p<0.01). Cessation medication utilization was greater among older individuals (≥ 25 years), females, non-Hispanic whites, and those with higher educational attainment. Comprehensive coverage, the number of smoking cessation medications covered and varenicline coverage were all positively associated with utilization; cigarette excise tax and per-capita tobacco control funding were also positively associated with utilization. Conclusions Utilization of medication benefits among fee-for-service Medicaid enrollees increased from 1999–2008 and varied by individual and state

  10. Generalized Ellingham diagrams for utilization in solid oxide fuel cells

    Directory of Open Access Journals (Sweden)

    Kishimoto H.

    2008-01-01

    Full Text Available Generalized Ellingham diagram for the P-O-H and the Ni-P-OH systems have been constructed to investigate thermodynamically the chemical stability of nickel anode against the gaseous impurities containing phosphorous compounds. In the same way as the original Ellingham diagram, the oxygen potential is used as the vertical axis, while the temperature is adopted as horizontal axis. For the P-O-H system which contains many gaseous species, the dominant areas of gaseous species are displayed with a parameter of their partial pressure in an analogous way to the aqueous species in the Pourbaix diagram. The multicomponent Ellingham diagram for the Ni-P-O-H system was constructed in a similar manner to the multicomponent Pourbaix diagram. The obtained diagrams have been discussed to examine the reactivity of nickel anodes with phosphorus compounds in SOFCs in terms of operational variables such as temperature, oxygen potential, overpotential under the anode polarization and so on.

  11. Forensic evaluation of medical liability cases in general surgery.

    Science.gov (United States)

    Moreira, H; Magalhães, T; Dinis-Oliveira, Rj; Taveira-Gomes, A

    2014-10-01

    Although medical liability (disciplinary, civil and criminal) is increasingly becoming an issue, few studies exist, particularly from the perspective of forensic science, which demonstrate the extent to which medical malpractice occurs, or when it does, the reasons for it. Our aims were to evaluate the current situation concerning medical liability in general surgery (GS) in Portugal, the reasons for claims, and the forensic evaluations and conclusions, as well as the association between these issues and the judicial outcomes. We analysed the Medico-Legal Council (CML) reports of the National Institute of Legal Medicine and Forensic Sciences of Portugal related to GS during 2001-2010. The judicial outcomes of each case were requested from the Public Prosecutor Office (PPO) and the court. Alleged cases of medical liability in GS represented 11.2% of the total cases analysed by the CML. We estimated that in Portugal, 4:100,000 surgeries are subject to litigation. The majority of complaints were due to the patient's death (75.4%), with laparoscopic cholecystectomy surgeries representing 55.2% of cases. In 76.1% of the cases, the CML believed that there was no violation of legesartis and in 55.2% of cases, no causal nexus was found between the medical practice and the alleged harm. The PPO prosecuted physicians in 6.4% of the cases and resulted in one conviction. Finally, the importance of the CML reports as a relevant technical-scientific tool for judicial decision was evident because these reports significantly (p < 0.05) influenced the prosecutor's decision, whether to prosecute or not.

  12. [Application of medical imaging to general thoracic surgery].

    Science.gov (United States)

    Oizumi, Hiroyuki

    2014-07-01

    Medical imaging technology is rapidly progressing. Positron emission tomography (PET) has played major role in the staging and choice of treatment modality in lung cancer patients. Magnetic resonance imaging (MRI) is now routinely used for mediastinal tumors and the use of diffusion-weighted images (DWI) may help in the diagnosis of malignancies including lung cancers. The benefits of medical imaging technology are not limited to diagnostics, and include simulation or navigation for complex lung resection and other procedures. Multidetector row computed tomography (MDCT) shortens imaging time to obtain detailed and precise volume data, which improves diagnosis of small-sized lung cancers. 3-dimensional reconstruction of the volume data allows the safe performance of thoracoscopic surgery. For lung lobectomy, identification of the branching structures, diameter, and length of the arteries is useful in selecting the procedure for blood vessel treatment. For lung segmentectomy, visualization of venous branches in the affected segments and intersegmental veins has facilitated the preoperative determination of the anatomical intersegmental plane. Therefore, the application of medical imaging technology is useful in general thoracic surgery.

  13. Discharge against medical advice at a general hospital in Catalonia.

    Science.gov (United States)

    Duñó, Rosó; Pousa, Esther; Sans, Jordi; Tolosa, Carles; Ruiz, Ada

    2003-01-01

    Some studies on discharge against medical advice (AMA) in general hospitals report a prevalence between 0.7-7% with 11-42% of this population identified as psychiatric patients. To study the sociodemographic and psychopathological features of patients who leave AMA, we performed a retrospective case-control comparison study of length of hospitalization and presence of psychiatric disturbances on patients who left AMA from the University General Hospital in Catalan Spain over a two-year period. An analysis of the hospital epidemiological discharge register and retrospective chart review for presence of psychiatric disturbances found that AMA prevalence was 0.34%, the total discharge number in the 2-year period being 41,648. AMA rates by medical department were 0.44% for the internal medicine department; 0.24% for surgery; 0.26% for orthopedic surgery, 0.32% for obstetrics-gynecology and 0.93% for rehabilitation. The mean age for AMA patients was 38.63 years, with a higher number of men (59.9%). A total of 45.8% AMA discharges were from the internal medicine department. No significant differences were found in the average length of hospitalization between the AMA and control groups. The presence of psychiatric pathology was significantly higher among the AMA group (Phistory of psychiatric pathology, mainly narcotic dependence.

  14. Utilization of smoking cessation medication benefits among medicaid fee-for-service enrollees 1999-2008.

    Science.gov (United States)

    Kahende, Jennifer; Malarcher, Ann; England, Lucinda; Zhang, Lei; Mowery, Paul; Xu, Xin; Sevilimedu, Varadan; Rolle, Italia

    2017-01-01

    To assess state coverage and utilization of Medicaid smoking cessation medication benefits among fee-for-service enrollees who smoked cigarettes. We used the linked National Health Interview Survey (survey years 1995, 1997-2005) and the Medicaid Analytic eXtract files (1999-2008) to assess utilization of smoking cessation medication benefits among 5,982 cigarette smokers aged 18-64 years enrolled in Medicaid fee-for-service whose state Medicaid insurance covered at least one cessation medication. We excluded visits during pregnancy, and those covered by managed care or under dual enrollment (Medicaid and Medicare). Multivariate logistic regression was used to determine correlates of cessation medication benefit utilization among Medicaid fee-for-service enrollees, including measures of drug coverage (comprehensive cessation medication coverage, number of medications in state benefit, varenicline coverage), individual-level demographics at NHIS interview, age at Medicaid enrollment, and state-level cigarette excise taxes, statewide smoke-free laws, and per-capita tobacco control funding. In 1999, the percent of smokers with ≥1 medication claims was 5.7% in the 30 states that covered at least one Food and Drug Administration (FDA)-approved cessation medication; this increased to 9.9% in 2008 in the 44 states that covered at least one FDA-approved medication (putilization was greater among older individuals (≥ 25 years), females, non-Hispanic whites, and those with higher educational attainment. Comprehensive coverage, the number of smoking cessation medications covered and varenicline coverage were all positively associated with utilization; cigarette excise tax and per-capita tobacco control funding were also positively associated with utilization. Utilization of medication benefits among fee-for-service Medicaid enrollees increased from 1999-2008 and varied by individual and state-level characteristics. Given that the Affordable Care Act bars state Medicaid

  15. PERCEIVED UTILITY OF JOURNAL CLUB BY RESIDENTS OF A PRIVATE MEDICAL COLLEGE OF CENTRAL INDIA

    Directory of Open Access Journals (Sweden)

    S Saroshe

    2012-10-01

    Full Text Available Introduction- Journal Club (JC is an established academic exercise in the residency training curriculum to obtain critical appraisal skills, update knowledge on current literature and enhance proficiency in clinical practice. Objective - To determine the effectiveness of journal clubs by seeking evidence of residents’ satisfaction with journal club. Materials and Methods- Study Type: Cross-Sectional Study; Study Period: November 2011; Study Site: R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India. Method: All the postgraduates student of 2nd and 3rd year of institute are included in study and interviewed by using a structured questionnaire. Responses to 13 questions were recorded on a 5-item Likert scale. Result- The participants rated workshops as the most preferred method of continuing education. 60% of the respondents perceived a change in critical appraisal skill as a result of attending JC. To keep up with current literature was rated by the residents as the most important goal of journal club. 45.71% agreed to the fact that mock presentation is a valuable exercise while preparing for journal club. Conclusion- Journal clubs can be effective in the training of residents to meet their core competencies. Educational value of preparing for journal club is the most rated utility of journal-club. They can enable residents to develop the knowledge; expertise and enthusiasm needed to undertake research plans enhancing their ability in critical thinking and scientific reading. Recommendation- Currently the effectiveness of Journal-club meetings in postgraduate medical education is unreported. Present Study achieved greater than 95 percent response rate, yet the sample represents only one medical college of M.P. Therefore, generalization requires caution and further explorative studies are required in this direction. Improved faculty participation in the journal club is required.

  16. The Culture of General Palliative Nursing Care in Medical Departments

    DEFF Research Database (Denmark)

    Bergenholtz, Heidi; Jarlbæk, Lene; Hølge-Hazelton, Bibi

    2015-01-01

    and the nurses' reflections on GPNC: (1) GPNC provided in a treatment setting, (2) transition to loving care and the licence to perform palliative care (PC) and (3) potential for team improvement. Conclusions: GPNC as a culture in medical departments seemed to be embedded in a setting not suited for dying...... patients. Palliative care was still practised according to the transition model of care, sharply dividing curative from palliative care, and was inappropriately conducted in a fragmented and individual-based way. The term ‘loving care’ was used as a ‘gate-opener’ to provide palliative care for the dying......Background: In many countries, approximately half of the population dies in hospital, making general palliative nursing care (GPNC) a core nursing task. GPNC in the hospital setting is described as challenging, however little is known about its actual practice. Aim: To explore the GPNC culture...

  17. Medical innovation and age-specific trends in health care utilization: findings and implications.

    Science.gov (United States)

    Wong, Albert; Wouterse, Bram; Slobbe, Laurentius C J; Boshuizen, Hendriek C; Polder, Johan J

    2012-01-01

    Health care utilization is expected to rise in the coming decades. Not only will the aggregate need for health care grow by changing demographics, so too will per capita utilization. It has been suggested that trends in health care utilization may be age-specific. In this paper, age-specific trends in health care utilization are presented for different health care sectors in the Netherlands, for the period 1981-2009. For the hospital sector we also explore the link between these trends and the state of medical technology. Using aggregated data from a Dutch health survey and a nationwide hospital register, regression analysis was used to examine age-specific trends in the probability of utilizing health care. To determine the influence of medical technology, the growth in age-specific probabilities of hospital care was regressed on the number of medical patents while adjusting for confounders related to demographics, health status, supply and institutional factors. The findings suggest that for most health care sectors, the trend in the probability of health care utilization is highest for ages 65 and up. Larger advances in medical technology are found to be significantly associated with a higher growth of hospitalization probability, particularly for the higher ages. Age-specific trends will raise questions on the sustainability of intergenerational solidarity in health care, as solidarity will not only be strained by the ageing population, but also might find itself under additional pressure as the gap in health care utilization between elderly and non-elderly grows over time. For hospital care utilization, this process might well be accelerated by advances in medical technology.

  18. Recall of general and medical vocabulary and text structure knowledge: An experimental study of English for Medical Purposes

    Directory of Open Access Journals (Sweden)

    Zarein-Dolab S

    2008-07-01

    Full Text Available Background and purpose: A 3-unit course is dedicated to general language in medical universities and the vocabulary and text structure of the courses have usually no relation to medical language. We examine whether teaching general language will be as effective as medical language as assessed through recall of general and medical vocabulary and text structure knowledge. Methods: an experimental study was designed, in that, the third year students who had participated in the 3-unit general language classes in the first year of their General Practitioner (GP program were selected and sat for a 60 MCQ tests. The 60 MCQ tests consisted of 30 questions of general language, 25 vocabulary and 5 comprehension questions and also 30 questions of medical language, 25 technical and semi-technical vocabulary and 5 comprehension questions. In all, 145 medical students attended the exam which took 40 minutes to accomplish. Results: The results of the study indicated that memory retention was significantly lower in general language than medical language. The technical and semi-technical vocabulary items were significantly better recalled and the medical text was significantly better understood by the participants. Conclusion: A 3-unit course in general language may be a futile effort since the students will not be exposed to the same vocabulary and text structure knowledge in later years of their GP program. It is recommended that the focus of all the university English courses be on the medical language. Key words: Medical Vocabulary, English For Specific Purposes, ESP

  19. The clinical utility of HIV outpatient pharmacist prescreening to reduce medication error and assess adherence.

    Science.gov (United States)

    Seden, K; Bradley, M; Miller, A R O; Beadsworth, M B J; Khoo, S H

    2013-03-01

    Antiretroviral therapy (ART) is complex and has high propensity for medication error and drug-drug interactions (DDIs). We evaluated the clinical utility of pharmacist prescreening for DDIs, adherence to ART and medicines reconciliation prior to HIV outpatient appointments. A pharmacist took detailed medication histories and ART adherence assessments, then screened medication for DDIs. A template detailing current medication, potential DDIs and adherence was filed in the clinical notes and physicians were asked for structured feedback. Potential DDIs were observed in 58% of 200 patients, with 22 (9%) potential DDIs occurring with medication that was not previously recorded in the patients' notes. Of 103 physician responses, 61.2% reported that the pharmacist consultation told them something they did not know, and pharmacist consultants led to change in management in 13.6% of cases. Pharmacist consultations were more likely to add benefit in patients taking two or more concomitant medications in addition to ART (P = 0.0012).

  20. Health utility after emergency medical admission: a cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Goodacre Steve W

    2012-02-01

    Full Text Available Abstract Objectives Health utility combines health related quality of life and mortality to produce a generic outcome measure reflecting both morbidity and mortality. It has not been widely used as an outcome measure in evaluations of emergency care and little is known about the feasibility of measurement, typical values obtained or baseline factors that predict health utility. We aimed to measure health utility after emergency medical admission, to compare health utility to age, gender and regional population norms, and identify independent predictors of health utility. Methods We selected 5760 patients across three hospitals who were admitted to hospital by ambulance as a medical emergency. The EQ-5D questionnaire was mailed to all who were still alive 30 days after admission. Health utility was estimated by applying tariff values to the EQ-5D responses or imputing a value of zero for those who had died. Multivariable analysis was used to identify independent predictors of health utility at 30 days. Results Responses were received from 2488 (47.7% patients, while 541 (9.4% had died. Most respondents reported some or severe problems with each aspect of health. Mean health utility was 0.49 (standard deviation 0.35 in survivors and 0.45 (0.36 including non-survivors. Some 75% had health utility below their expected value (mean loss 0.32, 95% confidence interval 0.31 to 0.33 and 11% had health utility below zero (worse than death. On multivariable modelling, reduced health utility was associated with increased age and lower GCS, varied according to ICD10 code and was lower among females, patients with recent hospital admission, steroid therapy, or history of chronic respiratory disease, malignancy, diabetes or epilepsy. Conclusions Health utility can be measured after emergency medical admission, although responder bias may be significant. Health utility after emergency medical admission is poor compared to population norms. We have identified

  1. The Nonsubsampled Contourlet Transform Based Statistical Medical Image Fusion Using Generalized Gaussian Density.

    Science.gov (United States)

    Yang, Guocheng; Li, Meiling; Chen, Leiting; Yu, Jie

    2015-01-01

    We propose a novel medical image fusion scheme based on the statistical dependencies between coefficients in the nonsubsampled contourlet transform (NSCT) domain, in which the probability density function of the NSCT coefficients is concisely fitted using generalized Gaussian density (GGD), as well as the similarity measurement of two subbands is accurately computed by Jensen-Shannon divergence of two GGDs. To preserve more useful information from source images, the new fusion rules are developed to combine the subbands with the varied frequencies. That is, the low frequency subbands are fused by utilizing two activity measures based on the regional standard deviation and Shannon entropy and the high frequency subbands are merged together via weight maps which are determined by the saliency values of pixels. The experimental results demonstrate that the proposed method significantly outperforms the conventional NSCT based medical image fusion approaches in both visual perception and evaluation indices.

  2. The Nonsubsampled Contourlet Transform Based Statistical Medical Image Fusion Using Generalized Gaussian Density

    Directory of Open Access Journals (Sweden)

    Guocheng Yang

    2015-01-01

    Full Text Available We propose a novel medical image fusion scheme based on the statistical dependencies between coefficients in the nonsubsampled contourlet transform (NSCT domain, in which the probability density function of the NSCT coefficients is concisely fitted using generalized Gaussian density (GGD, as well as the similarity measurement of two subbands is accurately computed by Jensen-Shannon divergence of two GGDs. To preserve more useful information from source images, the new fusion rules are developed to combine the subbands with the varied frequencies. That is, the low frequency subbands are fused by utilizing two activity measures based on the regional standard deviation and Shannon entropy and the high frequency subbands are merged together via weight maps which are determined by the saliency values of pixels. The experimental results demonstrate that the proposed method significantly outperforms the conventional NSCT based medical image fusion approaches in both visual perception and evaluation indices.

  3. Factors that influence the selection and utilization of children’s medical insurance

    OpenAIRE

    Shishu Zhang; Gregory J. Soukup

    2015-01-01

    The researchers analyzed how different regions in the USA, family structure, ethnicity, and family income levels influenced the selection and utilization of medical care programs and services by American children. To prevent any possible bias in the analysis and to produce reliable results, an endogenous switching model was utilized in the study. The researchers found no statistically significant differences in the number of doctor visits and hospital stays between children with insurance and...

  4. Drug utilization review of anticancer drugs in cancer outpatient department of the Government Medical College, Aurangabad

    OpenAIRE

    M. D. Kulkarni; Samra A. Hussaini; S. L. Padwal; P. N. Khandelwal; S. M. Doifode; P. P. More

    2014-01-01

    Background: To study drug utilization of anticancer drugs in cancer outpatient department (OPD) of Government Medical College, Aurangabad. Methods: Five hundred and twelve prescription records were screened and analyzed as per the study parameters from cancer OPD of Government Medical College and Hospital, Aurangabad. Commonly used anticancer drugs were recorded; furthermore, different types of carcinomas were noted. Results: Age group of patients was in between 30 and 70, 267 were fema...

  5. Utilizing field medical equipment to support fixed facilities during major renovation projects.

    Science.gov (United States)

    Call, C A; Maloney, J P

    1993-05-01

    When a fixed facility plans for renovation, the ultimate goal is to provide continuous, cost-effective medical operations. One alternative is to utilize field medical equipment. The Deployable Medical Systems (DEPMEDS), even though designed for battlefield medicine, has been successfully used for six fixed facility renovation projects. As a direct result of various studies, several improvements have been implemented and recommended for the DEPMEDS equipment when used to support fixed facilities. These projects have provided a rich learning experience and have significantly improved the readiness posture of the AMEDD.

  6. Medical devices for restless legs syndrome – clinical utility of the Relaxis pad

    Science.gov (United States)

    Mitchell, Ulrike H

    2015-01-01

    Restless Legs Syndrome or Willis–Ekbom Disease, a neurosensory disorder, can be treated with pharmaceuticals or conservatively. This review focuses on conservative treatments, more specifically on treatments with medical devices. Two modes of action, enhancement of circulation and counter stimulation, are introduced. Medical devices that use enhancement of circulation as their mechanism of action are whole body vibration, pneumatic compression, and near-infrared light. Medical devices that use counter stimulation include transcutaneous electrical nerve stimulation and the vibration Relaxis pad. The clinical utility of the Relaxis pad and its place in therapy is proposed. PMID:26664128

  7. Medical devices for restless legs syndrome - clinical utility of the Relaxis pad.

    Science.gov (United States)

    Mitchell, Ulrike H

    2015-01-01

    Restless Legs Syndrome or Willis-Ekbom Disease, a neurosensory disorder, can be treated with pharmaceuticals or conservatively. This review focuses on conservative treatments, more specifically on treatments with medical devices. Two modes of action, enhancement of circulation and counter stimulation, are introduced. Medical devices that use enhancement of circulation as their mechanism of action are whole body vibration, pneumatic compression, and near-infrared light. Medical devices that use counter stimulation include transcutaneous electrical nerve stimulation and the vibration Relaxis pad. The clinical utility of the Relaxis pad and its place in therapy is proposed.

  8. Medical care utilization during 1 year prior to death in suicides motivated by physical illnesses.

    Science.gov (United States)

    Cho, Jaelim; Lee, Won Joon; Moon, Ki Tae; Suh, Mina; Sohn, Jungwoo; Ha, Kyoung Hwa; Kim, Changsoo; Shin, Dong Chun; Jung, Sang Hyuk

    2013-05-01

    Many epidemiological studies have suggested that a variety of medical illnesses are associated with suicide. Investigating the time-varying pattern of medical care utilization prior to death in suicides motivated by physical illnesses would be helpful for developing suicide prevention programs for patients with physical illnesses. Suicides motivated by physical illnesses were identified by the investigator's note from the National Police Agency, which was linked to the data from the Health Insurance Review and Assessment. We investigated the time-varying patterns of medical care utilization during 1 year prior to suicide using repeated-measures data analysis after adjustment for age, gender, area of residence, and socioeconomic status. Among 1994 suicides for physical illness, 1893 (94.9%) suicides contacted any medical care services and 445 (22.3%) suicides contacted mental health care during 1 year prior to suicide. The number of medical care visits and individual medical expenditures increased as the date of suicide approached (psuicide significantly increased only in 40- to 64-year-old men (p=0.002), women suicides motivated by physical illnesses contacted medical care during 1 year prior to suicide, but many of them did not undergo psychiatric evaluation. This underscores the need for programs to provide psychosocial support to patients with physical illnesses.

  9. 14 CFR 67.113 - General medical condition.

    Science.gov (United States)

    2010-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other... that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment... the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

  10. 14 CFR 67.213 - General medical condition.

    Science.gov (United States)

    2010-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other... that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment... the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

  11. 14 CFR 67.313 - General medical condition.

    Science.gov (United States)

    2010-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other... that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment... the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

  12. 42 CFR 423.153 - Drug utilization management, quality assurance, and medication therapy management programs (MTMPs).

    Science.gov (United States)

    2010-10-01

    ... the procedures and performance of its drug utilization management program, according to guidelines...) Screening for potential drug therapy problems due to therapeutic duplication. (ii) Age/gender-related... quality assurance measures and systems, according to guidelines specified by CMS. (d) Medication therapy...

  13. Epidemiology of Emergency Medical Services (EMS) Utilization in Four Indian Emergency Departments.

    Science.gov (United States)

    Wijesekera, Olindi; Reed, Amanda; Chastain, Parker S; Biggs, Shauna; Clark, Elizabeth G; Kole, Tamorish; Chakrapani, Anoop T; Ashish, Nandy; Rajhans, Prasad; Breaud, Alan H; Jacquet, Gabrielle A

    2016-12-01

    Introduction Without a universal Emergency Medical Services (EMS) system in India, data on the epidemiology of patients who utilize EMS are limited. This retrospective chart review aimed to quantify and describe the burden of disease and patient demographics of patients who arrived by EMS to four Indian emergency departments (EDs) in order to inform a national EMS curriculum.

  14. The Contribution of Social and Emotional Factors to the Utilization of Navy Outpatient Medical Facilities.

    Science.gov (United States)

    1982-01-01

    found a significantly higher proportion of social/emotional problemA identified in university-base’d clinics than in non- university based clinics...1965, 1, 371-375. Jones, V.R., & Vischi, T.R. Impact of alcohol , drue abuse and mental health treatment on mediral care utilization. Medical Care

  15. Medical Service Utilization among Youth with School-Identified Disabilities in Residential Care

    Science.gov (United States)

    Lambert, Matthew C.; Trout, Alexandra L.; Nelson, Timothy D.; Epstein, Michael H.; W. Thompson, Ronald

    2016-01-01

    Background: Behavioral, social, emotional, and educational risks among children and youth with school identified disabilities served in residential care have been well documented. However, the health care needs and medical service utilization of this high-risk population are less well known. Given the risks associated with children with…

  16. Utilizing Electronic Health Record Information to Optimize Medication Infusion Devices: A Manual Data Integration Approach.

    Science.gov (United States)

    Chuk, Amanda; Maloney, Robert; Gawron, Joyce; Skinner, Colin

    Health information technology is increasingly utilized within healthcare delivery systems today. Two examples of this type of technology include the capture of patient-specific information within an electronic health record and intravenous medication infusion devices equipped with dose error reduction software known as drug libraries. Automatic integration of these systems, termed intravenous (IV) interoperability, should serve as the goal toward which all healthcare systems work to maximize patient safety. For institutions lacking IV interoperability, we describe a manual approach of querying the electronic health record to incorporate medication administration information with data from infusion device software to optimize drug library settings. This approach serves to maximize utilization of available information to optimize medication safety provided by drug library software.

  17. General pathologist-helper: The new medical app about general pathology

    Directory of Open Access Journals (Sweden)

    Iván Fernandez-Vega

    2015-01-01

    Full Text Available Introduction: Smartphone applications (apps have become increasingly prevalent in medicine. Due to most pathologists, pathology trainees, technicians, and medical students use smartphones; apps can be a different way for general pathology education. “General pathologist-helper (GP-HELPER” is a novel app developed as a reference tool in general pathology and especially for general pathologists, developed for Android and iOS platforms. Materials and Methods: “GP-HELPER,” was created using Mobincube website platform. This tool also integrates “FORUM GP-HELPER,” an external website created using Miarroba website (http://forum-gp-helper.mboards.com and “COMMUNITY GP-HELPER” a multichannel chat created using Chatango website platform. Results: The application was released in July 2015, and it is been periodically updated since then. The app has permanent information (offline data about different pathology protocols (TNM latest edition, protocols regarding management of tumors of unknown primary origin, and flowcharts for some of the most difficult tumors to diagnose and a database with more than 5000 immunohistochemistry results from different tumors. Online data have links to more than 1100 reference pathology video lectures, 250 antibodies information, more than 70 pathology association websites, 46 pathology providers, and 78 outstanding pathology journal websites. Besides this information, the app has two interactive places such as “FORUM GP-HELPER” and “COMMUNITY GP-HELPER” that let users to stay in touch everywhere and every time. Expert consult section is also available. Conclusions: “GP-HELPER” pretends to integrate offline and online data about pathology with two interactive external places in order to represent a reference tool for general pathologists and associate members.

  18. General pathologist-helper: The new medical app about general pathology.

    Science.gov (United States)

    Fernández-Vega, Iván

    2015-01-01

    Smartphone applications (apps) have become increasingly prevalent in medicine. Due to most pathologists, pathology trainees, technicians, and medical students use smartphones; apps can be a different way for general pathology education. "General pathologist-helper (GP-HELPER)" is a novel app developed as a reference tool in general pathology and especially for general pathologists, developed for Android and iOS platforms. "GP-HELPER," was created using Mobincube website platform. This tool also integrates "FORUM GP-HELPER," an external website created using Miarroba website (http://forum-gp-helper.mboards.com) and "COMMUNITY GP-HELPER" a multichannel chat created using Chatango website platform. The application was released in July 2015, and it is been periodically updated since then. The app has permanent information (offline data) about different pathology protocols (TNM latest edition, protocols regarding management of tumors of unknown primary origin, and flowcharts for some of the most difficult tumors to diagnose) and a database with more than 5000 immunohistochemistry results from different tumors. Online data have links to more than 1100 reference pathology video lectures, 250 antibodies information, more than 70 pathology association websites, 46 pathology providers, and 78 outstanding pathology journal websites. Besides this information, the app has two interactive places such as "FORUM GP-HELPER" and "COMMUNITY GP-HELPER" that let users to stay in touch everywhere and every time. Expert consult section is also available. "GP-HELPER" pretends to integrate offline and online data about pathology with two interactive external places in order to represent a reference tool for general pathologists and associate members.

  19. Partnered medication review and charting between the pharmacist and medical officer in the Emergency Short Stay and General Medicine Unit.

    Science.gov (United States)

    Tong, Erica Y; Roman, Cristina P; Smit, De Villiers; Newnham, Harvey; Galbraith, Kirsten; Dooley, Michael J

    2015-08-01

    A partnered medication review and charting model involving a pharmacist and medical officer was implemented in the Emergency Short Stay Unit and General Medicine Unit of a major tertiary hospital. The aim of the study was to describe the safety and effectiveness of partnered medication charting in this setting. A partnered medication review and charting model was developed. Credentialed pharmacists charted pre-admission medications and venous thromboembolism prophylaxis in collaboration with the admitting medical officer. The pharmacist subsequently had a clinical discussion with the treating nurse regarding the medication management plan for the patient. A prospective audit was undertaken of all patients from the initiation of the service. A total of 549 patients had medications charted by a pharmacist from the 14th of November 2012 to the 30th of April 2013. A total of 4765 medications were charted by pharmacists with 7 identified errors, corresponding to an error rate of 1.47 per 1000 medications charted. Partnered medication review and charting by a pharmacist in the Emergency Short Stay and General Medicine unit is achievable, safe and effective. Benefits from the model extend beyond the pharmacist charting the medications, with clinical value added to the admission process through early collaboration with the medical officer. Further research is required to provide evidence to further support this collaborative model. Copyright © 2015. Published by Elsevier Ltd.

  20. The Influence of Medication Attitudes on Utilization of Antiretroviral Therapy (ART) in Indonesian Prisons.

    Science.gov (United States)

    Culbert, Gabriel J; Bazazi, Alexander R; Waluyo, Agung; Murni, Astia; Muchransyah, Azalia P; Iriyanti, Mariska; Finnahari; Polonsky, Maxim; Levy, Judith; Altice, Frederick L

    2016-05-01

    Negative attitudes toward HIV medications may restrict utilization of antiretroviral therapy (ART) in Indonesian prisons where many people living with HIV (PLH) are diagnosed and first offered ART. This mixed-method study examines the influence of medication attitudes on ART utilization among HIV-infected Indonesian prisoners. Randomly-selected HIV-infected male prisoners (n = 102) completed face-to-face in-depth interviews and structured surveys assessing ART attitudes. Results show that although half of participants utilized ART, a quarter of those meeting ART eligibility guidelines did not. Participants not utilizing ART endorsed greater concerns about ART efficacy, safety, and adverse effects, and more certainty that ART should be deferred in PLH who feel healthy. In multivariate analyses, ART utilization was independently associated with more positive ART attitudes (AOR = 1.09, 95 % CI 1.03-1.16, p = 0.002) and higher internalized HIV stigma (AOR = 1.03, 95 % CI 1.00-1.07, p = 0.016). Social marketing of ART is needed to counteract negative ART attitudes that limit ART utilization among Indonesian prisoners.

  1. Gender differences in combat medic mental health services utilization, barriers, and stigma.

    Science.gov (United States)

    Elnitsky, Christine A; Chapman, Paula L; Thurman, Ryan M; Pitts, Barbara L; Figley, Charles; Unwin, Brian

    2013-07-01

    Military health care providers experience considerable stressors related to their exposure to death and traumatic injuries in others. This study used survey data from 799 active duty U.S. Army Combat Medics deployed to Operation Iraqi Freedom/Operation Enduring Freedom. Military experiences, combat exposures, and mental health care seeking of active duty Combat Medics were explored and compared across both genders. Barriers to care were also assessed. Male and female Combat Medics reported surprisingly similar experiences, exposures, and health issues. Overall, results indicate no striking differences in barriers for females compared to their male counterparts, suggesting the barriers to utilization of mental health services may be consistent across gender. Although medics endorsed barriers and stigma related to mental health counseling services, they still sought these health services. Female and male medics who endorsed barriers were more likely to report seeking services than those who did not endorse barriers. This study provides an initial description of utilization of mental health counseling services for U.S. Army Combat Medics, the majority of whom were involved in combat operations in Afghanistan or Iraq. Our findings indicate that comprehensive assessment of the military experiences and combat exposures is needed to appreciate their potential influence on military health care providers. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

  2. Utilization of case presentations in medical microbiology to enhance relevance of basic science for medical students.

    Science.gov (United States)

    Chamberlain, Neal R; Stuart, Melissa K; Singh, Vineet K; Sargentini, Neil J

    2012-01-01

    Small-group case presentation exercises (CPs) were created to increase course relevance for medical students taking Medical Microbiology (MM) and Infectious Diseases (ID) METHODS: Each student received a unique paper case and had 10 minutes to review patient history, physical exam data, and laboratory data. Students then had three minutes to orally present their case and defend why they ruled in or out each of the answer choices provided, followed by an additional three minutes to answer questions. Exam scores differed significantly between students who received the traditional lecture-laboratory curriculum (Group I) and students who participated in the CPs (Group II). In MM, median unit exam and final exam scores for Group I students were 84.4% and 77.8%, compared to 86.0% and 82.2% for Group II students (P<0.018; P<0.001; Mann-Whitney Rank Sum Test). Median unit and final ID exam scores for Group I students were 84.0% and 80.0%, compared to 88.0% and 86.7% for Group II students (P<0.001; P<0.001). Students felt that the CPs improved their critical thinking and presentation skills and helped to prepare them as future physicians.

  3. Utilization of case presentations in medical microbiology to enhance relevance of basic science for medical students

    Directory of Open Access Journals (Sweden)

    Neal R. Chamberlain

    2012-03-01

    Full Text Available Background : Small-group case presentation exercises (CPs were created to increase course relevance for medical students taking Medical Microbiology (MM and Infectious Diseases (ID Methods : Each student received a unique paper case and had 10 minutes to review patient history, physical exam data, and laboratory data. Students then had three minutes to orally present their case and defend why they ruled in or out each of the answer choices provided, followed by an additional three minutes to answer questions. Results : Exam scores differed significantly between students who received the traditional lecture-laboratory curriculum (Group I and students who participated in the CPs (Group II. In MM, median unit exam and final exam scores for Group I students were 84.4% and 77.8%, compared to 86.0% and 82.2% for Group II students (P < 0.018; P < 0.001; Mann-Whitney Rank Sum Test. Median unit and final ID exam scores for Group I students were 84.0% and 80.0%, compared to 88.0% and 86.7% for Group II students (P < 0.001; P < 0.001. Conclusion : Students felt that the CPs improved their critical thinking and presentation skills and helped to prepare them as future physicians.

  4. Utilization of case presentations in medical microbiology to enhance relevance of basic science for medical students

    Science.gov (United States)

    Chamberlain, Neal R.; Stuart, Melissa K.; Singh, Vineet K.; Sargentini, Neil J.

    2012-01-01

    Background Small-group case presentation exercises (CPs) were created to increase course relevance for medical students taking Medical Microbiology (MM) and Infectious Diseases (ID) Methods Each student received a unique paper case and had 10 minutes to review patient history, physical exam data, and laboratory data. Students then had three minutes to orally present their case and defend why they ruled in or out each of the answer choices provided, followed by an additional three minutes to answer questions. Results Exam scores differed significantly between students who received the traditional lecture-laboratory curriculum (Group I) and students who participated in the CPs (Group II). In MM, median unit exam and final exam scores for Group I students were 84.4% and 77.8%, compared to 86.0% and 82.2% for Group II students (P<0.018; P<0.001; Mann-Whitney Rank Sum Test). Median unit and final ID exam scores for Group I students were 84.0% and 80.0%, compared to 88.0% and 86.7% for Group II students (P<0.001; P<0.001). Conclusion Students felt that the CPs improved their critical thinking and presentation skills and helped to prepare them as future physicians. PMID:22435014

  5. Let's talk about medication: concordance in rating medication adherence among multimorbid patients and their general practitioners

    NARCIS (Netherlands)

    Ose, D.; Mahler, C.; Vogel, I.; Ludt, S.; Szecsenyi, J.; Freund, T.

    2012-01-01

    BACKGROUND: Medication adherence can be essential for improving health outcomes. Patients with multiple chronic conditions, often receiving multiple medications, are at higher risk for medication nonadherence. Previous research has focused on concordance between patients and providers about which me

  6. Sexual Dysfunction 1 - Sexual sequelae of general medical disorders

    NARCIS (Netherlands)

    Basson, Rosemary; Schultz, Willibrord Weijmar

    2007-01-01

    That sexual symptoms can signal serious underlying disease confirms the importance of sexual enquiry as an integral component of medical assessment. Data on sexual function are sparse in some medical specialties. However, increased scientific understanding of the central and peripheral physiology of

  7. Sexual Dysfunction 1 - Sexual sequelae of general medical disorders

    NARCIS (Netherlands)

    Basson, Rosemary; Schultz, Willibrord Weijmar

    2007-01-01

    That sexual symptoms can signal serious underlying disease confirms the importance of sexual enquiry as an integral component of medical assessment. Data on sexual function are sparse in some medical specialties. However, increased scientific understanding of the central and peripheral physiology of

  8. Spatial Variation in General Medical Services Income in Dublin General Practitioners

    Directory of Open Access Journals (Sweden)

    Conor Teljeur

    2011-01-01

    Full Text Available The general medical services (GMS scheme provides care free at the point of use for the 30% most economically deprived section of the population and the elderly. Almost all people of over-70-year olds are eligible for the GMS scheme potentially directing resources away from those most in need. The aim of this study is to analyse the relationship between practice GMS income and deprivation amongst Dublin-based general practitioners (GPs. The practice GMS income in Dublin was analysed in relation to practice characteristics including the number of GPs, catchment area population, proportion of over-70-year olds in the catchment area, catchment deprivation, number of GMS GPs within 2 km, and average GMS practice income within 2 km. Practice GMS income was highest in deprived areas but is also a valuable source of income in the least deprived areas. The capitation rate for over-70-year olds provides an incentive for GPs to locate in affluent areas and potentially directs resources away from those in greater need.

  9. The utility of simulation in medical education: what is the evidence?

    Science.gov (United States)

    Okuda, Yasuharu; Bryson, Ethan O; DeMaria, Samuel; Jacobson, Lisa; Quinones, Joshua; Shen, Bing; Levine, Adam I

    2009-08-01

    Medical schools and residencies are currently facing a shift in their teaching paradigm. The increasing amount of medical information and research makes it difficult for medical education to stay current in its curriculum. As patients become increasingly concerned that students and residents are "practicing" on them, clinical medicine is becoming focused more on patient safety and quality than on bedside teaching and education. Educators have faced these challenges by restructuring curricula, developing small-group sessions, and increasing self-directed learning and independent research. Nevertheless, a disconnect still exists between the classroom and the clinical environment. Many students feel that they are inadequately trained in history taking, physical examination, diagnosis, and management. Medical simulation has been proposed as a technique to bridge this educational gap. This article reviews the evidence for the utility of simulation in medical education. We conducted a MEDLINE search of original articles and review articles related to simulation in education with key words such as simulation, mannequin simulator, partial task simulator, graduate medical education, undergraduate medical education, and continuing medical education. Articles, related to undergraduate medical education, graduate medical education, and continuing medical education were used in the review. One hundred thirteen articles were included in this review. Simulation-based training was demonstrated to lead to clinical improvement in 2 areas of simulation research. Residents trained on laparoscopic surgery simulators showed improvement in procedural performance in the operating room. The other study showed that residents trained on simulators were more likely to adhere to the advanced cardiac life support protocol than those who received standard training for cardiac arrest patients. In other areas of medical training, simulation has been demonstrated to lead to improvements in medical

  10. Disparate patterns of prenatal care utilization stratified by medical and psychosocial risk.

    Science.gov (United States)

    Krans, Elizabeth E; Davis, Matthew M; Palladino, Christie L

    2013-05-01

    To evaluate patterns of prenatal care utilization stratified by medical and psychosocial risk. A retrospective cohort of 786 pregnant women who subsequently delivered live births from 1999 to 2003 at the University of Michigan were classified into high medical, high psychosocial, high medical and high psychosocial (dual high risk) and low-risk pregnancies. Chi-square and logistic regression analyses assessed the association between risk and prenatal care utilization using the Kotelchuck Index. Of 786 pregnancies, 202 (25.7%) were high medical risk, 178 (22.7%) were high psychosocial risk, 227 (28.9%) were dual high risk and 179 (22.8%) were low-risk. Over 31% of dual high risk and 25% of high medical risk pregnancies received "adequate plus" prenatal care versus 10% of high psychosocial risk pregnancies. In multivariate analyses, adjusted for risk, race and insurance, high psychosocial risk pregnancies (OR = 1.69; 95% CI 1.06-2.72) were significantly more likely to receive inadequate prenatal care than care of greater intensity. Many high psychosocial risk pregnancies do not receive adequate prenatal care.

  11. An analysis of lecture video utilization in undergraduate medical education: associations with performance in the courses

    Science.gov (United States)

    McNulty, John A; Hoyt, Amy; Gruener, Gregory; Chandrasekhar, Arcot; Espiritu, Baltazar; Price, Ron; Naheedy, Ross

    2009-01-01

    Background Increasing numbers of medical schools are providing videos of lectures to their students. This study sought to analyze utilization of lecture videos by medical students in their basic science courses and to determine if student utilization was associated with performance on exams. Methods Streaming videos of lectures (n = 149) to first year and second year medical students (n = 284) were made available through a password-protected server. Server logs were analyzed over a 10-week period for both classes. For each lecture, the logs recorded time and location from which students accessed the file. A survey was administered at the end of the courses to obtain additional information about student use of the videos. Results There was a wide disparity in the level of use of lecture videos by medical students with the majority of students accessing the lecture videos sparingly (60% of the students viewed less than 10% of the available videos. The anonymous student survey revealed that students tended to view the videos by themselves from home during weekends and prior to exams. Students who accessed lecture videos more frequently had significantly (p lectures are used by relatively few medical students and that individual use of videos is associated with the degree to which students are having difficulty with the subject matter. PMID:19173725

  12. An analysis of lecture video utilization in undergraduate medical education: associations with performance in the courses

    Directory of Open Access Journals (Sweden)

    Chandrasekhar Arcot

    2009-01-01

    Full Text Available Abstract Background Increasing numbers of medical schools are providing videos of lectures to their students. This study sought to analyze utilization of lecture videos by medical students in their basic science courses and to determine if student utilization was associated with performance on exams. Methods Streaming videos of lectures (n = 149 to first year and second year medical students (n = 284 were made available through a password-protected server. Server logs were analyzed over a 10-week period for both classes. For each lecture, the logs recorded time and location from which students accessed the file. A survey was administered at the end of the courses to obtain additional information about student use of the videos. Results There was a wide disparity in the level of use of lecture videos by medical students with the majority of students accessing the lecture videos sparingly (60% of the students viewed less than 10% of the available videos. The anonymous student survey revealed that students tended to view the videos by themselves from home during weekends and prior to exams. Students who accessed lecture videos more frequently had significantly (p Conclusion We conclude that videos of lectures are used by relatively few medical students and that individual use of videos is associated with the degree to which students are having difficulty with the subject matter.

  13. How does the New Cooperative Medical Scheme influence health service utilization? A study in two provinces in rural China

    Directory of Open Access Journals (Sweden)

    Tang Shenglan

    2010-05-01

    Full Text Available Abstract Background Many countries are developing health financing mechanisms to pursue the goal of universal coverage. In China, a rural health insurance system entitled New Cooperative Medical Scheme (NCMS is being developed since 2003. Although there is concern about whether the NCMS will influence the serious situation of inequity in health service utilization in rural China, there is only limited evidence available. This paper aims to assess the utilisation of outpatient and inpatient services among different income groups and provinces under NCMS in rural China. Methods Using multistage sampling processes, a cross-sectional household survey including 6,147 rural households and 22,636 individuals, was conducted in six counties in Shandong and Ningxia Provinces, China. Chi-square test, Poisson regression and log-linear regression were applied to analyze the association between NCMS and the utilization of outpatient and inpatient services and the length of stay for inpatients. Qualitative methods including individual interview and focus group discussion were applied to explain and complement the findings from the household survey. Results NCMS coverage was 95.9% in Shandong and 88.0% in Ningxia in 2006. NCMS membership had no significant association with outpatient service utilization regardless of income level and location. Inpatient service utilization has increased for the high income group under NCMS, but for the middle and low income, the change was not significant. Compared with non-members, NCMS members from Ningxia used inpatient services more frequently, while members from Shandong had a longer stay in hospital. High medical expenditure, low reimbursement rate and difference in NCMS policy design between regions were identified as the main reasons for the differences in health service utilization. Conclusions Outpatient service utilization has not significantly changed under NCMS. Although utilization of inpatient service in general

  14. How does the New Cooperative Medical Scheme influence health service utilization? A study in two provinces in rural China.

    Science.gov (United States)

    Yu, Baorong; Meng, Qingyue; Collins, Charles; Tolhurst, Rachel; Tang, Shenglan; Yan, Fei; Bogg, Lennart; Liu, Xiaoyun

    2010-05-10

    Many countries are developing health financing mechanisms to pursue the goal of universal coverage. In China, a rural health insurance system entitled New Cooperative Medical Scheme (NCMS) is being developed since 2003. Although there is concern about whether the NCMS will influence the serious situation of inequity in health service utilization in rural China, there is only limited evidence available. This paper aims to assess the utilisation of outpatient and inpatient services among different income groups and provinces under NCMS in rural China. Using multistage sampling processes, a cross-sectional household survey including 6,147 rural households and 22,636 individuals, was conducted in six counties in Shandong and Ningxia Provinces, China. Chi-square test, Poisson regression and log-linear regression were applied to analyze the association between NCMS and the utilization of outpatient and inpatient services and the length of stay for inpatients. Qualitative methods including individual interview and focus group discussion were applied to explain and complement the findings from the household survey. NCMS coverage was 95.9% in Shandong and 88.0% in Ningxia in 2006. NCMS membership had no significant association with outpatient service utilization regardless of income level and location.Inpatient service utilization has increased for the high income group under NCMS, but for the middle and low income, the change was not significant. Compared with non-members, NCMS members from Ningxia used inpatient services more frequently, while members from Shandong had a longer stay in hospital.High medical expenditure, low reimbursement rate and difference in NCMS policy design between regions were identified as the main reasons for the differences in health service utilization. Outpatient service utilization has not significantly changed under NCMS. Although utilization of inpatient service in general has increased under NCMS, people with high income tend to benefit

  15. Medical engagement and organizational characteristics in general practice

    DEFF Research Database (Denmark)

    Ahnfeldt-Mollerup, Peder; dePont Christensen, René; Halling, Anders;

    2016-01-01

    and this is determined by a complex interaction between both individual and organizational characteristics. Working in collaboration, having staff and being engaged in vocational training of junior doctors are all associated with enhanced levels of medical engagement among GPs.......BACKGROUND: Medical engagement is a mutual concept of the active and positive contribution of doctors to maintaining and enhancing the performance of their health care organization, which itself recognizes this commitment in supporting and encouraging high quality care. A Medical Engagement Scale...... results were analysed in conjunction with the GP register data. RESULTS: Statistically adjusted analyses revealed that the GPs' medical engagement varied substantially. GPs working in collaboration with colleagues were more engaged than GPs from single-handed practices, older GPs were less engaged than...

  16. Implementing Effective Substance Abuse Treatments in General Medical Settings: Mapping the Research Terrain.

    Science.gov (United States)

    Ducharme, Lori J; Chandler, Redonna K; Harris, Alex H S

    2016-01-01

    The National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), and Veterans Health Administration (VHA) share an interest in promoting high quality, rigorous health services research to improve the availability and utilization of evidence-based treatment for substance use disorders (SUD). Recent and continuing changes in the healthcare policy and funding environments prioritize the integration of evidence-based substance abuse treatments into primary care and general medical settings. This area is a prime candidate for implementation research. Recent and ongoing implementation projects funded by these agencies are reviewed. Research in five areas is highlighted: screening and brief intervention for risky drinking; screening and brief intervention for tobacco use; uptake of FDA-approved addiction pharmacotherapies; safe opioid prescribing; and disease management. Gaps in the portfolios, and priorities for future research, are described.

  17. Drug Utilization Study in Outpatient Ophthalmology Department of Government Medical College Jammu

    OpenAIRE

    Meenakshi Nehru, K. Kohli, B. Kapoor, P. Sadhotra, V. Chopra, R. Sharma

    2005-01-01

    The present study was undertaken to assess the patterns of prescription and drug utilization bymeasuring WHO delineated drug use indicators. This study was conducted in the PostgraduateDepartment of Pharmacology and Therapeutics in collaboration with the Postgraduate Departmentof Ophthalmology Govt. Medical College Hospital, Jammu. Total number of prescriptions analyzedwere 440 , in which total of 822 drugs were prescribed. Analysis of the prescriptions showed thataverage number of drugs per ...

  18. [Preliminary exploration on educational reform of general western medical history in medical colleges and universities under new situations and circumstances].

    Science.gov (United States)

    Fu, Deming; Wang, Hongqi; Yan, Juan; He, Peifeng

    2015-03-01

    With the appearance of the "biological-psychological-social" medical model, the purpose, value and significance of medicine are reviewed and reconsidered by the people, and the history of medicine becomes one of the core subjects in the medical humanist education, along with change of the teaching of general western medical history. Medical history is no longer the accumulation of the achievements of human knowledge and medical experience, the intellectual history of theorytransformation, and the history of reformation of medical technologies, but a concrete and colorful living situation, displayed by the scientists, physicians and normal peoplecommunity during the process of their consistent recognition and transformation on medicine. Therefore, the teaching of generalwestern medical history should adjust the compilation of teaching materials, update the educational concept, change the contents, methods of teaching and examination in order to lay stress on the cultural viewpoint and the function of humanity and quality of education.

  19. Training medical students in general practice: a qualitative study among general practitioner trainers in Sri Lanka.

    Science.gov (United States)

    Ramanayake, R P J C; De Silva, A H W; Perera, D P; Sumanasekera, R D N; Athukorala, L A C L; Fernando, K A T

    2015-01-01

    Worldwide Family Medicine has gained an important place in the undergraduate medical curriculum over the last few decades and general practices have become training centers for students. Exposure to patients early in the disease process, out patient management of common problems, follow up of chronic diseases and psychosocial aspects of health and disease are educational advantages of community based training but such training could have varying impact on patients, students and trainers. This study explored the views of General Practitioner (GP) trainers on their experience in training students. This qualitative study was conducted among GP trainers of the faculty of medicine, University of Kelaniya, Sri Lanka, to explore their experience on wide range of issues related to their role as GP trainers. The interviews were recorded and transcribed verbatim. Themes expressed were identified. Altruistic reasons, self-satisfaction, self-esteem and opportunity to improve their knowledge were the motivations for their involvement in teaching. Teachers were confident of their clinical and teaching skills. They perceived that patients were willing participants of the process and benefited from it. There was a positive impact on consultation dynamics. Time pressure was the major problem and ideal number of trainees per session was two. They were willing to attend teacher training workshops to update their knowledge. GP trainers driven by altruistic reasons were willing participants of student training process. The perceived advantages of involvement of teaching for trainers and patients were an encouragement for potential trainers. University should organize training sessions for trainers which will boost their knowledge, confidence and teaching skills which will eventually benefit students.

  20. Medical devices for restless legs syndrome – clinical utility of the Relaxis pad

    Directory of Open Access Journals (Sweden)

    Mitchell UH

    2015-12-01

    Full Text Available Ulrike H Mitchell Department of Exercise Sciences, Brigham Young University, Provo, UT, USA Abstract: Restless Legs Syndrome or Willis–Ekbom Disease, a neurosensory disorder, can be treated with pharmaceuticals or conservatively. This review focuses on conservative treatments, more specifically on treatments with medical devices. Two modes of action, enhancement of circulation and counter stimulation, are introduced. Medical devices that use enhancement of circulation as their mechanism of action are whole body vibration, pneumatic compression, and near-infrared light. Medical devices that use counter stimulation include transcutaneous electrical nerve stimulation and the vibration Relaxis pad. The clinical utility of the Relaxis pad and its place in therapy is proposed. Keywords: whole body vibration, pneumatic compression, near-infrared light, conservative treatment, RLS/WED 

  1. Direct medical resource utilization associated with osteoporosis-related nonvertebral fractures in postmenopausal women.

    Science.gov (United States)

    Jean, Sonia; Bessette, Louis; Belzile, Etienne L; Davison, K Shawn; Candas, Bernard; Morin, Suzanne; Dodin, Sylvie; Brown, Jacques P

    2013-02-01

    The purposes of this study were to assess direct medical resource utilization related to the treatment of nonvertebral osteoporotic fractures within 1 year postfracture and to evaluate whether age impacts resource utilization. A previously-validated algorithm for physician claims databases identified 15,327 women aged 50 years or older with incident fracture at nonvertebral osteoporotic sites between January 1, 2004 and December 31, 2005. Administrative databases of the health services available to all residents in Quebec served to study fracture-related health resource utilization in the year after fracture. Data were linked by a unique personal identifier, creating a longitudinal cohort of all fracture cases for health resource utilization. The proportions of fractures treated by open reduction, closed reduction, immobilization or follow-up by an orthopedic surgeon (OS) were evaluated. The mean number of claims for consultation with an OS or other clinicians in inpatient and outpatient visits, the hospitalization rate and length of stay (LOS) were assessed. Hip/femur fractures represented the highest rate of resource utilization because the majority of them required surgery (91.1%) and hospitalization (94.5%) with a mean (median) LOS of 39.2 (31) days. However, other nonvertebral fracture types needed significant clinical care related to surgery (27.9%), follow-up consultation with an OS (77.6%), and hospitalization (27.3% of total LOS). Even pelvic fractures, which often do not require surgical treatment, commanded high resource utilization due to the high hospitalization rate (67.4%) with mean (median) LOS of 34.2 (26) days. Moreover, age was an important determinant of health resource utilization, being associated with an increased number of visits to other physicians, hospitalization, and length of hospitalization (LOS), admissions to long term care (LTC), and death. Osteoporosis-related fractures accounted for substantial healthcare resource utilization

  2. Utility of the comprehensive marijuana motives questionnaire among medical cannabis patients.

    Science.gov (United States)

    Bohnert, Kipling M; Bonar, Erin E; Arnedt, J Todd; Conroy, Deirdre A; Walton, Maureen A; Ilgen, Mark A

    2017-08-03

    Little is known about motives for cannabis use among the population of adults using cannabis medically. Therefore, we evaluated the performance of the 12 factor, 36-item Comprehensive Marijuana Motives Questionnaire (CMMQ) among a sample of medical cannabis patients. Study participants were adults ages 21years or older with scheduled appointments to obtain new or renewed medical cannabis certification from clinics in one Midwestern state (n=1116). Confirmatory factor analysis was used to evaluate properties of the CMMQ. Multiple regressions were used to estimate associations between motives and cannabis use, physical health functioning, and mental health functioning. Fit indices were acceptable, and factor loadings ranged from 0.57 to 0.94. Based on regression analyses, motives accounted for 7% of the variance in recent cannabis use, and independent of cannabis use, accounted for 5% and 19% of physical and mental health functioning, respectively. Regression analyses also revealed that distinct motives were associated with cannabis use and physical and mental health functioning. Among adults seeking medical cannabis certification, the factor structure of the CMMQ was supported, and consistent with prior studies of adolescents and young adults using cannabis recreationally. Thus, individuals who use cannabis medically may have diverse reasons for use that extend beyond the management of medical symptoms. In addition, coping and sleep-related motives may be particularly salient for this population. Findings support the utility of the CMMQ in future research on medical cannabis use; however, expansion of the scale may be needed to address medical motives for use. Published by Elsevier Ltd.

  3. ADHD medication prescription: effects of child, sibling, parent and general practice characteristics.

    NARCIS (Netherlands)

    Heins, M.J.; Bruggers, I.; Dijk, L. van; Korevaar, J.C.

    2016-01-01

    Many children receive attention-deficit hyperactivity disorder (ADHD) medication, but factors that determine medication prescription are largely unknown. This study aimed to determine the relative impact of factors on the child, family and general practitioner (GP) practice level on ADHD medication

  4. Non-medical triggers of patients' contacts to general practitioners

    DEFF Research Database (Denmark)

    Eriksson, Tina

    family practice, general practice, primary health care, health care services, health behaviour, mass media, reasons for encounter, case-crossover, time-selection bias, recall bias, bi-directional study......family practice, general practice, primary health care, health care services, health behaviour, mass media, reasons for encounter, case-crossover, time-selection bias, recall bias, bi-directional study...

  5. General Principles of Radiation Protection in Fields of Diagnostic Medical Exposure

    OpenAIRE

    Do, Kyung Hyun

    2016-01-01

    After the rapid development of medical equipment including CT or PET-CT, radiation doses from medical exposure are now the largest source of man-made radiation exposure. General principles of radiation protection from the hazard of ionizing radiation are summarized as three key words; justification, optimization, and dose limit. Because medical exposure of radiation has unique considerations, diagnostic reference level is generally used as a reference value, instead of dose limits. In Korea, ...

  6. Medical Savings Account balance and outpatient utilization: Evidence from Guangzhou, China.

    Science.gov (United States)

    Zhang, Hui; Yuen, Peter P

    2016-02-01

    Medical Savings Account (MSA) is a financing instrument designed to reduce consumer-side moral hazards. The Urban Employee Basic Medical Insurance (UEBMI) scheme in China has an MSA component in addition to a Social Risk-pooling Fund. This study examines the association between MSA balance and outpatient utilization in Guangzhou, China, and determines MSA's impact on utilization under different circumstances. It also seeks to ascertain whether MSA has achieved its intended functions of "Cost-containment", "Saving for the future" and "Enabling utilization". The first group of 114,657 MSA account-holders, including both employees and retirees, who consistently insured with UEBMI from 2002 to 2007, are selected for this study. A two-part model is employed to estimate the effect of the MSA balance on the probability of outpatient services utilization and on the level of outpatient expenditure. Results show that MSA balance is significantly associated with the likelihood of using outpatient services as well as the level of outpatient expenditure. The association is a non-linear U-shaped relationship for working individuals, and an inverted U-shaped relationship for the retirees. The observed U-shaped relationship for working individuals implies that at lower MSA balance levels, a negative balance-expenditure relation exits, while at higher MSA balance levels, the relationship is positive--suggesting possible improper utilization when MSA balance reaches high levels. Setting a maximum MSA balance limit and/or allowing enrollees to use MSA funds to purchase private insurance appears to be desirable. The observed inverted U-shaped relationship for retirees suggests that many retirees have to spend whatever funds they have in their MSA for outpatient care, but the less healthy individuals are able to shift the spending to inpatient care which is mainly financed by the Social Risk-pooling Fund. The results of this study also affirm the usefulness of MSA in performing its

  7. Addressing the general medical needs of a patient with an altered mental state.

    Science.gov (United States)

    Boyer, Jenny L; Ginzburg, Harold M; Shah, Parind; Ardoin, Stan

    2008-12-01

    Patients presenting to an Emergency Department with an altered mental state, whether from a psychiatric, medical or surgical condition or a combination of psychiatric and medical or surgical conditions, require more than the usual amount of diagnostic acumen. General medical conditions often appear in the guise of dysfunctional emotions and/or behaviors. Acute and chronic psychosis may mask underlying acute and chronic medical and surgical conditions. As the case of Esmin Green of Brooklyn, New York, illustrates, the failure to identify underlying medical and surgical conditions in delirious, demented, or psychotic patients can prove fatal to the patient and economically costly to the medical center and its employees.

  8. General surgery in higher medical schools: innovative teaching methods

    Directory of Open Access Journals (Sweden)

    Horoshkevich A.V.

    2011-12-01

    Full Text Available Educational programmes and computer tests are important in teaching of general surgery. Application of modern computer and Internet technologies in the educational process improves quality of training

  9. Interval Generalized Ordered Weighted Utility Multiple Averaging Operators and Their Applications to Group Decision-Making

    Directory of Open Access Journals (Sweden)

    Yunna Wu

    2017-07-01

    Full Text Available We propose a new class of aggregation operator based on utility function and apply them to group decision-making problem. First of all, based on an optimal deviation model, a new operator called the interval generalized ordered weighted utility multiple averaging (IGOWUMA operator is proposed, it incorporates the risk attitude of decision-makers (DMs in the aggregation process. Some desirable properties of the IGOWUMA operator are studied afterward. Subsequently, under the hyperbolic absolute risk aversion (HARA utility function, another new operator named as interval generalized ordered weighted hyperbolic absolute risk aversion utility multiple averaging-HARA (IGOWUMA-HARA operator is also defined. Then, we discuss its families and find that it includes a wide range of aggregation operators. To determine the weights of the IGOWUMA-HARA operator, a preemptive nonlinear objective programming model is constructed, which can determine a uniform weighting vector to guarantee the uniform standard comparison between the alternatives and measure their fair competition under the condition of valid comparison between various alternatives. Moreover, a new approach for group decision-making is developed based on the IGOWUMA-HARA operator. Finally, a comparison analysis is carried out to illustrate the superiority of the proposed method and the result implies that our operator is superior to the existing operator.

  10. Trends in the utilization of medical imaging from 2003 to 2011: clinical encounters offer a complementary patient-centered focus.

    Science.gov (United States)

    Dodoo, Martey S; Duszak, Richard; Hughes, Danny R

    2013-07-01

    The aim of this study was to investigate trends in utilization and spending for medical imaging, using medical visits resulting in imaging as a novel metric of utilization. Utilization and spending for medical imaging were examined using (1) Medicare Part B claims data from 2003 to 2011 to measure per-enrollee spending and (2) household component events data on the elderly Medicare-age population from the Medical Expenditure Panel Survey from 2003 to 2010 to measure utilization as a function of clinical encounters. Annual health spending and Medicare payments for imaging for the elderly population grew from $294 per enrollee in 2003 to $418 in 2006 and had declined to $390 by 2011. Over this entire time, however, annual medical visits by a similar Medicare-age (≥ 65 years old) population resulting in imaging trended consistently downward, from 12.8% in 2003 to 10.6% in 2011. Despite early growth and then more recent declines in average Medicare spending per enrollee since 2003, the percentage of patient encounters resulting in medical imaging has significantly and consistently declined nationwide. Spending alone is thus an incomplete measure of changes in the role and utilization of medical imaging in overall patient care. As policymakers focus on medical imaging, a thoughtful analysis of payment policy influencing imaging utilization, and its role in concurrent and downstream patient care, will be critical to ensure appropriate patient access. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  11. Utilization of stainless steel crowns by general dentists and pediatric dental specialists in Indiana.

    Science.gov (United States)

    Kowolik, Joan; Kozlowski, Diana; Jones, James E

    2007-01-01

    The purpose of this study was to evaluate utilization of the stainless steel crown by both the general and pediatric dentists in Indiana. Although reports indicate that there has been a dramatic reduction in dental caries in the US, almost 20 percent of children have dental decay by age four, with almost 80 percent having a cavity by 17 years of age. After reviewing the literature, Seale has recommended that the stainless steel crown is the most successful restoration for children with a rate of high caries. All dental schools in North America teach the value of using stainless steel crowns and the method of tooth preparation. We hypothesized that greater use of the stainless steel crowns would be made by specialists than by general dentists. In this study, of the 200 questionnaires distributed, 62.5 percent were returned and analyzed. The results imply that stainless steel crowns are being significantly underutilized in general dental practice. It is interesting, and perhaps of concern, that the general dentists are not interested in continuing education courses about this subject. Over the next few years, with the aging of the pediatric dental community in Indiana, general (not specialty) dentists will treat most of the children. Because of this, pre-doctoral education needs to place more emphasis on preparation and utilization of the stainless steel crown.

  12. The utility of an electronic adherence assessment device in type 2 diabetes mellitus: a pilot study of single medication

    Directory of Open Access Journals (Sweden)

    Nadir Kheir

    2010-07-01

    Full Text Available Nadir Kheir1, William Greer2, Adil Yousif3, Hajer Al-Geed1, Randa Al Okkah1, Mahmoud Zirie4, Amy Sandridge5, Manal Zaidan61College of Pharmacy, 2Sidra Medical and Research Centre, 3Department of Statistics, College of Arts and Sciences, Qatar University, 4Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; 5Private Research Consultant, 6Al Amal Cancer Centre, Hamad Medical Corporation, Doha, QatarObjectives: The primary objective of this pilot study was to determine if the Medication Event Monitoring System (MEMS is capable of providing meaningful estimates of compliance within the indigenous Qatari population. The secondary objective was to highlight any specific problems which might be associated with the use of MEMS within this population.Method: A sample of adult diabetic Qatari patients attending an outpatient diabetic clinic were administered a Knowledge, Attitude, and Practices (KAP questionnaire and then dispensed one of their regular medications in a MEMS®-fitted bottle. Data contained in the MEMS® were downloaded after the patients returned for a refill and adherence was estimated using 2 methods: pill count and MEMS® data.Results: A total of 54 patients agreed to participate in this pilot study. Adherence to daily doses was 67.7% and with regimen 13.7%. No correlation was found between adherence assessed by pill count and MEMS®. The association between KAP and adherence was generally poor. A number of other issues and challenges in the use of MEMS® that could affect its utility were noted and will be discussed.Conclusions: Our results revealed problems associated with the use of MEMS® that could affect its usefulness in assessing adherence in this part of the world. Some issues identified in this pilot study included retrieving the MEMS®, registering extra opening of MEMS®, desire to hoard medicine by taking doses at different frequency than recorded in MEMS®. All these issues could be closely associated with the

  13. [Medical General Inspector Debenedetti and Algeria (1956-1961)].

    Science.gov (United States)

    Linon, Pierre-Jean

    2005-01-01

    M.G.I. Debenedetti was appointed as director of French Military Health Service in June 1956 for seven years, during the war of Algeria where he travelled eight times. Thus, he surveyed the good organisation of the Military Health Service in Algeria from 1956 to 1961 when he had his last journey in this country. This paper tries to report his career, his survey of the French Military Health Service on the theatre of operations, of the hospitals and of the Free Medical Care of Algeria.

  14. General practice observed. A do-it-yourself medical centre.

    Science.gov (United States)

    Ganner, A N; Lockie, A C

    1979-11-17

    A group practice commissioned a local building company to build their own medical centre comprising 370 m2 (4000 ft2) of building with an adequate car park at a total cost of 60 000 pounds with design to completion in nine months. A bank loan for 10 years was assigned to the partnership and each partner made his own arrangements for repayment. The updated cost for June 1979 is 80 000-85 000 pounds. Building a centre in this way is professionally and financially rewarding.

  15. Hospice Enrollment in Patients With Advanced Heart Failure Decreases Acute Medical Service Utilization.

    Science.gov (United States)

    Yim, Cindi K; Barrón, Yolanda; Moore, Stanley; Murtaugh, Chris; Lala, Anuradha; Aldridge, Melissa; Goldstein, Nathan; Gelfman, Laura P

    2017-03-01

    Patients with advanced heart failure (HF) enroll in hospice at low rates, and data on their acute medical service utilization after hospice enrollment is limited. We performed a descriptive analysis of Medicare fee-for-service beneficiaries, with at least one home health claim between July 1, 2009, and June 30, 2010, and at least 2 HF hospitalizations between July 1, 2009, and December 31, 2009, who subsequently enrolled in hospice between July 1, 2009, and December 31, 2009. We estimated panel-negative binomial models on a subset of beneficiaries to compare their acute medical service utilization before and after enrollment. Our sample size included 5073 beneficiaries: 55% were female, 45% were ≥85 years of age, 13% were non-white, and the mean comorbidity count was 2.38 (standard deviation 1.22). The median number of days between the second HF hospital discharge and hospice enrollment was 45. The median number of days enrolled in hospice was 15, and 39% of the beneficiaries died within 7 days of enrollment. During the study period, 11% of the beneficiaries disenrolled from hospice at least once. The adjusted mean number of hospital, intensive care unit, and emergency room admissions decreased from 2.56, 0.87, and 1.17 before hospice enrollment to 0.53, 0.19, and 0.76 after hospice enrollment. Home health care Medicare beneficiaries with advanced HF who enrolled in hospice had lower acute medical service utilization after their enrollment. Their pattern of hospice use suggests that earlier referral and improved retention may benefit this population. Further research is necessary to understand hospice referral and palliative care needs of advanced HF patients. © 2017 American Heart Association, Inc.

  16. Factors that influence the selection and utilization of children’s medical insurance

    Directory of Open Access Journals (Sweden)

    Shishu Zhang

    2015-12-01

    Full Text Available The researchers analyzed how different regions in the USA, family structure, ethnicity, and family income levels influenced the selection and utilization of medical care programs and services by American children. To prevent any possible bias in the analysis and to produce reliable results, an endogenous switching model was utilized in the study. The researchers found no statistically significant differences in the number of doctor visits and hospital stays between children with insurance and children without insurance. However, significant differences were determined regarding family structure, family income, geographic regions, and ethnicity. Children from single-parent families with insurance coverage (private, Medicaid, or SCHIP had statistically higher rates of doctor visits and hospital stays than children from two-parent families with insurance coverage. Family income, region, and ethnicity variables all had significant impacts on the type of health insurance coverage that was reported for children.

  17. Medications for Panic Disorder and Generalized Anxiety Disorder During Pregnancy

    OpenAIRE

    Rubinchik, Sofya M.; Kablinger, Anita S.; Gardner, J. Suzette

    2005-01-01

    Objective: Approximately 30% of women experience some type of anxiety disorder during their lifetime. In addition, some evidence exists that anxiety disorders can affect pregnancy outcomes. This article reviews the literature on the course of generalized anxiety disorder (GAD) and panic disorder during pregnancy and the postpartum period and presents guidelines for management.

  18. Influences on final year medical students’ attitudes to general practice as a career

    Directory of Open Access Journals (Sweden)

    Parker JE

    2014-03-01

    Full Text Available INTRODUCTION: General practice is under-represented in student career choices. This study aimed to identify and explore factors that influence the attitudes of final year medical students to general practice as a career. METHODS: This qualitative study used semi-structured interviews of focus groups of final year undergraduate medical students at the University of Otago, Christchurch, New Zealand. Thematic analysis and grounded theory were used to interpret the data. FINDINGS: General practitioners (GPs play a key role in influencing medical students’ attitudes to general practice as a career. Students identified their general practice placement during medical school training and personal contact with their own GP as principal factors. The media portrayal of general practice and the attitudes of friends and family were also influential. Students were positively influenced when they were made to feel part of the team, involved with consultations, allowed to carry out practical procedures under supervision, and witnessed what they perceived as good medical practice during clinical placements. Positive experiences often occurred later in training, when students felt more confident of their clinical abilities. While students reported occasional negative comments about general practice by some hospital doctors, these had a lesser role in influencing their perceptions of general practice compared with their own experiences, both as students and patients. CONCLUSION: GPs have a strong influence, positively and negatively, on the attitudes of medical students to general practice as a career. Effective influences include being made to feel welcome, involved, valued, and given legitimate roles during clinical placements.

  19. Successful strategy to decrease indwelling catheter utilization rates in an academic medical intensive care unit.

    Science.gov (United States)

    Gupta, Sushilkumar Satish; Irukulla, Pavan Kumar; Shenoy, Mangalore Amith; Nyemba, Vimbai; Yacoub, Diana; Kupfer, Yizhak

    2017-08-22

    Duration of indwelling urinary catheterization is an important risk factor for urinary tract infections. We devised a strategy to decrease the utilization of indwelling urinary catheters (IUCs). We also highlight the challenges of managing critically ill patients without IUCs and demonstrate some of the initiatives that we undertook to overcome these challenges. A retrospective observational outcomes review was performed in an adult medical intensive care unit (ICU) between January 2012 and December 2016. This period included a baseline and series of intervals, whereby different aspects of the strategies were implemented. IUC utilization ratio and catheter-associated urinary tract infection (CAUTI) rates were calculated. Our IUC utilization ratio had a statistically significant decrease from 0.92 (baseline) to 0.28 (after 3 interventions) (P decrease from 5.47 (baseline) to 1.08 (after 3 intervention) (P = .0134). These rates sustained a statistically significant difference over the 2-year follow-up period from the last intervention. Incontinence-associated dermatitis (IAD) was identified as a potential complication of not using an IUC. There was no statistically significant change in the IAD rates during 2013-2016. Our interventions demonstrated that aggressive and comprehensive IUC restriction protocol and provider training can lead to a successful decrease in IUC use, leading to a lower IUC utilization ratio and CAUTI rate in a large complex academic ICU setting. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  20. Medical care utilization and costs on end-of-life cancer patients: The role of hospice care.

    Science.gov (United States)

    Chang, Hsiao-Ting; Lin, Ming-Hwai; Chen, Chun-Ku; Chen, Tzeng-Ji; Tsai, Shu-Lin; Cheng, Shao-Yi; Chiu, Tai-Yuan; Tsai, Shih-Tzu; Hwang, Shinn-Jang

    2016-11-01

    Although there are 3 hospice care programs for terminal cancer patients in Taiwan, the medical utilization and expenses for these patients by programs have not been well-explored. The aim of this study was to examine the medical utilization and expenses of terminal cancer patients under different programs of hospice care in the last 90, 30, and 14 days of life.This was a retrospective observational study by secondary data analysis. By using the National Health Insurance claim database and Hospice Shared Care Databases. We identified cancer descents from these databases and classified them into nonhospice care and hospice care groups based on different combination of hospice care received. We then analyzed medical utilization including inpatient care, outpatient care, emergency room visits, and medical expenses by patient groups in the last 90, 30, and 14 days of life.Among 118,376 cancer descents, 46.9% ever received hospice care. Patients had ever received hospice care had significantly lower average medical utilization and expenses in their last 90, 30, and 14 days of life (all P hospice care group had significantly less medical utilization and expenses in the last 90, 30, and 14 days of life (all P hospice care program have different effects on medical care utilization reduction and cost-saving at different stage of the end of life of terminal cancer patients.

  1. [General recommendations for medical treatment after heart transplantation].

    Science.gov (United States)

    Guidon, A; Reverdin, S; Yarol, N; Yerly, P; Tozzi, P; Meyer, P; Hullin, R

    2014-05-28

    Heart transplantation remains the treatment of choice in selected patients with severe heart failure (HF) despite optimal medical therapy. Since long-term survival after HTX is improving, there is a growing need for evidence-based strategies that reduce long-term mortality resulting from both immunological and non-immunological risk. This manuscript summarizes recommendations for treatment of transplant vasculopathy, malignancy after transplantation, and prevention of corticosteroid induced bone disease. Based on actual understanding of cardiovascular risk factors in the population, preservation of renal function, prevention and treatment of hyperlipidemia and diabetes, as well as blood pressure control play an important role in the long-term follow-up after heart transplantation.

  2. Medical Resource Utilizations and Economic Burden in Chinese Cancer Patients with Chemotherapy-induced Anemia:A Populational Database Study

    Institute of Scientific and Technical Information of China (English)

    Chieh-Yu LIU; Tsang-Wu LIU; Jih-Shin LIU; Chin-Fu HSIAO; Li-Tzong CHEN

    2008-01-01

    Objective:Most of published studies emphasized the medical cost of treating chemotherapy-induced anemia(CIA)by using specific agents,for example,epoetin α,epoetin β,darbepoetin α or combined with red blood cell transfusions,however,the investigation of the overall medical resources utilizations and economic burden of CIA is still limited.Besides,such studies which emphasized Chinese population still lack.The aim of this study is to investigate the medical resource utilization and the economic burden of Chinese cancer patients with CIA by using a populational representative claim database. Methods:The data for this study are from the 2000-2003 Population Health Insurance Research Database(PHIRD)in Taiwan.On the basis of issuing catastrophic illness cards in the enrollment data files,a total of 26,053 beneficiaries were identified from the PHIRD,who were newly diagnosed with these four cancers in 2001 and 2002(2001:n=12,954;2002:n=13099).A generalized linear model(GLM)was employed for analyzing the differences of medical resource utilization and economic burden between the anemic and non-anemic groups. Results:Analyses showed that the anemic patients were significantly more likely to have longer length of hospital stay than non-anemic patients(P<0.05)across all these four cancers and in two study periods(except women breast cancer in 2002/03).As regards the health care expenditures,the average one-year total medical cost was USD$8,982(2001/02)and USD$8,990(2002/03)for anemic patients among these four cancers,and USD$7,769(2001/02)and USD$7713(2002/03)for non-anemic patients(P<0.0001).As for ambulatory costs,anemic patients'was significantly higher than non-anemic patients' for lung cancer(in 2001/02),women breast cancer(in 2001/02 and 2002/03)and the summarized data(in 2001/02).As for inpatient costs,anemic patients' was significantly higher than non-anemic patients'for gastric cancer(in 2002/03),colon and rectal cancer(in 2001/02 and 2002/03),lung cancer

  3. Increase in Utilization of Afterhours Medical Imaging: A Study of Three Canadian Academic Centers.

    Science.gov (United States)

    Chaudhry, Shivani; Dhalla, Irfan; Lebovic, Gerald; Rogalla, Patrik; Dowdell, Timothy

    2015-11-01

    The objectives of our study were to assess trends in afterhours medical imaging utilization for emergency department (ED) and inpatient (IP) patient populations from 2006-2013, including analysis by modality and specialty and with adjustment for patient volume. For this retrospective study, we reviewed the number of CT, MRI, and ultrasound studies performed for the ED and IP patients during the afterhours time period (5pm - 8am on weekdays and 24 hours on weekends and statutory holidays) from 2006-2013 at three different Canadian academic hospitals. We used the Jonckheere-Terpstra (JT) test to determine statistical significance of imaging and patient volume trends. A regression model was used to examine whether there was an increasing trend over time in the volume of imaging tests per 1000 patients. For all three sites from 2006-2013 during the afterhours time period: There was a statistically significant increasing trend in total medical imaging volume, which also held true when the volumes were assessed by modality and by specialty. There was a statistically significant increasing trend in ED and IP patient volume. When medical imaging volumes were adjusted for patient volumes, there was a statistically significant increasing trend in imaging being performed per patient. Afterhours medical imaging volumes demonstrated a statistically significant increasing trend at all three sites from 2006-2013 when assessed by total volume, modality, and specialty. During the same time period and at all three sites, the ED and IP patient volumes also demonstrated a statistically significant increasing trend with more medical imaging, however, being performed per patient. Copyright © 2015 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

  4. Posttraumatic stress disorder in primary care: prevalence and relationships with physical symptoms and medical utilization.

    Science.gov (United States)

    Gillock, Karen L; Zayfert, Claudia; Hegel, Mark T; Ferguson, Robert J

    2005-01-01

    This study estimates the prevalence of posttraumatic stress disorder (PTSD) and describes the relationships among PTSD status and health indices in a civilian primary care patient sample. Participants (N = 232) completed a paper-and-pencil survey of life events, PTSD symptoms, physical symptoms and health functioning. Utilization was assessed from medical records. Nine percent of the participants met the criteria for full PTSD (based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) and another 25% were defined as partial PTSD. The full-PTSD group evidenced higher rates of medical utilization, more intense physical symptoms and poorer health functioning than the no-PTSD group. The partial-PTSD group more closely resembled the full-PTSD group. This study, although limited by sample size and diagnosis by questionnaire vs. diagnostic interview, suggests research directions for enhancing our understanding of PTSD among civilian primary care patients and for developing appropriate interventions that can be conducted in the primary care setting.

  5. Provision of medical student teaching in UK general practices: a cross-sectional questionnaire study

    Science.gov (United States)

    Harding, Alex; Rosenthal, Joe; Al-Seaidy, Marwa; Gray, Denis Pereira; McKinley, Robert K

    2015-01-01

    Background Health care is increasingly provided in general practice. To meet this demand, the English Department of Health recommends that 50% of all medical students should train for general practice after qualification. Currently 19% of medical students express general practice as their first career choice. Undergraduate exposure to general practice positively influences future career choice. Appropriate undergraduate exposure to general practice is therefore highly relevant to workforce planning Aim This study seeks to quantify current exposure of medical students to general practice and compare it with past provision and also with postgraduate provision. Design and setting A cross-sectional questionnaire in the UK. Method A questionnaire regarding provision of undergraduate teaching was sent to the general practice teaching leads in all UK medical schools. Information was gathered on the amount of undergraduate teaching, how this was supported financially, and whether there was an integrated department of general practice. The data were then compared with results from previous studies of teaching provision. The provision of postgraduate teaching in general practice was also examined. Results General practice teaching for medical students increased from teaching in 1968 to 13.0% by 2008; since then, the percentage has plateaued. The total amount of general practice teaching per student has fallen by 2 weeks since 2002. Medical schools providing financial data delivered 14.6% of the clinical curriculum and received 7.1% of clinical teaching funding. The number of departments of general practice has halved since 2002. Provision of postgraduate teaching has tripled since 2000. Conclusion Current levels of undergraduate teaching in general practice are too low to fulfil future workforce requirements and may be falling. Financial support for current teaching is disproportionately low and the mechanism counterproductive. Central intervention may be required to solve

  6. Personal health records in the preclinical medical curriculum: modeling student responses in a simple educational environment utilizing Google Health

    Directory of Open Access Journals (Sweden)

    Karamanlis Dimokratis A

    2012-09-01

    Full Text Available Abstract Background Various problems concerning the introduction of personal health records in everyday healthcare practice are reported to be associated with physicians’ unfamiliarity with systematic means of electronically collecting health information about their patients (e.g. electronic health records - EHRs. Such barriers may further prevent the role physicians have in their patient encounters and the influence they can have in accelerating and diffusing personal health records (PHRs to the patient community. One way to address these problems is through medical education on PHRs in the context of EHR activities within the undergraduate medical curriculum and the medical informatics courses in specific. In this paper, the development of an educational PHR activity based on Google Health is reported. Moreover, student responses on PHR’s use and utility are collected and presented. The collected responses are then modelled to relate the satisfaction level of students in such a setting to the estimation about their attitude towards PHRs in the future. Methods The study was conducted by designing an educational scenario about PHRs, which consisted of student instruction on Google Health as a model PHR and followed the guidelines of a protocol that was constructed for this purpose. This scenario was applied to a sample of 338 first-year undergraduate medical students. A questionnaire was distributed to each one of them in order to obtain Likert-like scale data on the sample’s response with respect to the PHR that was used; the data were then further analysed descriptively and in terms of a regression analysis to model hypothesised correlations. Results Students displayed, in general, satisfaction about the core PHR functions they used and they were optimistic about using them in the future, as they evaluated quite high up the level of their utility. The aspect they valued most in the PHR was its main role as a record-keeping tool, while

  7. Optimization of the dressing parameters in cylindrical grinding based on a generalized utility function

    Science.gov (United States)

    Aleksandrova, Irina

    2016-01-01

    The existing studies, concerning the dressing process, focus on the major influence of the dressing conditions on the grinding response variables. However, the choice of the dressing conditions is often made, based on the experience of the qualified staff or using data from reference books. The optimal dressing parameters, which are only valid for the particular methods and dressing and grinding conditions, are also used. The paper presents a methodology for optimization of the dressing parameters in cylindrical grinding. The generalized utility function has been chosen as an optimization parameter. It is a complex indicator determining the economic, dynamic and manufacturing characteristics of the grinding process. The developed methodology is implemented for the dressing of aluminium oxide grinding wheels by using experimental diamond roller dressers with different grit sizes made of medium- and high-strength synthetic diamonds type ??32 and ??80. To solve the optimization problem, a model of the generalized utility function is created which reflects the complex impact of dressing parameters. The model is built based on the results from the conducted complex study and modeling of the grinding wheel lifetime, cutting ability, production rate and cutting forces during grinding. They are closely related to the dressing conditions (dressing speed ratio, radial in-feed of the diamond roller dresser and dress-out time), the diamond roller dresser grit size/grinding wheel grit size ratio, the type of synthetic diamonds and the direction of dressing. Some dressing parameters are determined for which the generalized utility function has a maximum and which guarantee an optimum combination of the following: the lifetime and cutting ability of the abrasive wheels, the tangential cutting force magnitude and the production rate of the grinding process. The results obtained prove the possibility of control and optimization of grinding by selecting particular dressing

  8. Awareness and utilization of peer support programs in Singapore public general hospitals.

    Science.gov (United States)

    Chan, Angelina O M; Kee, Jass P C; Chan, Yiong Huak

    2012-01-01

    To address the effects of acute, chronic and cumulative stress in the healthcare environment in Singapore, the Ministry of Health provided funding to develop a comprehensive crisis response management system (peer support programs/PSPs) that increases mental health awareness, provides emotional support to affected staff during work-related critical incidents and assists hospital management to better understand the emotional needs of the employees. This paper reports the awareness and utilization of PSPs in Singapore public general hospitals about one year after they were set up.

  9. ADHD medication prescription: effects of child, sibling, parent and general practice characteristics.

    OpenAIRE

    Heins, M.J.; Bruggers, I.; van Dijk, L; Korevaar, J.C.

    2016-01-01

    Many children receive attention-deficit hyperactivity disorder (ADHD) medication, but factors that determine medication prescription are largely unknown. This study aimed to determine the relative impact of factors on the child, family and general practitioner (GP) practice level on ADHD medication prescription. We included 1259 Dutch children aged 6-18 years with a diagnostic code of ADHD or related behavioural problems (ICPC codes P20-P22) in NIVEL primary care database. Using multilevel an...

  10. Variables Associated with Utilization of a Centralized Medical Post in the Andean Community of Pampas Grande, Peru

    Science.gov (United States)

    Merry, Stephen P.; Rohrer, James E.; Thacher, Thomas D.; Summers, Matthew R.; Alpern, Jonathan D.; Contino, Robert W.

    2012-01-01

    Context: Integral to the location of health resources is the distance decay of utilization observed in a population. In rural Peru, a nongovernmental organization planning to increase the availability of health services needed this information. Purpose: To determine variables associated with utilization of a central medical clinic and determine…

  11. Impact of a new reimbursement program on hepatitis B antiviral medication cost and utilization in Beijing, China.

    Directory of Open Access Journals (Sweden)

    Qian Qiu

    Full Text Available BACKGROUND: Hepatitis B virus (HBV infection is a significant clinical and financial burden for chronic hepatitis B (CHB patients. In Beijing, China, partial reimbursement on antiviral agents was first implemented for the treatment of CHB patients in July 1, 2011. AIMS: In this study, we describe the medical cost and utilization rates of antiviral therapy for CHB patients to explore the impact of the new partial reimbursement policy on the medical care cost, the composition, and antivirals utilization. METHODS: Clinical and claims data of a retrospective cohort of 92,776 outpatients and 2,774 inpatients with non-cirrhotic CHB were retrieved and analyzed from You'an Hospital, Beijing between February 14, 2008 and December 31, 2012. The propensity score matching was used to adjust factors associated with the annual total cost, including age, gender, medical insurance type and treatment indicator. RESULTS: Compared to patients who paid out-of-pocket, medical cost, especially antiviral costs increased greater among patients with medical insurance after July 1, 2011, the start date of reimbursement policy. Outpatients with medical insurance had 16% more antiviral utilization; usage increased 3% among those who paid out-of-pocket after the new partial reimbursement policy was implemented. CONCLUSIONS: Direct medical costs and antiviral utilization rates of CHB patients with medical insurance were higher than those from paid out-of-pocket payments, even after adjusting for inflation and other factors. Thus, a new partial reimbursement program may positively optimize the cost and standardization of antiviral treatment.

  12. [Utilization of radionuclide therapy facility and assembly-temporary type therapeutic facility for medical treatment of radioactivity contaminated patients in nuclear emergency].

    Science.gov (United States)

    Watanabe, Naoyuki; Satro, Hiroyuki; Kawahara, Hiroshi; Sasaki, Yasuhito

    2011-05-01

    Medical management of patients internally contaminated in nuclear emergency needs, in addition to general medical treatment, to evaluate doses due to intakes of radioactive materials, to conduct effective treatment with stable isotopes and chelating agents and to keep public away from radioactive materials in and excreted from patients. The idea of medical treatment for internal contamination is demonstrated in the general principles on medical management of victims in nuclear emergency issued by the Cabinet Office in Japan. However, if impressive number patients with internal contamination are generated, the current medical management scheme in nuclear emergency is not able to admit them. The utilization of radionuclide therapy facilities where patients with thyroid diseases are treated with radioisotope and assembly-temporary housing type treatment facilities dedicated for internal contaminated patients may be expected to complement the medical management scheme in nuclear emergency. The effect or more medical management system for patients internally contaminated may become one of the safety nets in the contemporary society that inclines to use nuclear energy on account of accessibility.

  13. Making sense of medically unexplained symptoms in general practice: a grounded theory study

    OpenAIRE

    Stone, Louise

    2013-01-01

    Background General practitioners often encounter patients with medically unexplained symptoms. These patients share many common features, but there is little agreement about the best diagnostic framework for describing them.

  14. Intention to Encourage Complementary and Alternative Medicine among General Practitioners and Medical Students

    Science.gov (United States)

    Godin, Gaston; Beaulieu, Dominique; Touchette, Jean-Sebastien; Lambert, Leo-Daniel; Dodin, Sylvie

    2007-01-01

    The authors' goal was to identify factors explaining intention to encourage a patient to follow complementary and alternative medicine (CAM) treatment among general practitioners (GPs), fourth-year medical students, and residents in family medicine. They surveyed 500 GPs and 904 medical students via a self-administered mailed questionnaire that…

  15. 76 FR 20840 - Medical Devices; General and Plastic Surgery Devices; Classification of the Low Level Laser...

    Science.gov (United States)

    2011-04-14

    ... HUMAN SERVICES Food and Drug Administration 21 CFR Part 878 Medical Devices; General and Plastic Surgery...? In accordance with section 513(f)(1) of the Federal Food, Drug, and Cosmetic Act (the FD&C Act) (21 U... Medical devices. Therefore, under the Federal Food, Drug, and Cosmetic Act and under authority...

  16. How competent do graduates feel to undertake the skills required by the General Medical Council?

    Science.gov (United States)

    Watmough, Simon; Kennedy, Tom

    2014-08-01

    The General Medical Council outlines the skills medical students are meant to learn as undergraduates. This article summarizes how competent some foundation year one doctors from one deanery felt to undertake these skills, what had prepared them and what they would like more training on.

  17. Effects of New Rural Cooperative Medical Scheme on Medical Service Utilization and Medical Expense Control of Inpatients: A 3-year Empirical Study of Hainan Province in China

    Institute of Scientific and Technical Information of China (English)

    Tao Dai; Hong-Pu Hu; Xu Na; Ya-Zi Li; Yan-Li Wan; Li-Qin Xie

    2016-01-01

    Background:The New Rural Cooperative Medical Scheme (NCMS) has been further adjusted and optimized to reduce the financial burden of rural residents and to achieve universal coverage for them.In this study,we aimed to explore the impact of NCMS on medical service utilization and medical expense of inpatients in recent years.Methods:The research data of Hainan Province were extracted from the Chinese NCMS platform from 2012 to 2014.Detailed information included total expenditure,average inpatients costs,average out-of-pocket payments,actual reimbursement rate,and average annual growth rate of the above indicators.Descriptive analysis was used to gauge the effects of NCMS.Results:In the utilization of medical services,NCMS inpatients in tertiary hospital decreased from 25.49% in 2012 to 20.39% in 2014,inpatients in county hospitals increased from 39.49% to 55.92%,simultaneously.The total expenditure in county hospitals rose steadily from 28.46% to 46.66%,meanwhile,the total expenditure in tertiary hospitals fell from 60.44% to 44.51%.The average out-of-pocket costs of rural inpatients remained stable over the years.Furthermore,the compensation fund ofNCMS inpatients grew significantly.The actual inpatient reimbursement rate at township health centers increased from 76.93% to 84.04%.Meanwhile,the rate at county hospitals and tertiary hospitals increased slightly from 59.37% and 46.10% to 61.25% and 47.71%,respectively.Conclusions:With the improvement of the reimbursement ability,especially after the new health care reform in 2009,the NCMS have been playing a prominent role in alleviating the economic burden of farmers' medical treatment.Meanwhile,more patients go to primary hospitals than tertiary hospitals,and the capability of primary hospitals has been greatly improved.

  18. From Ambiguity Aversion to a Generalized Expected Utility. Modeling Preferences in a Quantum Probabilistic Framework

    CERN Document Server

    Aerts, Diederik

    2015-01-01

    Ambiguity and ambiguity aversion have been widely studied in decision theory and economics both at a theoretical and an experimental level. After Ellsberg's seminal studies challenging subjective expected utility theory (SEUT), several (mainly normative) approaches have been put forward to reproduce ambiguity aversion and Ellsberg-type preferences. However, Machina and other authors have pointed out some fundamental difficulties of these generalizations of SEUT to cope with some variants of Ellsberg's thought experiments, which has recently been experimentally confirmed. Starting from our quantum modeling approach to human cognition, we develop here a general probabilistic framework to model human decisions under uncertainty. We show that our quantum theoretical model faithfully represents different sets of data collected on both the Ellsberg and the Machina paradox situations, and is flexible enough to describe different subjective attitudes with respect to ambiguity. Our approach opens the way toward a quan...

  19. A Survey Aimed at General Citizens of the US and Japan about Their Attitudes toward Electronic Medical Data Handling

    Directory of Open Access Journals (Sweden)

    Michio Kimura

    2014-04-01

    Full Text Available Objectives: To clarify the views of the general population of two countries (US and Japan, concerning the handling of their medical records electronically. Methods: We contacted people nationwide in the United States at random via Random Digit Dialing (RDD to obtain 200 eligible responders. The questionnaire was for obtaining the information on their attitudes towards handling of their medical records, disclosure of the name of disease, secondary usage of information, compiling their records into a lifelong medical record, and access to their medical records on the Internet. We had also surveyed people of Shizuoka prefecture in Japan using same questionnaires sent by mail, for which we obtained 457 valid answers. Results: Even in an unidentifiable manner, US people feel profit-oriented usage of medical data without specific consent is not acceptable. There is a significant difference between usage of unidentifiable medical data for profit (about 50% feel negatively and for official/research purposes (about 30% feel negatively. About 60% of the US responders have a negative view on the proposal that unidentifiable medical information be utilized for profit by private companies to attain healthcare cost savings. As regards compiling a lifelong medical record, positive answers and negative answers are almost equally divided in the US (46% vs. 38% while more positive attitudes are seen in Japan (74% vs. 12%. However, any incentive measures aimed at changing attitudes to such a compiling including the discount of healthcare costs or insurance fees are unwelcomed by people regardless of their age or health condition in both surveys. Regarding the access to their own medical record via the Internet, 38% of the US responders feel this is unacceptable while 50.5% were willing to accept it. Conclusions: Participants from the US think that the extent of the sharing their identifiable medical records should be limited to the doctors-in-charge and specified

  20. The influence of experiential learning on medical equipment adoption in general practices.

    Science.gov (United States)

    Bourke, Jane; Roper, Stephen

    2014-10-01

    The benefits of the availability and use of medical equipment for medical outcomes are understood by physicians and policymakers alike. However, there is limited understanding of the decision-making processes involved in adopting and using new technologies in health care organisations. Our study focuses on the adoption of medical equipment in Irish general practices which are marked by considerable autonomy in terms of commercial practice and the range of medical services they provide. We examine the adoption of six items of medical equipment taking into account commercial, informational and experiential stimuli. Our analysis is based on primary survey data collected from a sample of 601 general practices in Ireland on practice characteristics and medical equipment use. We use a multivariate Probit to identify commonalities in the determinants of the adoption. Many factors, such as GP and practice characteristics, influence medical equipment adoption. In addition, we find significant and consistent evidence of the influence of learning-by-using effects on the adoption of medical equipment in a general practice setting. Knowledge generated by experiential or applied learning can have commercial, organisational and health care provision benefits in small health care organisations. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. Extending the Utility of the Parabolic Approximation in Medical Ultrasound Using Wide-Angle Diffraction Modeling.

    Science.gov (United States)

    Soneson, Joshua E

    2017-04-01

    Wide-angle parabolic models are commonly used in geophysics and underwater acoustics but have seen little application in medical ultrasound. Here, a wide-angle model for continuous-wave high-intensity ultrasound beams is derived, which approximates the diffraction process more accurately than the commonly used Khokhlov-Zabolotskaya-Kuznetsov (KZK) equation without increasing implementation complexity or computing time. A method for preventing the high spatial frequencies often present in source boundary conditions from corrupting the solution is presented. Simulations of shallowly focused axisymmetric beams using both the wide-angle and standard parabolic models are compared to assess the accuracy with which they model diffraction effects. The wide-angle model proposed here offers improved focusing accuracy and less error throughout the computational domain than the standard parabolic model, offering a facile method for extending the utility of existing KZK codes.

  2. Syndromic surveillance in companion animals utilizing electronic medical records data: development and proof of concept

    Directory of Open Access Journals (Sweden)

    Philip H. Kass

    2016-05-01

    Full Text Available In an effort to recognize and address communicable and point-source epidemics in dog and cat populations, this project created a near real-time syndromic surveillance system devoted to companion animal health in the United States. With over 150 million owned pets in the US, the development of such a system is timely in light of previous epidemics due to various causes that were only recognized in retrospect. The goal of this study was to develop epidemiologic and statistical methods for veterinary hospital-based surveillance, and to demonstrate its efficacy by detection of simulated foodborne outbreaks using a database of over 700 hospitals. Data transfer protocols were established via a secure file transfer protocol site, and a data repository was constructed predominantly utilizing open-source software. The daily proportion of patients with a given clinical or laboratory finding was contrasted with an equivalent average proportion from a historical comparison period, allowing construction of the proportionate diagnostic outcome ratio and its confidence interval for recognizing aberrant heath events. A five-tiered alert system was used to facilitate daily assessment of almost 2,000 statistical analyses. Two simulated outbreak scenarios were created by independent experts, blinded to study investigators, and embedded in the 2010 medical records. Both outbreaks were detected almost immediately by the alert system, accurately detecting species affected using relevant clinical and laboratory findings, and ages involved. Besides demonstrating proof-in-concept of using veterinary hospital databases to detect aberrant events in space and time, this research can be extended to conducting post-detection etiologic investigations utilizing exposure information in the medical record.

  3. Knowledge of and attitudes toward electroconvulsive therapy among medical students, psychology students, and the general public.

    Science.gov (United States)

    Aki, Ozlem Erden; Ak, Sertac; Sonmez, Yunus Emre; Demir, Basaran

    2013-03-01

    Electroconvulsive therapy (ECT) is safe and effective for the treatment of various psychiatric disorders. Despite being a well-known treatment method among health care professionals, lay people generally have a negative opinion of ECT. The present study aimed to examine knowledge of and attitudes toward ECT among medical students, psychology students, and the general public. Psychology students were included because they are among the important groups in mental health care in Turkey. A Likert-type questionnaire was administered to fifth-year medical students (n = 28), master of science and doctor of philosophy clinical psychology students (n = 35), and a sample of the general public (n = 26). The questionnaire included questions about the general principles of and indications for ECT, and sources of knowledge of and attitudes toward ECT. The medical students were the most knowledgeable about ECT, as expected. The medical students also had a more positive attitude toward ECT than the other 2 groups. More psychology students had negative attitudes on some aspects than general public sample, despite being more knowledgeable. Medical school theoretical and practical training in ECT played an important role in increasing the level of knowledge of and decreasing the prevalence of negative attitudes toward ECT among the medical students; similar training for psychology students is required to achieve similar results.

  4. 76 FR 42713 - General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Amendment of...

    Science.gov (United States)

    2011-07-19

    ... HUMAN SERVICES Food and Drug Administration General and Plastic Surgery Devices Panel of the Medical... General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee. This meeting was... of the General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee would be...

  5. Determinants of Emergency Medical Services Utilization Among Acute Ischemic Stroke Patients in Hubei Province in China.

    Science.gov (United States)

    Yin, Xiaoxv; Yang, Tingting; Gong, Yanhong; Zhou, Yanfeng; Li, Wenzhen; Song, Xingyue; Wang, Mengdie; Hu, Bo; Lu, Zuxun

    2016-03-01

    Emergency medical services (EMS) can effectively shorten the prehospital delay for patients with acute ischemic stroke. This study aimed to investigate EMS utilization and its associated factors in patients with acute ischemic stroke in China. A cross-sectional study was conducted from October 1, 2014, to January 31, 2015, which included 2096 patients admitted for acute ischemic stroke from 66 hospitals in Hubei province in China. A multivariable stepwise logistic regression model was undertaken to identify the factors associated with EMS utilization. Of the 2096 participants, only 323 cases (15.4%) used EMS. Those acute ischemic stroke patients who previously used EMS (odds ratio [OR] =9.8), whose National Institutes of Health Stroke Scale score was ≥10 (OR=3.7), who lived in urban communities (OR=2.5), who had sudden onset of symptoms (OR=2.4), who experienced their first stroke (OR=1.8), and who recognized initial symptom as stroke (OR=1.4) were more likely to use EMS. Additionally, when acute ischemic stroke patients' stroke symptom were noticed first by others (OR=2.1), rather than by the patients, EMS was more likely to be used. A very low proportion of patients with acute ischemic stroke used the EMS in Hubei province in China. Considerable education programs are required regarding knowledge of potential symptoms and the importance of EMS for stroke. © 2016 American Heart Association, Inc.

  6. Characterization and Utilization of castor bean seed oil extract for production of medicated soap.

    Directory of Open Access Journals (Sweden)

    Abdulrasheed A

    2015-12-01

    Full Text Available The research work is to investigate the potential utilization of castor bean seed oil extract in the production of medicated soap. The oil was extracted via soxhlet extractor using hexane as solvent. The characterization analysis reveals the acid value and saponification value of the oil which were between the ranges of values specified by ASTM. The soap produced gave a pH of (8.9, foam height (16cm, alcohol insoluble (3.45%, moisture content (4.2% and free acidity of (0.10. The antibacterial activity of soap produced from castor oil on bacteria isolate (Staphylococcus Aureus was promising with an inhibition zone of 15.5mm but at dilutions of 10-1 , 10-2 and 10-3 , were found to be 11.5mm, 9.5mm and 6mm respectively. This shows that as concentration decreases, the sensitivity of the soap to the bacteria isolate also decreases. The sensitivity of the medicated soap to the bacteria isolate is as a result of the presence of ricinoleic acid present in large proportion in the fatty acid composition of castor oil. It can be concluded that a highly effective soap can be produced from castor bean seed oil extract.

  7. Association between resource utilization and patient satisfaction at a tertiary care medical center.

    Science.gov (United States)

    Biondi, Eric A; Hall, Matthew; Leonard, Michael S; Pirraglia, Paul A; Alverson, Brian K

    2016-11-01

    The Centers for Medicare and Medicaid Services has emphasized patient satisfaction as a means by which hospitals should be compared and as a component of financial reimbursement. We sought to identify whether resource utilization is associated with patient satisfaction ratings. This was a retrospective, cohort study over a 27-month period from January 2012 to April 2014 of adult respondents (n = 10,007) to the Hospital Consumer Assessment of Healthcare Providers and Systems survey at a tertiary care medical center. For each returned survey, we developed a resource intensity score related to the corresponding hospitalization. We calculated a raw satisfaction rating (RSR) for each returned survey. Multivariable logistic regression was used to determine the association between resource intensity and top decile RSRs, using those with the lowest resource intensity as the reference group. Adjusting for age, gender, insurance payer, severity of illness, and clinical service, patients in higher resource intensity groups were more likely to assign top decile RSRs than the lowest resource intensity group ("moderate" [adjusted odds ratio {aOR}: 1.42, 95% confidence interval {CI}: 1.11-1.83], "major" [aOR: 1.56, 95% CI: 1.22-2.01], and "extreme" [aOR: 2.29, 95% CI: 1.8-2.92]). Resource utilization may be positively associated with patient satisfaction. These data suggest that hospitals with higher per-patient expenditures may receive higher ratings, which could result in hospitals with higher per-patient resource utilization appearing more attractive to healthcare consumers. Journal of Hospital Medicine 2016;11:785-791. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

  8. National data analysis of general radiography projection method in medical imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Su; Seo, Deok Nam; Choi, In Seok [Dept. of Bio-Convergence Engineering, Korea University Graduate School, Seoul (Korea, Republic of); and others

    2014-09-15

    According to database of medical institutions of health insurance review and assessment service in 2013, 1,118 hospitals and clinics have department of radiology in Korea. And there are CT, fluoroscopic and general radiographic equipment in those hospitals. Above all, general radiographic equipment is the most commonly used in the radiology department. And most of the general radiographic equipment are changing the digital radiography system from the film-screen types of the radiography system nowadays. However, most of the digital radiography department are used the film-screen types of the radiography system. Therefore, in this study, we confirmed present conditions of technical items for general radiography used in hospital and research on general radiographic techniques in domestic medical institutions. We analyzed 26 radiography projection method including chest, skull, spine and pelvis which are generally used in the radiography department.

  9. Vertical Integration in Teaching And Learning (VITAL): an approach to medical education in general practice.

    Science.gov (United States)

    Dick, Marie-Louise B; King, David B; Mitchell, Geoffrey K; Kelly, Glynn D; Buckley, John F; Garside, Susan J

    2007-07-16

    There is increasing demand to provide clinical and teaching experiences in the general practice setting. Vertical integration in teaching and learning, whereby teaching and learning roles are shared across all learner stages, has the potential to decrease time demands and stress on general practitioners, to provide teaching skills and experience to GP registrars, and to improve the learning experience for medical students, and may also help meet the increased demand for teaching in general practice. We consider potential advantages and barriers to vertical integration of teaching in general practice, and provide results of focus group discussions with general practice principals and registrars about vertical integration. We recommend further research into the feasibility of using vertical integration to enhance the capacity to teach medical students in general practice.

  10. ADHD medication prescription: Effects of child, sibling, parent and general practice characteristics.

    Science.gov (United States)

    Heins, Marianne J; Bruggers, Inge; van Dijk, Liset; Korevaar, Joke C

    2016-10-05

    Many children receive attention-deficit hyperactivity disorder (ADHD) medication, but factors that determine medication prescription are largely unknown. This study aimed to determine the relative impact of factors on the child, family and general practitioner (GP) practice level on ADHD medication prescription. We included 1259 Dutch children aged 6-18 years with a diagnostic code of ADHD or related behavioural problems (ICPC codes P20-P22) in NIVEL primary care database. Using multilevel analyses, we examined predictors of ADHD medication prescription. Children diagnosed as 'hyperactive' were 16 times more likely to be prescribed ADHD medication than those with 'behavioural concerns'. Children with a parent or sibling receiving ADHD medication were three to four times more likely to be prescribed ADHD medication themselves. Children from GP practices with a high percentage of children with ADHD were twice as likely to be prescribed ADHD medication. Concluding, factors on the individual, family and GP practice level determine ADHD medication prescription. Future research into the decision-making process for ADHD medication is warranted.

  11. For the General Internist: A Summary of Key Innovations in Medical Education.

    Science.gov (United States)

    Roy, Brita; Chheda, Shobhina G; Bates, Carol; Dunn, Kathel; Karani, Reena; Willett, Lisa L

    2016-08-01

    We conducted a review of published medical education articles to identify high-quality research and innovation relevant to educators in general medicine. Our review team consisted of six general internists with expertise in medical education and a professional medical librarian. We manually searched 15 journals in pairs (a total of 3062 citations) for original research articles in medical education published in 2014. Each pair of reviewers independently rated the relevance, importance, and generalizability of articles on medical education in their assigned journals using a 27-point scale (maximum of 9 points for each characteristic). From this list, each team member independently reviewed the 22 articles that received a score of 20 or higher from both initial reviewers, and for each selected article rated the quality and global relevance for the generalist educator. We included the seven top-rated articles for presentation in this review, and categorized the studies into four general themes: continuity clinic scheduling, remediation, interprofessional education, and quality improvement and patient safety. We summarized key findings and identified significant limitations of each study. Further studies assessing patient outcomes are needed to strengthen the literature in medical education. This summary of relevant medical education articles can inform future research, teaching, and practice.

  12. Differences in the volume of pharmaceutical advertisements between print general medical journals.

    Science.gov (United States)

    Gettings, Jennifer; O'Neill, Braden; Chokshi, Dave A; Colbert, James A; Gill, Peter; Lebovic, Gerald; Lexchin, Joel; Persaud, Navindra

    2014-01-01

    Pharmaceutical advertisements have been argued to provide revenue that medical journals require but they are intended to alter prescribing behaviour and they are known to include low quality information. We determined whether a difference exists in the current level of pharmaceutical advertising in print general medical journals, and we estimated the revenue generated from print pharmaceutical advertising. Six print general medical journals in Canada, the United States, and the United Kingdom were sampled between 2007 and 2012. The number of advertisements and other journal content in selected issues of the Canadian Medical Association Journal (CMAJ), Canadian Family Physician (CFP), Journal of the American Medical Association (JAMA), New England Journal of Medicine (NEJM), British Medical Journal (BMJ), and Lancet were determined. Revenue gained from pharmaceutical advertising was estimated using each journal's 2013 advertising price list. The two Canadian journals sampled (CMAJ, CFP) contained five times more advertisements than the two American journals (JAMA, NEJM), and two British journals (BMJ, Lancet) (pjournals, with the two Canadian journals sampled containing the most advertisements. International and temporal variations suggest that there is an opportunity for all general medical journals to reduce the number of pharmaceutical advertisements, explore other sources of revenue, and increase transparency regarding sources of revenue.

  13. An examination of generalized anxiety disorder and dysthymia utilizing the Rorschach inkblot method.

    Science.gov (United States)

    Slavin-Mulford, Jenelle; Clements, Alyssa; Hilsenroth, Mark; Charnas, Jocelyn; Zodan, Jennifer

    2016-06-30

    This study examined transdiagnostic features of generalized anxiety disorder (GAD) and dysthymia in an outpatient clinical sample. Fifteen patients who met DSM-IV criteria for GAD and twenty-one patients who met DSM-IV criteria for dysthymia but who did not have comorbid anxiety disorder were evaluated utilizing the Rorschach. Salient clinical variables were then compared. Results showed that patients with GAD scored significantly higher on variables related to cognitive agitation and a desire/need for external soothing. In addition, there was a trend for patients with GAD to produce higher scores on a measure of ruminative focus on negative aspects of the self. Thus, not surprisingly, GAD patients' experienced more distress than the dysthymic patients. The implications of these findings are discussed with regards to better understanding the shared and distinct features of GAD and dysthymia.

  14. A survey on acquaintance, orientation and behavior of general medical practitioners toward periodontal diseases

    Directory of Open Access Journals (Sweden)

    Supreet Kaur

    2015-01-01

    Full Text Available Background: An association between oral conditions such as periodontal diseases and systemic conditions is noted. As such, periodontal disease is associated with an increased risk of systemic illnesses such as cardiovascular disease, diabetes, adverse pregnancy outcome, atherosclerosis, stroke and hospital acquired pneumonia. The concept of diagnosing and treating a potential patient to minimize the deleterious effects of this chronic infectious and inflammatory condition on systemic conditions represents both an unprecedented challenge and opportunity to our profession. Keeping this in view, the present survey was designed to evaluate the acquaintance, orientation and behavior of general medical practitioners; concerning the effects of periodontal disease on systemic health. Materials and Methods: A typed questionnaire carrying four sets of questions was distributed among general medical practitioners of seven different government and private medical colleges and hospitals. Questionnaire was developed to assess the acquaintance, orientation and behavior of general medical practitioners toward periodontal disease. Results: Most of the respondents have knowledge regarding the signs and symptoms of periodontal disease and its association with cardiovascular disease. However, majority of them do not know about the potential effect of periodontal disease on other organ systems. Conclusion: General medical practitioners have inadequate knowledge regarding periodontal diseases. Hence, oral health related training should be an integral part of the medical curriculum.

  15. CAVE3: A general transient heat transfer computer code utilizing eigenvectors and eigenvalues

    Science.gov (United States)

    Palmieri, J. V.; Rathjen, K. A.

    1978-01-01

    The method of solution is a hybrid analytical numerical technique which utilizes eigenvalues and eigenvectors. The method is inherently stable, permitting large time steps even with the best of conductors with the finest of mesh sizes which can provide a factor of five reduction in machine time compared to conventional explicit finite difference methods when structures with small time constants are analyzed over long time periods. This code will find utility in analyzing hypersonic missile and aircraft structures which fall naturally into this class. The code is a completely general one in that problems involving any geometry, boundary conditions and materials can be analyzed. This is made possible by requiring the user to establish the thermal network conductances between nodes. Dynamic storage allocation is used to minimize core storage requirements. This report is primarily a user's manual for CAVE3 code. Input and output formats are presented and explained. Sample problems are included which illustrate the usage of the code as well as establish the validity and accuracy of the method.

  16. Min-max optimization and the radial approach to the public service system design with generalized utility

    Directory of Open Access Journals (Sweden)

    Jaroslav Janáček

    2016-04-01

    Full Text Available The paper deals with the min-max public service system design, where the generalized utility is considered. In contrast to the formulations presented in the literature, the generalized utility defined for a public service system assumes that the user’s utility comes generally from more than one located service center and the individual contributions from relevant centers are weighted by reduction coefficients depending on a center order. Given that commercial IP-solvers often fail due to enormous computational times or extreme memory demands when resolving this issue, we suggested and compared several approaches based on a bisection process with the purpose of developing an effective max-min approach to the public service system design with a generalized utility.

  17. Utilization of a consultation liaison psychiatry service in a general hospital.

    Science.gov (United States)

    Gobar, A H; Collins, J L; Mathura, C B

    1987-05-01

    This retrospective study was conducted in response to a need to evaluate the overall utilization rates of the psychiatric consultation liaison service by nonpsychiatric units within Howard University Hospital, which deals almost exclusively with a black, inner-city population. The study covers a three-year period (July 1982 to July 1985). During this time only 815 patients (2 percent) were referred for psychiatric evaluation out of the total number of hospital admissions (40,000 patients).Patient characteristics and general attitudes appear to have had a major role in this low ratio of referrals, particularly a lack of awareness and bias against psychiatry. This latter finding is in disparity with other published reports. Diagnostically, depression, organic mental disorders (acute), and substance abuse (mainly PCP) constituted the greater bulk of the patients seen by the consultation liaison psychiatry service. The review of a random sample of psychiatric inpatients (n = 100) revealed that in 50 percent of the cases there was a coexisting physical illness or abnormality.The role of mental health education and the liaison function needs to be emphasized. It is suggested that efforts should be directed toward a wider acceptance and utilization of consultation liaison psychiatry by primary care physicians in general hospitals. The factors listed by physicians and patients that may account for the observed underutilization of consultation liaison services are discussed. The results of 20 interviews and the reasons given by referring physicians as to whether or not they will seek consultation from the consultation liaison services are also reviewed.

  18. No Difference in Psychotropic Medication Use in Cosmetic and General Dermatology Patients.

    Science.gov (United States)

    Hamilton, Heather K; Lilly, Evelyn; Arndt, Kenneth A; Dover, Jeffrey S

    2016-07-01

    Patients presenting for appearance-related concerns are often perceived as being more difficult (ie, more needy, more difficult to satisfy) than patients presenting for medical dermatologic problems. While the reasons for this perception are many, some hypothesize that this may be related to a higher rate of anxiety, depression, or body image issues among these patients. To determine the prevalence of psychotropic medication use in cosmetic dermatology patients compared to the prevalence of such medication use in general dermatology patients. METHODS & The study was a retrospective chart review of female patients, 18 or older, new to a private practice. Exclusion criteria included dermatologic disorders with known psychosocial comorbidity. Psychotropic medication use was recorded. The percentage of subjects in the medical group (n=156) who reported using psychotropic medications was 22.2% compared to 26.8% in the cosmetic group (n=154; P=0.09). The prevalence of psychotropic medication use among all dermatology patients in our practice was relatively high, but there was no statistically significant difference in the rate of psychotropic medication use in cosmetic dermatology patients compared to general dermatology patients. J Drugs Dermatol. 2016;15(7):858-861.

  19. General Duties Medical Officer Role 1 remote supervision in the era of Army Contingency Operations.

    Science.gov (United States)

    Martin-Bates, Alexander James; Jefferys, S E

    2016-08-01

    The return to contingency after Operation HERRICK (2002-2014 Afghanistan conflict) has seen an emerging trend for small-scale rapidly developing expeditionary operations. The associated small, remote medical footprint for such operations, often within a coalition construct, reliant on host nation support is in direct conflict with the General Medical Council (GMC) guidelines for junior doctor supervision in an 'approved practice setting'. If a General Duties Medical Officer (GDMO) is nominated to support future operations, the provision of assured patient care and supervision within GMC guidelines, while ensuring career progression and ongoing education, may prove a challenge. Recently published British Army Policy aims to provide a framework to meet these challenges. The authors' first-hand experience in implementing this policy is explored further. The deployment of a remotely supervised GDMO, in line with British Army Policy, is both suitable and safe. This should assure quality medical care delivery during the era of Army Contingency Operations.

  20. Impact of late-stage CKD and aging on medical utilization in the elderly population: a closed-cohort study in Taiwan.

    Science.gov (United States)

    Lin, Ming-Yen; Hwang, Shang-Jyh; Mau, Lih-Wen; Chen, Hung-Chun; Hwang, Su-Chen; Wu, Ling-Chu; Chiu, Herng-Chia

    2010-10-01

    Taiwan has the highest incidence and prevalence of end-stage renal disease globally, especially in the elderly population. The elderly with chronic kidney disease (CKD) also had high mortality. However, population-based research on how the elderly with CKD utilize medical services is still unexplored. We aimed to examine the effects of CKD severity and aging on medical utilizations in the elderly population. This retrospective closed cohort study analysed 7868 elderly residents of Kaohsiung City, who participated in the government-sponsored annual physical examination in 1997. The information of medical services and expenses were obtained from the claimed data of the National Health Insurance from 1996 to 1999. CKD was grouped into five stages according to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF K-DOQI) criteria with modifications. Late-stage CKD was defined as CKD Stages 3 to 5 [estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m(2)]. Those subjects with eGFR above 60 ml/min/1.73 m(2) were treated as the reference group. After adjusting all covariates, the odds ratios of hospitalization for elderly subjects with CKD stages 3a, 3b and 4/5 were 1.19 (95% CI = 1.08-1.32), 1.48 (95% CI = 1.26-1.73) and 1.68 (95% CI = 1.21-2.33) compared with the reference group, respectively (P < 0.001). The autoregressive generalized estimating equation analysis revealed that CKD stage had linear associations with medical expenditures during the study period, especially for those elderly subjects with later stage CKD. Increases in medical utilizations and expenses were demonstrated in elderly CKD subjects, especially those with late stage CKD. Early prevention of CKD is necessary to lessen the financial impact on medical health care.

  1. Community pharmacy and mail order cost and utilization for 90-day maintenance medication prescriptions.

    Science.gov (United States)

    Khandelwal, Nikhil; Duncan, Ian; Rubinstein, Elan; Ahmed, Tamim; Pegus, Cheryl

    2012-04-01

    Pharmacy benefit management (PBM) companies promote mail order programs that typically dispense 90-day quantities of maintenance medications, marketing this feature as a key cost containment strategy to address plan sponsors' rising prescription drug expenditures. In recent years, community pharmacies have introduced 90-day programs that provide similar cost advantages, while allowing these prescriptions to be dispensed at the same pharmacies that patients frequent for 30-day quantities. To compare utilization rates and corresponding costs associated with obtaining 90-day prescriptions at community and mail order pharmacies for payers that offer equivalent benefits in different 90-day dispensing channels. We performed a retrospective, cross-sectional investigation using pharmacy claims and eligibility data from employer group clients of a large PBM between January 2008 and September 2010. We excluded the following client types: government, third-party administrators, schools, hospitals, 340B (federal drug pricing), employers in Puerto Rico, and miscellaneous clients for which the PBM provided billing services (e.g., the pharmacy's loyalty card program members). All employer groups in the sample offered 90-day community pharmacy and mail order dispensing and received benefits management services, such as formulary management and mail order pharmacy, from the PBM. We further limited the sample to employer groups that offered equivalent benefits for community pharmacy and mail order, defined as groups in which the mean and median copayments per claim for community and mail order pharmacy, by tier, differed by no more than 5%. Enrollees in the sample were required to have a minimum of 6 months of eligibility in each calendar year but were not required to have filled a prescription in any year. We evaluated pharmacy costs and utilization for a market basket of 14 frequently dispensed therapeutic classes of maintenance medications. The proportional share of claims for

  2. Differences in the volume of pharmaceutical advertisements between print general medical journals.

    Directory of Open Access Journals (Sweden)

    Jennifer Gettings

    Full Text Available BACKGROUND: Pharmaceutical advertisements have been argued to provide revenue that medical journals require but they are intended to alter prescribing behaviour and they are known to include low quality information. We determined whether a difference exists in the current level of pharmaceutical advertising in print general medical journals, and we estimated the revenue generated from print pharmaceutical advertising. METHODS: Six print general medical journals in Canada, the United States, and the United Kingdom were sampled between 2007 and 2012. The number of advertisements and other journal content in selected issues of the Canadian Medical Association Journal (CMAJ, Canadian Family Physician (CFP, Journal of the American Medical Association (JAMA, New England Journal of Medicine (NEJM, British Medical Journal (BMJ, and Lancet were determined. Revenue gained from pharmaceutical advertising was estimated using each journal's 2013 advertising price list. FINDINGS: The two Canadian journals sampled (CMAJ, CFP contained five times more advertisements than the two American journals (JAMA, NEJM, and two British journals (BMJ, Lancet (p<0.0001. The estimated annual revenue from pharmaceutical advertisements ranged from £0.025 million (for Lancet to £3.8 million (for JAMA. The cost savings due to revenue from pharmaceutical advertising to each individual subscriber ranged from £0.02 (for Lancet to £3.56 (for CFP per issue. CONCLUSION: The volume of pharmaceutical advertisements differs between general medical journals, with the two Canadian journals sampled containing the most advertisements. International and temporal variations suggest that there is an opportunity for all general medical journals to reduce the number of pharmaceutical advertisements, explore other sources of revenue, and increase transparency regarding sources of revenue.

  3. The medical science fiction of James White: Inside and Outside Sector General.

    Science.gov (United States)

    Howard, Richard

    2016-12-01

    James White was a Northern Irish science fiction author working in the subgenre of medical science fiction from the mid-1950s to the end of the twentieth century. The aim of this article is to introduce White to scholars working in the medical humanities, pointing to features of interest and critiquing the more excessive utopian impulses of the author. The article covers White's Sector General series, set on a vast intergalactic hospital, as well as the author's standalone fictions.

  4. Utility of the Morisky Medication Adherence Scale in gout: a prospective study

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    Tan CSL

    2016-12-01

    Full Text Available CSL Tan,1 GG Teng,1,2 KJ Chong,2 PP Cheung,1,2 AYN Lim,1,2 HL Wee,3,4 A Santosa1,2 1University Medicine Cluster, Division of Rheumatology, National University Health System, 2Department of Medicine, Yong Loo Lin School of Medicine, 3Department of Pharmacy, Faculty of Science, 4Saw Swee Hock School of Public Health, National University of Singapore, Singapore Background: The outcomes of any chronic illness often depend on patients’ adherence with their treatment. A tool is lacking to assess adherence in gout that is standardized, allows real-time feedback, and is easy to understand.Objective: We set out to evaluate the utility of the 8-item Morisky Medication Adherence Scale (MMAS-8 in monitoring medication adherence in a multiethnic Asian gout cohort on urate-lowering therapy (ULT.Methods: This cohort study recruited patients with gout where baseline and 6-monthly clinical data, self-report of adherence, and health status by Gout Impact Scale (GIS and EuroQoL-5 dimension 3 levels were collected. Those who received at least 9 months of ULT were analyzed. Convergent and construct validities of MMAS-8 were evaluated against medication possession ratio (MPR and known groups, clinical outcomes, and patient-reported outcomes. Internal consistency and test–retest reliability were assessed using Cronbach’s alpha and intraclass correlation coefficient (ICC, respectively.Results: Of 91 patients, 92.3% were male, 72.5% Chinese with mean age 53.5 years. MMAS-8 (mean 6.17 and MPR (mean 96.3% were poorly correlated (r=0.069, P=0.521. MMAS-8 did not differ between those who did or did not achieve target serum urate (SU <360 µmol/L (P=0.852; or among those whose SU improved, stagnated, or worsened during follow-up (P=0.777. Adherence was associated with age (β=0.256, P=0.015 and education level (P=0.011 but not comorbidities, polypharmacy, or flare frequency. Concerns for medication side effects and anxiety or depression were associated with lower MMAS

  5. Surgery or general medicine: a study of the reasons underlying the choice of medical specialty

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    Patrícia Lacerda Bellodi

    Full Text Available CONTEXT: The reality of medical services in Brazil points towards expansion and diversification of medical knowledge. However, there are few Brazilian studies on choosing a medical specialty. OBJECTIVE: To investigate and characterize the process of choosing the medical specialty among Brazilian resident doctors, with a comparison of the choice between general medicine and surgery. TYPE OF STUDY: Stratified survey. SETTING: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP. METHODS: A randomized sample of resident doctors in general medicine (30 and surgery (30 was interviewed. Data on sociodemographic characteristics and the moment, stability and reasons for the choice of specialty were obtained. RESULTS: The moment of choice between the two specialties differed. Surgeons (30% choose the specialty earlier, while general doctors decided progressively, mainly during the internship (43%. Most residents in both fields (73% general medicine, 70% surgery said they had considered another specialty before the current choice. The main reasons for general doctors' choice were contact with patients (50%, intellectual activities (30% and knowledge of the field (27%. For surgeons the main reasons were practical intervention (43%, manual activities (43% and the results obtained (40%. Personality was important in the choice for 20% of general doctors and for 27% of surgeons. DISCUSSION: The reasons found for the choice between general medicine and surgery were consistent with the literature. The concepts of wanting to be a general doctor or a surgeon are similar throughout the world. Personality characteristics were an important influencing factor for all residents, without statistical difference between the specialties, as was lifestyle. Remuneration did not appear as a determinant. CONCLUSION: The results from this group of Brazilian resident doctors corroborated data on choosing a medical specialty from other countries

  6. For the general internist: a review of relevant 2013 innovations in medical education.

    Science.gov (United States)

    Roy, Brita; Willett, Lisa L; Bates, Carol; Duffy, Briar; Dunn, Kathel; Karani, Reena; Chheda, Shobhina G

    2015-04-01

    We conducted a review of articles published in 2013 to identify high-quality research in medical education that was relevant to general medicine education practice. Our review team consisted of six general internists with expertise in medical education of varying ranks, as well as a professional medical librarian. We manually searched 15 journals in pairs, and performed an online search using the PubMed search engine for all original research articles in medical education published in 2013. From the total 4,181 citations identified, we selected 65 articles considered most relevant to general medicine educational practice. Each team member then independently reviewed and rated the quality of each selected article using the modified Medical Education Research Study Quality Instrument. We then reviewed the quality and relevance of each selected study and grouped them into categories of propensity for inclusion. Nineteen studies were felt to be of adequate quality and were of moderate to high propensity for inclusion. Team members then independently voted for studies they felt to be of the highest relevance and quality within the 19 selected studies. The ten articles with the greatest number of votes were included in the review. We categorized the studies into five general themes: Improving Clinical Skills in UME, Inpatient Clinical Teaching Methods, Advancements in Continuity Clinic, Handoffs/Transitions in Care, and Trainee Assessment. Most studies in our review of the 2013 literature in general medical education were limited to single institutions and non-randomized study designs; we identified significant limitations of each study. Selected articles may inform future research and practice of medical educators.

  7. Medical ultrasound imaging method combining minimum variance beamforming and general coherence factor

    Institute of Scientific and Technical Information of China (English)

    WU Wentao; PU Jie; LU Yi

    2012-01-01

    In medical ultrasound imaging field, in order to obtain high resolution and correct the phase errors induced by the velocity in-homogeneity of the tissue, a high-resolution medical ultrasound imaging method combining minimum variance beamforming and general coherence factor was presented. First, the data from the elements is delayed for focusing; then the multi-channel data is used for minimum variance beamforming; at the same time, the data is transformed from array space to beam space to calculate the general coherence factor; in the end, the general coherence factor is used to weight the results of minimum variance beamforming. The medical images are gotten by the imaging system. Experiments based on point object and anechoic cyst object are used to verify the proposed method. The results show the proposed method in the aspects of resolution, contrast and robustness is better than minimum variance beamforming and conventional beamforming.

  8. 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

    BACKGROUND: Practical descriptions of procedures used for pharmacists' medication reviews are sparse. OBJECTIVE: To describe a model for medication review by pharmacists tailored to a general practice setting. METHODS: A stepwise model is described. The model is based on data from the medical chart...... 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...... concerned the reporting of interventions and the considerations of the GPs. 208 interventions were proposed among the 50 patients. The acceptance rate among the GPs was 82%. The most common interventions were lack of clinical or laboratory data (n=57, 27%) and drugs that should be discontinued as they had...

  9. Emergency Medical Services Utilization in EMS Priority Conditions in Beirut, Lebanon.

    Science.gov (United States)

    El Sayed, Mazen; Tamim, Hani; Chehadeh, Ahel Al-Hajj; Kazzi, Amin A

    2016-12-01

    Early activation and use of Emergency Medical Services (EMS) are associated with improved patient outcomes in EMS priority conditions in developed EMS systems. This study describes patterns of EMS use and identifies predictors of EMS utilization in EMS priority conditions in Lebanon METHODS: This was a cross-sectional study of a random sample of adult patients presenting to the emergency department (ED) of a tertiary care center in Beirut with the following EMS priority conditions: chest pain, major trauma, respiratory distress, cardiac arrest, respiratory arrest, and airway obstruction. Patient/proxy survey (20 questions) and chart review were completed. The responses to survey questions were "disagree," "neutral," or "agree" and were scored as one, two, or three with three corresponding to higher likelihood of EMS use. A total scale score ranging from 20 to 60 was created and transformed from 0% to 100%. Data were analyzed based on mode of presentation (EMS vs other). Among the 481 patients enrolled, only 112 (23.3%) used EMS. Mean age for study population was 63.7 years (SD=18.8 years) with 56.5% males. Mean clinical severity score (Emergency Severity Index [ESI]) was 2.5 (SD=0.7) and mean pain score was 3.1 (SD=3.5) at ED presentation. Over one-half (58.8%) needed admission to hospital with 21.8% to an intensive care unit care level and with a mortality rate of 7.3%. Significant associations were found between EMS use and the following variables: severity of illness, degree of pain, familiarity with EMS activation, previous EMS use, perceived EMS benefit, availability of EMS services, trust in EMS response times and treatment, advice from family, and unavailability of immediate private mode of transport (P≤.05). Functional screening, or requiring full assistance (OR=4.77; 95% CI, 1.85-12.29); acute symptoms onset ≤ one hour (OR=2.14; 95% CI, 1.08-4.26); and higher scale scores (OR=2.99; 95% CI, 2.20-4.07) were significant predictors of EMS use. Patients

  10. National Trends in the Utilization of Emergency Medical Services for Acute Myocardial Infarction and Stroke

    Directory of Open Access Journals (Sweden)

    Katie Tataris

    2014-11-01

    Full Text Available Introduction: The emergency medical services (EMS system plays a crucial role in the chain of survival for acute myocardial infarction (AMI and stroke. While regional studies have shown underutilization of the 911 system for these time-sensitive conditions, national trends have not been studied. Our objective was to describe the national prevalence of EMS use for AMI and stroke, examine trends over a six-year period, and identify patient factors that may contribute to utilization. Methods: Using the National Hospital Ambulatory Medical Care Survey-ED (NHAMCS dataset from 2003-2009, we looked at patients with a discharge diagnosis of AMI or stroke who arrived to the emergency department (ED by ambulance. We used a survey-weighted χ2 test for trend and logistic regression analysis. Results: In the study, there were 442 actual AMI patients and 220 (49.8% presented via EMS. There were 1,324 actual stroke patients and 666 (50.3% presented via EMS. There was no significant change in EMS usage for AMI or stroke over the six-year period. Factors independently associated with EMS use for AMI and stroke included age (OR 1.21; 95% CI 1.12-1.31, Non-Hispanic black race (OR 1.72; 95% CI 1.16-2.29, and nursing home residence (OR 11.50; 95% CI 6.19-21.36. Conclusion: In a nationally representative sample of ED visits from 20003-2009, there were no trends of increasing EMS use for AMI and stroke. Efforts to improve access to care could focus on patient groups that underutilize the EMS system for such conditions. [West J Emerg Med. 2014;15(7:–0.

  11. Characteristics of Orthopedic Publications in High-Impact General Medical Journals.

    Science.gov (United States)

    Nwachukwu, Benedict U; Kahlenberg, Cynthia A; Lehman, Jason D; Lyman, Stephen; Marx, Robert G

    2017-05-01

    Orthopedic studies are occasionally published in high-impact general medical journals; these studies are often given high visibility and have significant potential to impact health care policy and inform clinical decision-making. The purpose of this review was to investigate the characteristics of operative orthopedic studies published in high-impact medical journals. The number of orthopedic studies published in high-impact medical journals is relatively low; however, these studies demonstrate methodological characteristics that may bias toward nonoperative treatment. Careful analysis and interpretation of orthopedic studies published in these journals is warranted. [Orthopedics. 2017; 40(3):e405-e412.]. Copyright 2017, SLACK Incorporated.

  12. Complementary and alternative medical therapy utilization by people with chronic fatiguing illnesses in the United States

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    Jones Ann-Britt

    2007-04-01

    Full Text Available Abstract Background Chronic fatiguing illnesses, including chronic fatigue syndrome (CFS, pose a diagnostic and therapeutic challenge. Previous clinical reports addressed the utilization of health care provided to patients with CFS by a variety of practitioners with other than allopathic training, but did not examine the spectrum of complementary and alternative medicine (CAM therapies used. This study was designed to measure CAM therapy use by persons with fatiguing illnesses in the United States population. Methods During a random-digit dialing survey to estimate the prevalence of CFS-like illness in urban and rural populations from different geographic regions of the United States, we queried the utilization of CAM including manipulation or body-based therapies, alternative medical systems, mind-body, biologically-based, and energy modalities. Results Four hundred forty fatigued and 444 non-fatigued persons from 2,728 households completed screening. Fatigued subjects included 53 persons with prolonged fatigue, 338 with chronic fatigue, and 49 with CFS-like illness. Mind-body therapy (primarily personal prayer and prayer by others was the most frequently used CAM across all groups. Among women, there was a significant trend of increasing overall CAM use across all subgroups (p-trend = 0.003. All categories of CAM use were associated with significantly poorer physical health scores, and all but one (alternative medicine systems were associated with significantly poorer mental health scores. People with CFS-like illness were significantly more likely to use body-based therapy (chiropractic and massage than non-fatigued participants (OR = 2.52, CI = 1.32, 4.82. Use of body-based therapies increased significantly in a linear trend across subgroups of non-fatigued, prolonged fatigued, chronic fatigued, and CFS-like subjects (p-trend = 0.002. People with chronic fatigue were also significantly more likely to use body-based therapy (OR = 1.52, CI = 1

  13. Nonresearch Industry Payments to Radiologists: Characteristics and Associations With Regional Medical Imaging Utilization.

    Science.gov (United States)

    Kokabi, Nima; Junn, Jacqueline C; Xing, Minzhi; Hemingway, Jennifer; Hughes, Danny R; Duszak, Richard

    2017-03-01

    United States radiologists received nonresearch payments from industry. At the state level, medical imaging utilization does not seem to be influenced by such financial relationships. Copyright © 2016. Published by Elsevier Inc.

  14. Biomedicine, holism and general medical practice: responses to the 2004 General Practitioner contract.

    Science.gov (United States)

    Checkland, Kath; Harrison, Stephen; McDonald, Ruth; Grant, Suzanne; Campbell, Stephen; Guthrie, Bruce

    2008-07-01

    In 2004 a new contract was introduced for General Practitioners in the UK, which introduced a significant element of 'pay-for-performance', including both clinical and organisational targets. The introduction of this contract has caused interest across the world, particularly amongst those responsible for commissioning primary care services. It can be argued that the clinical targets in the contract (known as the Quality and Outcomes Framework, QOF) represent a move towards a more biomedical model of health and illness, which is contrary to the ideal of providing holistic (or biopsychosocial) care that has been traditionally espoused by GPs. This paper reports results from two linked studies (in England and Scotland) investigating the early stages of the new contract. We describe the way in which four practices with different organisational approaches and espoused identities have all changed their practice structures, consultations and clinical care in response to QOF in ways which will result in patients receiving a more biomedical type of care. In spite of these observed changes, respondents continued to maintain discursive claims to holism. We discuss how this disconnection between rhetoric and reality can be maintained, and consider its implications for the future development of GPs' claims to a professional identity.

  15. Drug Utilization Study in Outpatient Ophthalmology Department of Government Medical College Jammu

    Directory of Open Access Journals (Sweden)

    Meenakshi Nehru, K. Kohli, B. Kapoor, P. Sadhotra, V. Chopra, R. Sharma

    2005-07-01

    Full Text Available The present study was undertaken to assess the patterns of prescription and drug utilization bymeasuring WHO delineated drug use indicators. This study was conducted in the PostgraduateDepartment of Pharmacology and Therapeutics in collaboration with the Postgraduate Departmentof Ophthalmology Govt. Medical College Hospital, Jammu. Total number of prescriptions analyzedwere 440 , in which total of 822 drugs were prescribed. Analysis of the prescriptions showed thataverage number of drugs per prescription was 1.87. The maximum number of drugs prescribed werein the form of eye drops (66.18%, followed by ointments (16%, capsules (9.5%, tablet (6.57%,syrup (0.73%, injection (0.73% and lotion (0.24%. The dosage form was indicated for 94%,frequency of drug administration for 98% drugs and duration of treatment for only 75% of the drugsprescribed. The number of antibiotics prescribed was 266 (32.26%, out of these 160 (60.15%antibiotics prescribed in the form of drops, 100 (37.59% as ointment and 6 (2.26% orally. Numberof encounters with anti-inflammatory and antiallergic drugs was 92 (11.2%, mydriatics and cycloplegics64(7.9%, miotics 20 (2.4%, multivitamins 58 (7.05% andothers used were lubricant and miscellaneouseye drops 322 (40%. Common prescription writing errors were minimum and there was no evidence ofpolypharmacy. However, duration of treatment and prescribing by generic name was very low.

  16. General Practice as a career choice among undergraduate medical students in Greece

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    Stefanadis Christodoulos

    2007-06-01

    Full Text Available Abstract Background Although General Practice (GP was recognized as a medical specialty in Greece in 1986, the number of GPs is insufficient to cover needs and only few medical graduates choose GP as a career option. In the present study we investigated the profile of medical students in terms of their decisions regarding specialization and the possible association of career choices different from GP with the status of undergraduate training regarding GP. Methods The sample consisted of final year students in the Medical School of the University of Athens, Greece. Students filled in a self-reported questionnaire focusing on medical specialization, and GP in particular. Results Response rate was 82.5% with 1021 questionnaires collected, out of 1237 eligible medical students. Only 44 out of the 1021 (4.3% respondents stated that GP is -or could be- among their choices for specialty. The most popular medical specialty was General Surgery (10.9%, followed by Cardiology (9.6%, Endocrinology (8.7% and Obstetrics-Gynaecology (8.3%. The most common criterion for choosing GP was the guaranteed employment on completion of the residency (54.6% while a 56.6% of total respondents were positive to the introduction of GP/FM as a curriculum course during University studies. Conclusion Despite the great needs, GP specialty is currently not a career option among undergraduate students of the greater Medical University in Greece and is still held in low esteem. A university department responsible for undergraduate teaching, promotion and research in GP (where not available is essential; the status of undergraduate training in general practice/family medicine seems to be one of the most important factors that influence physician career choices regarding primary care specialties.

  17. General Medical Burden in Bipolar Disorder: Findings from the LiTMUS Comparative Effectiveness Trial

    Science.gov (United States)

    Kemp, David E.; Sylvia, Louisa G.; Calabrese, Joseph R.; Nierenberg, Andrew A.; Thase, Michael E.; Reilly-Harrington, Noreen A.; Ostacher, Michael J.; Leon, Andrew C.; Ketter, Terence A.; Friedman, Edward S.; Bowden, Charles L.; Pencina, Michael; Iosifescu, Dan V.

    2013-01-01

    Objective This study examined general medical illnesses and their association with clinical features of bipolar disorder. Methods Data were cross-sectional and derived from the Lithium Treatment – Moderate Dose Use Study (LiTMUS), which randomized symptomatic adults (n=264 with available medical comorbidity scores) with bipolar disorder to moderate doses of lithium plus optimized treatment (OPT) or to OPT alone. Clinically significant high and low medical comorbidity burden were defined as a Cumulative Illness Rating Scale (CIRS) score ≥ 4 and < 4, respectively. Results The baseline prevalence of significant medical comorbidity was 53% (n=139). Patients with high medical burden were more likely to present in a major depressive episode (P=.04), meet criteria for obsessive-compulsive disorder (P=.02), and experience a greater number of lifetime mood episodes (P=0.02). They were also more likely to be prescribed a greater number of psychotropic medications (P=.002). Sixty-nine percent of the sample was overweight or obese as defined by body mass index (BMI), with African-Americans representing the racial group with the highest proportion of stage II obesity (BMI ≥ 35; 31%, n=14). Conclusions The burden of comorbid medical illnesses was high in this generalizable sample of treatment-seeking patients and appears associated with worsened course of illness and psychotropic medication patterns. (Funded by NIMH Contract N01MH80001; ClinicalTrials.gov number NCT00667745). PMID:23465084

  18. Utilization of Behavioral Medicine Services to Refine Medical Diagnostic Formulation in the Face of Uncertain Symptom Presentation

    Directory of Open Access Journals (Sweden)

    David A. Moore

    2016-08-01

    Full Text Available In the ever expanding realm of cancer care, the psychosocial impact of disease and medical treatments has been garnering increased attention. To address these needs, the integration of behavioral medicine services into inpatient and outpatient medical settings has added a unique resource available to oncologists. Psycho-oncologists may assist providers via the provision of psychological assessment and intervention, supplying valuable consultation to members of the medical team and much needed clinical services to patients. The authors present a complex case in which the utilization of behavioral medicine consultation to clarify the diagnostic picture was critical to identifying underlying anatomic disease.

  19. 75 FR 61507 - General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Amendment of...

    Science.gov (United States)

    2010-10-05

    ... HUMAN SERVICES Food and Drug Administration General and Plastic Surgery Devices Panel of the Medical... General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee. This meeting was... Surgery Devices Panel of the Medical Devices Advisory Committee would be held on November 18, 2010. On...

  20. Flexible but boring: medical students' perceptions of a career in general practice.

    Science.gov (United States)

    Koehler, Nicole; McMenamin, Christine

    2016-07-01

    Australia will continue to face a general practitioner (GP) shortage unless a significant number of medical students make general practice their chosen career. Perceptions regarding general practice may influence career choices. Thus this study investigated what Australian medical students perceived to be the advantages and disadvantages of pursuing a career in general practice via an anonymous online survey. Fifty-one students indicated general practice to be their first ranked career preference, 200 indicated a career other than general practice, and 106 were undecided. Two-hundred and two students reported having been on a GP placement, whereas 88 students had not. Flexibility, continuity of patient care and work-life balance were the three most common stated advantages to pursuing a career in general practice whereas general practice being boring, poorly paid, and of low prestige were the three most common disadvantages stated. Some disadvantages stated by those with a non-GP preference were not stated by those with a GP preference (e.g. lack of procedural skills, lack of career advancement opportunities). Students with more than 80 h of GP placement experience were more likely to list the advantages of work-life balance and a diversity of problems/illnesses/patients than those with no placement experience but were also more likely to list the disadvantage of low prestige. Negative stereotypes regarding general practice continue to exist which may influence students' career choices.

  1. Medical resource utilization and associated costs in patients with ulcerative colitis in the UK: a chart review analysis.

    Science.gov (United States)

    Bodger, Keith; Yen, Linnette; Szende, Agota; Sharma, Gunjan; Chen, Yaozhu J; McDermott, John; Hodgkins, Paul

    2014-02-01

    Limited evidence is available on the economic burden of ulcerative colitis (UC) in the UK, particularly relating to the impact of relapse frequency on direct medical costs. This study identifies and assesses medical resource utilization (MRU) and associated direct costs in mild and moderate UC patients in the UK. A retrospective chart review of patients with mild-to-moderate UC diagnosed at least 1 year before the study was performed. From 33 general practitioner (GP) and 34 gastroenterologist sites, charts of the last three UC patients fulfilling the inclusion criteria were reviewed. Descriptive statistics were calculated for MRU and 2011 costs (GB£) by number of relapses. The study population included 201 patients with a mean age of 39.9 years; 44% were women and the mean disease duration was 7.4 years. UC-related costs of each MRU category increased with the number of relapses. Comparing patients without relapse with those with more than two relapses, the mean annual UC-related costs were £14 versus £2556 for hospitalizations; £218 versus £988 for visits (including nurse, GP, specialist, and other visits); £21 versus £1303 for procedures; £17 versus £188 for diagnostics; and £1168 versus £6660 for all-cause total costs. Age, sex, and site of data reporting (GP vs. gastroenterologist) were not associated with MRU or costs. Patients with mild-to-moderate UC incurred considerable costs that increased markedly with the number of relapses. These findings support the importance of maintenance therapies in UC that reduce or prevent relapses. Quantifying the relationship between relapse rate and costs will inform future health economic studies.

  2. High blood pressure, antihypertensive medication and lung function in a general adult population

    Directory of Open Access Journals (Sweden)

    Meisinger Christa

    2011-04-01

    Full Text Available Abstract Background Several studies showed that blood pressure and lung function are associated. Additionally, a potential effect of antihypertensive medication, especially beta-blockers, on lung function has been discussed. However, side effects of beta-blockers have been investigated mainly in patients with already reduced lung function. Thus, aim of this analysis is to determine whether hypertension and antihypertensive medication have an adverse effect on lung function in a general adult population. Methods Within the population-based KORA F4 study 1319 adults aged 40-65 years performed lung function tests and blood pressure measurements. Additionally, information on anthropometric measurements, medical history and use of antihypertensive medication was available. Multivariable regression models were applied to study the association between blood pressure, antihypertensive medication and lung function. Results High blood pressure as well as antihypertensive medication were associated with lower forced expiratory volume in one second (p = 0.02 respectively p = 0.05; R2: 0.65 and forced vital capacity values (p = 0.01 respectively p = 0.05, R2: 0.73. Furthermore, a detailed analysis of antihypertensive medication pointed out that only the use of beta-blockers was associated with reduced lung function, whereas other antihypertensive medication had no effect on lung function. The adverse effect of beta-blockers was significant for forced vital capacity (p = 0.04; R2: 0.65, while the association with forced expiratory volume in one second showed a trend toward significance (p = 0.07; R2: 0.73. In the same model high blood pressure was associated with reduced forced vital capacity (p = 0.01 and forced expiratory volume in one second (p = 0.03 values, too. Conclusion Our analysis indicates that both high blood pressure and the use of beta-blockers, but not the use of other antihypertensive medication, are associated with reduced lung function in a

  3. Medical diagnoses of pediatric dental patients treated under general anesthesia: a 19 year review.

    Science.gov (United States)

    Roberts, Michael W; Milano, Michael; Lee, Jessica Y

    2009-01-01

    The objective of this study was to examine the records of pediatric dental patients treated under general anesthesia to determine if there had been any significant change in preoperative diagnoses between 1990-99 and 2000-08. The records of 3298 pediatric dental patients treated in the operating room under general anesthesia at the University of North Carolina (UNC) Children's Hospital were examined and medical diagnoses recorded. The number of cases treated by calendar year was obtained. The results of this study did not find any significant differences in percentage frequency of medical diagnoses between the years of 1990-99 and 2000-08. There has been a steady increase in the number of cases treated under general anesthesia over the period of the study. 1. Dental care under general anesthesia remains an important treatment option. 2. The medical diagnoses of children provided dental treatment under general anesthesia has not changed significantly over the past nineteen years at the UNC Children's Hospital. 3. The demand to provide dental care for children under general anesthesia has continued to increase.

  4. The utilization of a paediatric emergency room in a general hospital in Kuwait.

    Science.gov (United States)

    al-Hay, A A; Boresli, M; Shaltout, A A

    1997-12-01

    A descriptive study was conducted in Al-Amiri Hospital, Kuwait to evaluate the use of the paediatric emergency room (PER) by children under 12 years of age over an 11-week period. Socio-demographic data on the families, reasons for the visits, the pattern of referral and the diagnoses were reviewed and analyzed. A total of 277 children were enrolled in the study, the majority of whom (81%) were generally well, only 4% requiring admission to hospital. The paediatrician in the emergency room considered that 64% of visits were not emergencies. Some form of treatment and one to two routine investigations were needed in 21% and 21.6%, respectively. Stated reasons for seeking medical care were: symptoms of the child (34%), unavailability of primary clinic at night (22%) and perceived better services in hospital (20%). The median of parental satisfaction at the end of the visit was 95%. We conclude that most visits to the PER at Al-Amiri Hospital are inappropriate and that intensive health education is required to improve use of the PER and to increase public awareness of the difference between primary care and paediatric emergency facilities.

  5. Impact factor trends for general medical journals: non-English-language journals are lagging behind

    DEFF Research Database (Denmark)

    Vinther, Siri; Rosenberg, Jacob

    2012-01-01

    The impact factor (IF) is a common citation metric used for evaluating and comparing scientific journals within a certain field. Previous studies have shown that IFs are increasing. However, rates may depend on journal publication language. The aim of this study was to determine IF values...... and trends for general medical journals, comparing non-English-language with English-language journals....

  6. Randomized controlled trial of the effect of medical audit on AIDS prevention in general practice

    DEFF Research Database (Denmark)

    Sandbæk, Annelli

    1999-01-01

    OBJECTIVE: We aimed to evaluate the effect of a medical audit on AIDS prevention in general practice. METHODS: We conducted a prospective randomized controlled study performed as 'lagged intervention'. At the time of comparison, the intervention group had completed 6 months of audit including...

  7. Collaboration with general practitioners : preferences of medical specialists - a qualitative study

    NARCIS (Netherlands)

    Berendsen, Annette J.; Benneker, Wim H. G. M.; Schuling, Jan; Rijkers-Koorn, Nienke; Slaets, Joris P. J.; Meyboom-de Jong, Betty

    2006-01-01

    Background: Collaboration between general practitioners (GPs) and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates medical specialists to initiate and continue

  8. Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

    DEFF Research Database (Denmark)

    Ingebrigtsen, Truls S; Marott, Jacob L; Nordestgaard, Børge G;

    2015-01-01

    OBJECTIVE: We tested the hypothesis that use of and adherence to maintenance medication is low among individuals in the general population who have chronic obstructive pulmonary disease (COPD) , even in cases of severe and very severe COPD. DESIGN AND PARTICIPANTS: We identified 5,812 individuals...

  9. National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module IV. General Pharmacology.

    Science.gov (United States)

    National Highway Traffic Safety Administration (DOT), Washington, DC.

    This instructor's lesson plan guide on general pharmacology is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Five units of study are presented: (1) the sources of drugs, drug names, solids and liquids, and the different forms in which drugs may be dispersed; (2) the action (effects) of…

  10. General practitioners' continuing medical education: A prospective study from the County of Aarhus

    DEFF Research Database (Denmark)

    Nielsen, Jan E.; Lous, Jørgen; Adeler, H.F.;

    2002-01-01

    Participation of Danish general practitioners (GPs) in continuing medical education (CME) has often been the subject of debate, although very little is known about the extent and content of activities. One-hundred-and-sixty-one Danish GPs participated in this one-year prospective study...

  11. 76 FR 6803 - National Institute of General Medical Sciences; Notice of Closed Meeting

    Science.gov (United States)

    2011-02-08

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of General Medical Sciences; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory Committee Act, as amended (5 U.S.C. App.), notice is hereby given of the following...

  12. [No increase in medical consumption in general practice after induced abortion

    NARCIS (Netherlands)

    Kooistra, P.A.; Vastbinder, M.B.; Lagro-Janssen, A.L.M.

    2007-01-01

    OBJECTIVE: To compare medical consumption in general practice between women who underwent an induced abortion and women who did not. DESIGN: Historical cohort study. METHOD: We selected 19o women who underwent an induced abortion in the period 1975-2004 and 145 control patients. Women were selected

  13. 76 FR 10039 - National Institute of General Medical Sciences; Notice of Closed Meeting

    Science.gov (United States)

    2011-02-23

    ... review and evaluate grant applications. Place: National Institutes of Health, Natcher Building, 45 Center..., Scientific Review Officer, Office of Scientific Review, National Institute of General Medical Sciences... Support; 93.821, Cell Biology and Biophysics Research; 93.859, Pharmacology, Physiology, and...

  14. 76 FR 13196 - National Institute of General Medical Sciences; Notice of Closed Meeting

    Science.gov (United States)

    2011-03-10

    ... review and evaluate grant applications. Place: National Institutes of Health, Natcher Building, 45 Center..., Scientific Review Officer, Office of Scientific Review, National Institute of General Medical Sciences... Support; 93.821, Cell Biology and Biophysics Research; 93.859, Pharmacology, Physiology, and...

  15. 78 FR 66947 - National Institute of General Medical Sciences; Notice of Closed Meeting

    Science.gov (United States)

    2013-11-07

    ... of Committee: National Institute of General Medical Sciences Special Emphasis Panel; Review of P01 Grant Application. Date: November 21, 2013. Time: 12:00 p.m. to 5:00 p.m. Agenda: To review and evaluate..., Cell Biology and Biophysics Research; 93.859, Pharmacology, Physiology, and Biological...

  16. 77 FR 5816 - National Institute of General Medical Sciences Notice of Closed Meeting

    Science.gov (United States)

    2012-02-06

    ...; Review of R24 Grant Applications. Date: February 10, 2012. Time: 12 PM to 2 PM. Agenda: To review and... Review Officer, Office of Scientific Review, National Institute of General Medical Sciences, National..., Cell Biology and Biophysics Research; 93.859, Pharmacology, Physiology, and Biological...

  17. The EMR-scan: assessing the quality of Electronic Medical Records in general practice.

    NARCIS (Netherlands)

    Verheij, R.; Jabaaij, L.; Njoo, K.; Hoogen, H. van den; Bakker, D. de

    2008-01-01

    Background: The use of electronic medical records (EMR) in general practice has spread rapidly in the last decade (more than 90% today). Traditionally, these records are primarily used for direct patient care and for administrative purposes by the practice involved. In recent years, further technica

  18. 76 FR 67199 - National Institute of General Medical Sciences; Notice of Closed Meeting

    Science.gov (United States)

    2011-10-31

    ... of Committee: National Institute of General Medical Sciences Initial Review Group, Biomedical Research and Research Training Review Subcommittee A. Date: November 17, 2011. Time: 8 a.m. to 5 p.m... such as patentable material, and personal information concerning individuals associated with the grant...

  19. 77 FR 35413 - National Institute of General Medical Sciences; Notice of Closed Meeting

    Science.gov (United States)

    2012-06-13

    ... such as patentable material, and personal information concerning individuals associated with the grant... of Committee: National Institute of General Medical Sciences Special Emphasis Panel; Review of Minority Biomedical Research Grant Applications. Date: June 28, 2012. Time: 1:00 p.m. to 4:00 p.m. Agenda...

  20. 76 FR 29773 - National Institute of General Medical Sciences; Notice of Closed Meeting

    Science.gov (United States)

    2011-05-23

    ... of Committee: National Institute of General Medical Sciences Initial Review Group, Biomedical Research and Research Training Review Subcommittee B. Date: June 17, 2011. Time: 8 a.m. to 5 p.m. Agenda... such as patentable material, and personal information concerning individuals associated with the grant...

  1. 76 FR 64954 - National Institute of General Medical Sciences Notice of Closed Meeting

    Science.gov (United States)

    2011-10-19

    ... of Committee: National Institute of General Medical Sciences Initial Review Group Biomedical Research and Research Training Review Subcommittee B Date: November 16-17, 2011. Time: 8 a.m. to 5 p.m. Agenda... such as patentable material, and personal information concerning individuals associated with the grant...

  2. 75 FR 7488 - National Institute of General Medical Sciences; Notice of Closed Meeting

    Science.gov (United States)

    2010-02-19

    ... of Committee: National Institute of General Medical Sciences Initial Review Group, Biomedical Research and Research Training Review Subcommittee A. Date: March 4, 2010. Time: 8 a.m. to 5 p.m. Agenda... such as patentable material, and personal information concerning individuals associated with the grant...

  3. 77 FR 31862 - National Institute of General Medical Sciences; Notice of Closed Meeting

    Science.gov (United States)

    2012-05-30

    ... of Committee: National Institute of General Medical Sciences Initial Review Group Biomedical Research and Research Training Review Subcommittee B. Date: June 21, 2012. Time: 8:30 a.m. to 5:00 p.m. Agenda... such as patentable material, and personal information concerning individuals associated with the grant...

  4. 77 FR 6809 - National Institute of General Medical Sciences; Notice of Closed Meeting

    Science.gov (United States)

    2012-02-09

    ... of Committee: National Institute of General Medical Sciences Initial Review Group Biomedical Research and Research Training Review Subcommittee A. Date: March 8, 2012. Time: 8 a.m. to 5 p.m. Agenda: To... such as patentable material, and personal information concerning individuals associated with the grant...

  5. 75 FR 42759 - National Institute of General Medical Sciences; Notice of Closed Meeting

    Science.gov (United States)

    2010-07-22

    ... such as patentable material, and personal information concerning individuals associated with the grant... of Committee: National Institute of General Medical Sciences Special Emphasis Panel, Review of Minority Biomedical Research Support Chemistry Applications. Date: July 26, 2010. Time: 12 p.m. to 6 p.m...

  6. 75 FR 30408 - National Institute of General Medical Sciences; Notice of Closed Meeting

    Science.gov (United States)

    2010-06-01

    ... Committee: National Institute of General Medical Sciences Review Group; ] Biomedical Research and Research Training Review Subcommittee B. Date: June 18, 2010. Time: 8 a.m. to 5 p.m. Agenda: To review and evaluate... patentable materials, and personal information concerning individuals associated with the grant applications...

  7. [No increase in medical consumption in general practice after induced abortion

    NARCIS (Netherlands)

    Kooistra, P.A.; Vastbinder, M.B.; Lagro-Janssen, A.L.M.

    2007-01-01

    OBJECTIVE: To compare medical consumption in general practice between women who underwent an induced abortion and women who did not. DESIGN: Historical cohort study. METHOD: We selected 19o women who underwent an induced abortion in the period 1975-2004 and 145 control patients. Women were selected

  8. Awareness of the association between periodontal disease and pre-term births among general dentists, general medical practitioners and gynecologists

    Directory of Open Access Journals (Sweden)

    Fouzia Tarannum

    2013-01-01

    Full Text Available In the recent decades, periodontal disease has been identified as a risk factor for pre-term deliveries. Hence, it is important to evaluate the awareness of health-care providers of the association between periodontal diseases and pre-term birth. A self-administered questionnaire was distributed to random samples representing general medical practitioners (GMPs, general dental practitioners (GDPs and Gynecologists for this study. A knowledge score was calculated for correct answers to 11 survey questions related to oral health effects during pregnancy and compared among the three groups. In this study, 133 physicians, 135 dentists and 100 Gynecologists completed the questionnaire. More GDPs (67.4% than GMPs (56.4% and Gynecologists (63% reported there was an association between periodontal disease and pre-term low birth weight. Efforts to increase this awareness may prove valuable in improving preventive care during pregnancy.

  9. Using an iconic language to improve access to electronic medical records in general medicine.

    Science.gov (United States)

    Simon, Christian; Hassler, Sylvain; Beuscart-Zephir, Marie-Catherine; Favre, Madeleine; Venot, Alain; Duclos, Catherine; Lamy, Jean-Baptiste

    2014-01-01

    Physicians have difficulties to access and analyse information in a medical record. In a previous work on drug databanks, we have shown that with an iconic language as VCM, an icon-based presentation can help physicians to access medical information. Our objective, herein, is to study whether VCM can be used in an electronic medical record for facilitating physician access in general practice. We identify the data and the functionalities of an electronic medical record that could benefit from VCM icons representing clinical findings, patient history, etc. We also present a preliminary evaluation of this new icon-focused interface. We conclude by discussing the results like the assessment of the user's satisfaction and pointing out the importance of coding data.

  10. The adequacy of education for general practice: a medical educator's viewpoint.

    Science.gov (United States)

    STEWART, C B

    1963-04-06

    The effect on medical education of the doubling of medical knowledge every 10 years is discussed. A brilliant student who might successfully master all the present facts and theories by graduation would be seriously out of date 10 years later, and hopelessly so by retirement age unless he continued his education while in practice. Lengthening the undergraduate course is not considered an effective solution, nor is increasing the general practice internship to two years. Emphasis should be placed on self-education by the medical student, on the inculcation of habits of study and motivation to encourage lifelong learning, and on the provision of more adequate programs of continuing education for the practising doctor. Teachers in medical schools require a better understanding of and interest in the learning processes of their students rather than concentrating on the exposition of their own knowledge.

  11. Utilizing three years of epidemiological data from medical missions in Cambodia to shape the mobile medical clinic formulary

    Directory of Open Access Journals (Sweden)

    Jeany Kim Jun

    2017-01-01

    Full Text Available Objective: The purpose of this project was to gather epidemiological data on common diseases and medications dispensed during medical mission trips to Cambodia to shape the mobile medical clinic formulary. Methods: Data for patients seen during week-long mobile medical clinics was collected in Cambodia during Septembers 2012 to 2014. Each patient’s gender, age, weight, blood pressure, glucose, pertinent laboratory values, diagnoses, and medications dispensed were collected. Blood pressure and glucose levels were measured in patients 18 years and above. Data collected onto paper intake forms were transferred onto spreadsheets without patient identifying information and analyzed for aggregate means, common diseases, and most dispensed medications. This project received institutional review board approval. Results: A total of 1,015 patients were seen over three years. Women made up 61.4%, and the mean age was 41.8 years. The most common diagnosis was gastrointestinal disorders (22.9% that included gastroesophageal reflux disease and intestinal parasites. Next, 20.1% of patients had hypertension (BP>140/90, 18.0% had presbyopia, 15.4% had back and joint pain, followed by 8.8% with headache, including migraines. Approximately 8.4% of patients had hyperglycemia (RPG >140 mg/dl. The top five medications dispensed were acetaminophen, omeprazole, multivitamin, ibuprofen, and metformin. For hypertension, amlodipine and lisinopril were dispensed. Conclusion: Cambodia lacks systematic public health collection of epidemiological data for prevalence of diseases. Hence, investigators collected and analyzed information from week-long mobile medical clinics over three years. Proton-pump inhibitors and H. pylori lab tests were recommended for gastrointestinal disorders. Acetaminophen and ibuprofen were recommended for pain. Angiotensin-converting-enzyme inhibitors and dihydropyridine calcium channel blockers were recommended over diuretics since patients were

  12. Changing resident test ordering behavior: a multilevel intervention to decrease laboratory utilization at an academic medical center.

    Science.gov (United States)

    Vidyarthi, Arpana R; Hamill, Timothy; Green, Adrienne L; Rosenbluth, Glenn; Baron, Robert B

    2015-01-01

    Hospital laboratory test volume is increasing, and overutilization contributes to errors and costs. Efforts to reduce laboratory utilization have targeted aspects of ordering behavior, but few have utilized a multilevel collaborative approach. The study team partnered with residents to reduce unnecessary laboratory tests and associated costs through multilevel interventions across the academic medical center. The study team selected laboratory tests for intervention based on cost, volume, and ordering frequency (complete blood count [CBC] and CBC with differential, common electrolytes, blood enzymes, and liver function tests). Interventions were designed collaboratively with residents and targeted components of ordering behavior, including system changes, teaching, social marketing, academic detailing, financial incentives, and audit/feedback. Laboratory ordering was reduced by 8% cumulatively over 3 years, saving $2 019 000. By involving residents at every stage of the intervention and targeting multiple levels simultaneously, laboratory utilization was reduced and cost savings were sustained over 3 years. © 2014 by the American College of Medical Quality.

  13. A General Fuzzy Cerebellar Model Neural Network Multidimensional Classifier Using Intuitionistic Fuzzy Sets for Medical Identification

    Directory of Open Access Journals (Sweden)

    Jing Zhao

    2016-01-01

    Full Text Available The diversity of medical factors makes the analysis and judgment of uncertainty one of the challenges of medical diagnosis. A well-designed classification and judgment system for medical uncertainty can increase the rate of correct medical diagnosis. In this paper, a new multidimensional classifier is proposed by using an intelligent algorithm, which is the general fuzzy cerebellar model neural network (GFCMNN. To obtain more information about uncertainty, an intuitionistic fuzzy linguistic term is employed to describe medical features. The solution of classification is obtained by a similarity measurement. The advantages of the novel classifier proposed here are drawn out by comparing the same medical example under the methods of intuitionistic fuzzy sets (IFSs and intuitionistic fuzzy cross-entropy (IFCE with different score functions. Cross verification experiments are also taken to further test the classification ability of the GFCMNN multidimensional classifier. All of these experimental results show the effectiveness of the proposed GFCMNN multidimensional classifier and point out that it can assist in supporting for correct medical diagnoses associated with multiple categories.

  14. A General Fuzzy Cerebellar Model Neural Network Multidimensional Classifier Using Intuitionistic Fuzzy Sets for Medical Identification.

    Science.gov (United States)

    Zhao, Jing; Lin, Lo-Yi; Lin, Chih-Min

    2016-01-01

    The diversity of medical factors makes the analysis and judgment of uncertainty one of the challenges of medical diagnosis. A well-designed classification and judgment system for medical uncertainty can increase the rate of correct medical diagnosis. In this paper, a new multidimensional classifier is proposed by using an intelligent algorithm, which is the general fuzzy cerebellar model neural network (GFCMNN). To obtain more information about uncertainty, an intuitionistic fuzzy linguistic term is employed to describe medical features. The solution of classification is obtained by a similarity measurement. The advantages of the novel classifier proposed here are drawn out by comparing the same medical example under the methods of intuitionistic fuzzy sets (IFSs) and intuitionistic fuzzy cross-entropy (IFCE) with different score functions. Cross verification experiments are also taken to further test the classification ability of the GFCMNN multidimensional classifier. All of these experimental results show the effectiveness of the proposed GFCMNN multidimensional classifier and point out that it can assist in supporting for correct medical diagnoses associated with multiple categories.

  15. Becoming a general practitioner--which factors have most impact on career choice of medical students?

    Science.gov (United States)

    Kiolbassa, Kathrin; Miksch, Antje; Hermann, Katja; Loh, Andreas; Szecsenyi, Joachim; Joos, Stefanie; Goetz, Katja

    2011-05-09

    In Germany, there is a shortage of young physicians in several specialties, the situation of general practitioners (GP) being especially precarious. The factors influencing the career choice of German medical students are poorly understood. This study aims to identify factors influencing medical students' specialty choice laying a special focus on general practice. The study was designed as a cross-sectional survey. In 2010, students at the five medical schools in the federal state of Baden-Wuerttemberg (Germany) filled out an online-questionnaire. On 27 items with 5-point Likert scales, the students rated the importance of specified individual and occupational aspects. Furthermore, students were asked to assign their intended medical specialty. 1,299 students participated in the survey. Thereof, 1,114 students stated a current choice for a specialty, with 708 students choosing a career in one of the following 6 specialties: internal medicine, surgery, gynaecology and obstetrics, paediatrics, anaesthetics and general practice. Overall, individual aspects ('Personal ambition', 'Future perspective', 'Work-life balance') were rated as more important than occupational aspects (i.e. 'Variety in job', 'Job-related ambition') for career choice. For students favouring a career as a GP individual aspects and the factor 'Patient orientation' among the occupational aspects were significantly more important and 'Job-related ambition' less important compared to students with other specialty choices. This study confirms that future GPs differ from students intending to choose other specialties particularly in terms of patient-orientation and individual aspects such as personal ambition, future perspective and work-life balance. Improving job-conditions in terms of family compatibility and work-life balance could help to increase the attractiveness of general practice. Due to the shortage of GPs those factors should be made explicit at an early stage at medical school to increase

  16. An analysis of radiological research publications in high impact general medical journals between 1996 and 2010

    Energy Technology Data Exchange (ETDEWEB)

    Ku, You Jin [Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 445 Gil-dong Kangdong-Gu, Seoul 134-701 (Korea, Republic of); Yoon, Dae Young, E-mail: evee0914@chollian.net [Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 445 Gil-dong Kangdong-Gu, Seoul 134-701 (Korea, Republic of); Yun, Eun Joo [Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 445 Gil-dong Kangdong-Gu, Seoul 134-701 (Korea, Republic of); Baek, Sora [Department of Nuclear Medicine, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 445 Gil-dong Kangdong-Gu, Seoul 134-701 (Korea, Republic of); Lim, Kyoung Ja; Seo, Young Lan; Choi, Chul Soon; Bae, Sang Hoon [Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 445 Gil-dong Kangdong-Gu, Seoul 134-701 (Korea, Republic of)

    2013-06-15

    Highlights: ► Radiologists published only 0.2% of articles in five general medical journals. ► Most original articles from radiologists were funded and were prospective studies. ► Radiology researchers from only 11 countries published at least one original article. -- Abstract: Objective: To evaluate scientific papers published by radiologists in high impact general medical journals between 1996 and 2010. Methods: A MEDLINE search was performed in five high impact general medical journals (AIM, BMJ, JAMA, Lancet, and NEJM) for all articles of which a radiologist was the first author between 1996 and 2010. The following information was abstracted from the original articles: radiological subspecialty, imaging technique used, type of research, sample size, study design, statistical analysis, study outcome, declared funding, number of authors, collaboration, and country of the first author. Results: Of 216 (0.19%) articles were published by radiologists in five general medical journals between 1996 and 2010, 83 were original articles. Fifteen (18.1%) original articles were concerned with the field of vascular/interventional radiology, 24 (28.9%) used combined imaging techniques, 76 (91.6%) were clinical research, 63 (75.9%) had a sample size of >50, 65 (78.3%) were prospective, 78 (94.0%) performed statistical analysis, 83 (100%) showed positive study outcomes, 57 (68.7%) were funded, 49 (59.0%) had from four to seven authors, and 79 (95.2%) were collaborative studies. Conclusions: A very small number (0.19%) in five high impact general medical journals was published by radiologists between 1996 and 2010.

  17. Becoming a general practitioner - Which factors have most impact on career choice of medical students?

    Directory of Open Access Journals (Sweden)

    Loh Andreas

    2011-05-01

    Full Text Available Abstract Background In Germany, there is a shortage of young physicians in several specialties, the situation of general practitioners (GP being especially precarious. The factors influencing the career choice of German medical students are poorly understood. This study aims to identify factors influencing medical students' specialty choice laying a special focus on general practice. Methods The study was designed as a cross-sectional survey. In 2010, students at the five medical schools in the federal state of Baden-Wuerttemberg (Germany filled out an online-questionnaire. On 27 items with 5-point Likert scales, the students rated the importance of specified individual and occupational aspects. Furthermore, students were asked to assign their intended medical specialty. Results 1,299 students participated in the survey. Thereof, 1,114 students stated a current choice for a specialty, with 708 students choosing a career in one of the following 6 specialties: internal medicine, surgery, gynaecology and obstetrics, paediatrics, anaesthetics and general practice. Overall, individual aspects ('Personal ambition', 'Future perspective', 'Work-life balance' were rated as more important than occupational aspects (i.e. 'Variety in job', 'Job-related ambition' for career choice. For students favouring a career as a GP individual aspects and the factor 'Patient orientation' among the occupational aspects were significantly more important and 'Job-related ambition' less important compared to students with other specialty choices. Conclusions This study confirms that future GPs differ from students intending to choose other specialties particularly in terms of patient-orientation and individual aspects such as personal ambition, future perspective and work-life balance. Improving job-conditions in terms of family compatibility and work-life balance could help to increase the attractiveness of general practice. Due to the shortage of GPs those factors should

  18. Medical innovation and age-specific trends in health care utilization: findings and implications

    NARCIS (Netherlands)

    Wong, A.; Wouterse, B.; Slobbe, L.C.; Boshuizen, H.C.; Polder, J.J.

    2012-01-01

    Health care utilization is expected to rise in the coming decades. Not only will the aggregate need for health care grow by changing demographics, so too will per capita utilization. It has been suggested that trends in health care utilization may be age-specific. In this paper, age-specific trends

  19. The legal authority of mature minors to consent to general medical treatment.

    Science.gov (United States)

    Coleman, Doriane Lambelet; Rosoff, Philip M

    2013-04-01

    The nature and scope of mature adolescents' legal authority to consent to general medical treatment without parental involvement is often misrepresented by commentators. This state of affairs is further complicated by the law itself, which has developed a broad "mature minor exception" to the general requirement of parental consent in abortion cases and which has additionally carved out numerous specific status-based and condition-based exceptions to that requirement. In these circumstances, it is not always a simple matter for physicians and other medical professionals who treat adolescents to ascertain the applicable law. In this article, we discuss the underlying differences between medical ethics and law, which have caused some of the confusion in this area, and we set out the most current legal rules governing adolescent decision-making authority in general medical settings. A comprehensive analysis of both statutory and common law demonstrates that in such settings, parental consent continues to be required by most jurisdictions, even when the minor can be considered cognitively "mature."

  20. Medical Students’ View about the Effects of Practical Courses on Learning the General Theoretical Concepts of Basic Medical Sciences

    Directory of Open Access Journals (Sweden)

    Leila Roshangar

    2014-05-01

    Full Text Available Introduction: The basic medical sciences section requires 2.5 years in the medical education curriculum. Practical courses complement theoretical knowledge in this period to improve their appreciation. Despite spending lots of disbursement and time, this period’s efficacy is not clearly known. Methods: One hundred thirty-three General Practitioner (GP students have been included in this descriptive cross-sectional study and were asked by questionnaire about the positive impact of practical courses on learning theoretical knowledge. Data were analyzed by descriptive statistics. Result: The agreement in “Practical Head and Neck Anatomy” was 40.91% ± 29.45, in “Practical Trunk Anatomy” was 63.62% ± 2.32 and in “Practical Anatomy of Extremities” was 56.16% ± 2.57. In “Practical Histology”, agreement was 69.50%±2.19; “Practical Biophysics” was 45.97%±2.25, “Practical Physiology” 61.75%±2.17; “Practical Biochemistry” 36.28%±2.42; “Practical Pathology” 59.80%±2.53; “Practical Immunology” 56.25%±26.40; “Practical Microbiology and Virology” 60.39%±2.27 and “Practical Mycology and Parasitology” 68.2%± 2.16.Conclusion: GP students in Tabriz University of Medical Sciences are not optimistic about the applicability of practical courses of basic medical sciences lessons.

  1. Combating Fraud in Medical Research: Research Validation Standards Utilized by the Journal of Surgical Radiology

    Directory of Open Access Journals (Sweden)

    Bhavin Patel

    2013-11-01

    Full Text Available Fraud in medical publishing has risen to the national spotlight as manufactured and suspect data have led to retractions of papers in prominent journals. Moral turpitude in medical research has led to the loss of National Institute of Health (NIH grants, directly affected patient care, and has led to severe legal ramifications for some authors. While there are multiple checks and balances in medical research to prevent fraud, the final enforcement lies with journal editors and publishers. There is an ethical and legal obligation to make careful and critical examinations of the medical research published in their journals. Failure to follow the highest standards in medical publishing can lead to legal liability and destroy a journal’s integrity. More significant, however, is the protection of the medical profession’s trust with their colleagues and the public they serve. This article discusses various techniques and tools available to editors and publishers that can help curtail fraud in medical publishing.

  2. National utilization of antihypertensive medications from 2000 to 2006 in the Veterans Health Administration: focus on thiazide diuretics.

    Science.gov (United States)

    Furmaga, Elaine M; Cunningham, Francesca E; Cushman, William C; Dong, Diane; Jiang, Rong; Basile, Jan; Katz, Lois A; Rutan, Gale H; Berlowitz, Dan R; Papademetriou, Vasilios; Glassman, Peter A

    2008-10-01

    The authors sought to determine the prescribing practices of clinicians treating veterans with hypertension. A descriptive analysis was performed using a national pharmacy database of patients with a diagnosis of hypertension receiving antihypertensive medication in the fiscal years 2000 to 2006. Angiotensin-converting enzyme inhibitors were the most frequently prescribed antihypertensive class, with utilization increasing from 56.0% in fiscal year 2000 to 63.2% of patients in 2006. Utilization of thiazide-type diuretics increased from 31.9% of patients in fiscal year 2000 to 42.0% in 2006. When patient comorbidities were taken into consideration, 48.1% of patients defined as having uncomplicated hypertension had at least one prescription for a thiazide diuretic in fiscal year 2006. Utilization by monotherapy and combination therapy were also evaluated. The trends in utilization allowed for identification of areas in which a change in prescribing practices may improve blood pressure control and health outcomes in the Veterans Health Administration.

  3. Antidepressant medication augmented with cognitive-behavioral therapy for generalized anxiety disorder in older adults.

    Science.gov (United States)

    Wetherell, Julie Loebach; Petkus, Andrew J; White, Kamila S; Nguyen, Hoang; Kornblith, Sander; Andreescu, Carmen; Zisook, Sidney; Lenze, Eric J

    2013-07-01

    OBJECTIVE Generalized anxiety disorder is common among older adults and leads to diminished health and cognitive functioning. Although antidepressant medications are efficacious, many elderly individuals require augmentation treatment. Furthermore, little is known about maintenance strategies for older people. The authors examined whether sequenced treatment combining pharmacotherapy and cognitive-behavioral therapy (CBT) boosts response and prevents relapse in older adults with generalized anxiety disorder. METHOD Participants were individuals at least 60 years of age with generalized anxiety disorder (N=73) who were recruited from outpatient clinics at three sites. Participants received 12 weeks of open-label escitalopram and were then randomly assigned to one of four conditions: 16 weeks of escitalopram (10-20 mg/day) plus modular CBT, followed by 28 weeks of maintenance escitalopram; escitalopram alone, followed by maintenance escitalopram; escitalopram plus CBT, followed by pill placebo; and escitalopram alone, followed by placebo. RESULTS Escitalopram augmented with CBT increased response rates on the Penn State Worry Questionnaire but not on the Hamilton Anxiety Rating Scale compared with escitalopram alone. Both escitalopram and CBT prevented relapse compared with placebo. CONCLUSIONS This study demonstrates effective strategies for treatment of generalized anxiety disorder in older adults. The sequence of antidepressant medication augmented with CBT leads to worry reduction in the short-term. Continued medication prevents relapse, but for many individuals, CBT would allow sustained remission without requiring long-term pharmacotherapy.

  4. General practitioners' views on reattribution for patients with medically unexplained symptoms: a questionnaire and qualitative study

    Directory of Open Access Journals (Sweden)

    Salmon Peter

    2008-08-01

    Full Text Available Abstract Background The successful introduction of new methods for managing medically unexplained symptoms in primary care is dependent to a large degree on the attitudes, experiences and expectations of practitioners. As part of an exploratory randomised controlled trial of reattribution training, we sought the views of participating practitioners on patients with medically unexplained symptoms, and on the value of and barriers to the implementation of reattribution in practice. Methods A nested attitudinal survey and qualitative study in sixteen primary care teams in north-west England. All practitioners participating in the trial (n = 74 were invited to complete a structured survey. Semi-structured interviews were undertaken with a purposive sub-sample of survey respondents, using a structured topic guide. Interview transcripts were used to identify key issues, concepts and themes, which were grouped to construct a conceptual framework: this framework was applied systematically to the data. Results Seventy (95% of study participants responded to the survey. Survey respondents often found it stressful to work with patients with medically unexplained symptoms, though those who had received reattribution training were more optimistic about their ability to help them. Interview participants trained in reattribution (n = 12 reported that reattribution increased their confidence to practice in a difficult area, with heightened awareness, altered perceptions of these patients, improved opportunities for team-building and transferable skills. However general practitioners also reported potential barriers to the implementation of reattribution in routine clinical practice, at the level of the patient, the doctor, the consultation, diagnosis and the healthcare context. Conclusion Reattribution training increases practitioners' sense of competence in managing patients with medically unexplained symptoms. However, barriers to its implementation are

  5. Atopic children and use of prescribed medication: A comprehensive study in general practice.

    Science.gov (United States)

    Pols, David H J; Nielen, Mark M J; Bohnen, Arthur M; Korevaar, Joke C; Bindels, Patrick J E

    2017-01-01

    A comprehensive and representative nationwide general practice database was explored to study associations between atopic disorders and prescribed medication in children. All children aged 0-18 years listed in the NIVEL Primary Care Database in 2014 were selected. Atopic children with atopic eczema, asthma and allergic rhinitis (AR) were matched with controls (not diagnosed with any of these disorders) within the same general practice on age and gender. Logistic regression analyses were performed to study the differences in prescribed medication between both groups by calculating odds ratios (OR); 93 different medication groups were studied. A total of 45,964 children with at least one atopic disorder were identified and matched with controls. Disorder-specific prescriptions seem to reflect evidence-based medicine guidelines for atopic eczema, asthma and AR. However, these disorder-specific prescriptions were also prescribed for children who were not registered as having that specific disorder. For eczema-related medication, about 3.7-8.4% of the children with non-eczematous atopic morbidity received these prescriptions, compared to 1.4-3.5% of the non-atopic children. The same pattern was observed for anti-asthmatics (having non-asthmatic atopic morbidity: 0.8-6.2% vs. controls: 0.3-2.1%) and AR-related medication (having non-AR atopic morbidity: 4.7-12.5% vs. controls: 2.8-3.1%). Also, non-atopic related medication, such as laxatives and antibiotics were more frequently prescribed for atopic children. The present study shows that atopic children received more prescriptions, compared to non-atopic children. Non-atopic controls frequently received specific prescriptions for atopic disorders. This indicates that children with atopic disorders need better monitoring by their GP.

  6. The Use of Electronic Medical Records To Facilitate Identification of Patients Presenting With Oro-facial Complaints To The General Medical Practitioners

    OpenAIRE

    Chan, Sze Seng

    2014-01-01

    ABSTRACTThe University of ManchesterSzeSeng ChanMaster of Philosophy in Oral and Maxillofacial SurgeryThe Use of Electronic Medical Records to Facilitate Identification of Patients Presenting With Oro-facial Complaints To The General Medical PractitionersJanuary 2014Aims : To study the pattern of attendance of patients who present to General Medical Practitioners (GMPs) with oro-facial or/and dental complaints. Data Source : All the Primary Medical Cares (PMCs) in the North West e-health data...

  7. Why and when do Danish medical doctors choose to become a general practitioner?

    DEFF Research Database (Denmark)

    Lewandowska, Karolina; Kjær, Niels Kristian; Lillevang, Gunver

    -graduate training the structure of the postgraduate educational program, working conditions, respect for general practice, uncertainty about the future for general practice as a profession, when did I decide to choose family medicine. Out of these themes we identified factors, which influenced the choice...... of the junior doctors. Exposure to general practice as part the basic postgraduate training programme was important. Acceptance of the postgraduate training programme also has a positive impact. Factors with negative impact were limited awareness of family medicine during medical school and worrying......Background and Aim: Continued supply of qualified general practitioners is essential for the vitality of the primary health care sector. In Denmark however we have observed a decline in the number of applicants for our family medicine specialist training program, leaving some posts vacant. The aim...

  8. Epidural Steroids for Lumbosacral Radicular Syndrome Compared to Usual Care : Quality of Life and Cost Utility in General Practice

    NARCIS (Netherlands)

    Spijker-Huiges, Antje; Vermeulen, Karin; Winters, Jan C.; van Wijhe, Marten; van der Meer, Klaas

    Objective: To investigate the effect of adding segmental epidural steroid injections (SESIs) to usual care compared with usual care alone on quality of life and cost utility in lumbosacral radicular syndrome (LRS) in general practice. Design: A pragmatic randomized controlled trial. Results were

  9. Proposed standards for medical education submissions to the Journal of General Internal Medicine.

    Science.gov (United States)

    Cook, David A; Bowen, Judith L; Gerrity, Martha S; Kalet, Adina L; Kogan, Jennifer R; Spickard, Anderson; Wayne, Diane B

    2008-07-01

    To help authors design rigorous studies and prepare clear and informative manuscripts, improve the transparency of editorial decisions, and raise the bar on educational scholarship, the Deputy Editors of the Journal of General Internal Medicine articulate standards for medical education submissions to the Journal. General standards include: (1) quality questions, (2) quality methods to match the questions, (3) insightful interpretation of findings, (4) transparent, unbiased reporting, and (5) attention to human subjects' protection and ethical research conduct. Additional standards for specific study types are described. We hope these proposed standards will generate discussion that will foster their continued evolution.

  10. The Nonsubsampled Contourlet Transform Based Statistical Medical Image Fusion Using Generalized Gaussian Density

    OpenAIRE

    Guocheng Yang; Meiling Li; Leiting Chen; Jie Yu

    2015-01-01

    We propose a novel medical image fusion scheme based on the statistical dependencies between coefficients in the nonsubsampled contourlet transform (NSCT) domain, in which the probability density function of the NSCT coefficients is concisely fitted using generalized Gaussian density (GGD), as well as the similarity measurement of two subbands is accurately computed by Jensen-Shannon divergence of two GGDs. To preserve more useful information from source images, the new fusion rules are devel...

  11. An evaluation of the impact of patient cost sharing for antihypertensive medications on adherence, medication and health care utilization, and expenditures

    Directory of Open Access Journals (Sweden)

    Pesa JA

    2012-01-01

    Full Text Available Jacqueline A Pesa1, Jill Van Den Bos2, Travis Gray2, Colleen Hartsig2, Robert Brett McQueen3, Joseph J Saseen3, Kavita V Nair31Janssen Scientific Affairs, LLC, Louisville, CO, USA; 2Milliman, Inc, Denver, CO, USA; 3University of Colorado Anschutz Medical Campus, Aurora, CO, USAObjective: To assess the impact of patient cost-sharing for antihypertensive medications on the proportion of days covered (PDC by antihypertensive medications, medical utilization, and health care expenditures among commercially insured individuals assigned to different risk categories.Methods: Participants were identified from the Consolidated Health Cost Guidelines (CHCG database (January 1, 2006–December 31, 2008 based on a diagnosis (index claim for hypertension, continuous enrollment ≥12 months pre- and post-index, and no prior claims for antihypertensive medications. Participants were assigned to: low-risk group (no comorbidities, high-risk group (1+ selected comorbidities, or very high-risk group (prior hospitalization for 1+ selected comorbidities. The relationship between patient cost sharing and PDC by antihypertensive medications was assessed using standard linear regression models, controlling for risk group membership, and various demographic and clinical factors. The relationship between PDC and health care service utilization was subsequently examined using negative binomial regression models.Results: Of the 28,688 study patients, 66% were low risk. The multivariate regression model supported a relationship between patient cost sharing per 30-day fill and PDC in the following year. For every US$1.00 increase in cost sharing, PDC decreased by 1.1 days (P < 0.0001. Significant predictors of PDC included high risk, older age, gender, Charlson Comorbidity Index score, geography, and total post-index insurer- and patient-paid costs. An increase in PDC was associated with a decrease in all-cause and hypertension-related inpatient, outpatient, and emergency

  12. First-Year Residents' Caring, Medical Knowledge, and Clinical Judgment in Relation to Laboratory Utilization.

    Science.gov (United States)

    Yarnold, Paul R.; And Others

    1994-01-01

    A study of 36 first-year Northwestern University (Illinois) medical residents found that students' medical knowledge was a predictor of increased laboratory test use, that clinical judgment was a predictor of decreased laboratory use, and that level of caring was statistically unrelated to amount of laboratory use. (Author/MSE)

  13. A Medical Logistics Officer Training Needs Assessment Utilizing Feedback from Operation Iraqi Freedom

    Science.gov (United States)

    2004-01-01

    focused on honing and expanding the skill set of medical logistics officers to ensure they possess the most current tools required to accomplish their...Linkages). 60 1. Medical Chemical Defense Materiels ( MCDM ) and Weapons of Mass Destruction 2. Logistical Information Management ie. CAD, CALS, ECAT, LIDS

  14. Measuring the Efficient Utilization of Medical Personnel at Navy Military Treatment Facilities

    Science.gov (United States)

    1990-06-01

    Subject Terms (continue on reverse if necessary and Identify by block number) Field Group Subgroup effectiveness,efficiency,health,hospital,medical, NIHSS ...the study.v, xi I. INTRODUCTION A. PROBLEM Managers of medical treatment facilities (MTFs) lack reliable performance measures that capture, in a...Value Engineering b. Product diversification c. Product simplification d. Research and development e. Product standardization f. Reliability

  15. Identification of common mental disorders by general medical doctors in Taiwan.

    Science.gov (United States)

    Liu, Shen-Ing; Mann, Anthony; Cheng, Andrew; Tjung, Jin-Jin; Hwang, Lee-Ching

    2004-01-01

    The aims of the study were to examine the detection rate of common mental disorders (CMD) by general medical doctors and which patient-related factors associated with increased chances of detection in Taiwan. A two-phase case-identification using the Chinese Health Questionnaire and the Revised Clinical Interview Schedule (CIS-R) was carried out among a sample of consecutive new attenders (n=990) in community and hospital-based clinics. Physicians completed a checklist of the problems that they identified during each consultation. General medical doctors missed more than 85% of the CIS-R cases of defined mental disorder. Physicians performed better identification of CMD among attenders with a higher socioeconomic status, without physical illness, having psychological presentation or attribution, suffering from more serious common mental disorders, or having a longer duration of illness. The very low identification rate of CMD has strongly implied the need to improve postgraduate training in psychiatry for general medical doctors in Taiwan. Simply adding one or two questions about mood and attributions of presenting symptoms might help physicians to identify CMD.

  16. Sleep quality and health service utilization in Chinese general population: a cross-sectional study in Dongguan, China.

    Science.gov (United States)

    Zhang, Hui-Shan; Mai, Yan-Bing; Li, Wei-Da; Xi, Wen-Tao; Wang, Jin-Ming; Lei, Yi-Xiong; Wang, Pei-Xi

    The aims of this study were to explore the Pittsburgh Sleep Quality Index (PSQI) and health service utilization in Chinese general population, to investigate the association between PSQI and health service utilization and to identify the independent contributions of social demographic variables, health related factors and PSQI to health service utilization. In a cross-sectional community-based health survey using a multi-instrument questionnaire, 4067 subjects (≥15 years old) were studied. The Chinese version of the PSQI was used to assess sleep quality. Health service utilization was measured by recent two-week physician visit and annual hospitalization rates. Higher PSQI scores were associated with more frequent health service utilization. Higher scores in subjective sleep quality were associated with higher rate of recent two-week physician visit (adjusted OR = 1.24 per SD increase, P = 0.015). Higher scores in habitual sleep efficiency (adjusted OR = 1.24 per SD increase, P = 0.038) and sleep disturbances (adjusted OR = 2.09 per SD increase, P quality predicted more frequent health service utilization. The independent contribution of PSQI on health service utilization was smaller than social demographic variables. Copyright © 2016. Published by Elsevier B.V.

  17. Micro Data Analysis of Medical and Long-Term Care Utilization Among the Elderly in Japan

    Science.gov (United States)

    Hashimoto, Hideki; Horiguchi, Hiromasa; Matsuda, Shinya

    2010-01-01

    Japan is currently experiencing the most rapid population aging among all OECD countries. Increasing expenditures on medical care in Japan have been attributed to the aging of the population. Authors in the recent debate on end-of-life care and long-term care (LTC) cost in the United States and Europe have attributed time to death and non-medical care cost for the aged as a source of rising expenditures. In this study, we analyzed a large sample of local public insurance claim data to investigate medical and LTC expenditures in Japan. We examined the impact of aging, time to death, survivorship, and use of LTC on medical care expenditure for people aged 65 and above. On the basis of these findings, we conclude that age is a contributing factor to the rising expenditures on LTC, and that the contribution of aging to rising medical care expenditures should be distinguished according to survivorship. PMID:20948944

  18. [Medical resource utilization and allocation in Japan--evaluation of surgical expenditures].

    Science.gov (United States)

    Hiki, Yoshiki

    2004-05-01

    We evaluated the appropriateness of medical cost allocation in Japan from the global aspect especially the percentage of the national budget for medical cost to gross national product (GDP). Base on OECD-Health Data in 2002, Japan was ranked high in the world in terms of medical services but was ranked the second lowest in terms of the percentage of medical cost to GDP (7.6%) among G7 advanced countries. In addition, at surgical departments, allocated medical cost is mostly used for surgical supplies and instruments, and only negligibly for doctor's fee. Unless this situation is improved, the surgical department in Japan will decline. Improvement measures should be taken without delay.

  19. Maximizing the utilization and impact of medical educational software by designing for local area network (LAN) implementation.

    Science.gov (United States)

    Stevens, R; Reber, E

    1993-01-01

    The design, development and implementation of medical education software often occurs without sufficient consideration of the potential benefits that can be realized by making the software network aware. These benefits can be considerable and can greatly enhance the utilization and potential impact of the software. This article details how multiple aspects of the IMMEX problem solving project have benefited from taking maximum advantage of LAN resources.

  20. Concordance between patient self-reports and claims data on clinical diagnoses, medication use, and health system utilization in Taiwan.

    Directory of Open Access Journals (Sweden)

    Chi-Shin Wu

    Full Text Available PURPOSE: The aim of this study was to evaluate the concordance between claims records in the National Health Insurance Research Database and patient self-reports on clinical diagnoses, medication use, and health system utilization. METHODS: In this study, we used the data of 15,574 participants collected from the 2005 Taiwan National Health Interview Survey. We assessed positive agreement, negative agreement, and Cohen's kappa statistics to examine the concordance between claims records and patient self-reports. RESULTS: Kappa values were 0.43, 0.64, and 0.61 for clinical diagnoses, medication use, and health system utilization, respectively. Using a strict algorithm to identify the clinical diagnoses recorded in claims records could improve the negative agreement; however, the effect on positive agreement and kappa was diverse across various conditions. CONCLUSION: We found that the overall concordance between claims records in the National Health Insurance Research Database and patient self-reports in the Taiwan National Health Interview Survey was moderate for clinical diagnosis and substantial for both medication use and health system utilization.

  1. 41 CFR 102-79.55 - Is there a general hierarchy of consideration that agencies must follow in their utilization of...

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Is there a general hierarchy of consideration that agencies must follow in their utilization of space? 102-79.55 Section 102-79... Utilization of Space Utilization of Space § 102-79.55 Is there a general hierarchy of consideration that...

  2. 75 FR 1395 - General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Amendment of...

    Science.gov (United States)

    2010-01-11

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration General and Plastic Surgery Devices Panel of the Medical... the General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee. This meeting...

  3. Pediatric patients on ketogenic diet undergoing general anesthesia-a medical record review.

    Science.gov (United States)

    Soysal, Elif; Gries, Heike; Wray, Carter

    2016-12-01

    To identify guidelines for anesthesia management and determine whether general anesthesia is safe for pediatric patients on ketogenic diet (KD). Retrospective medical record review. Postoperative recovery area. All pediatric patients who underwent general anesthesia while on KD between 2009 and 2014 were reviewed. We identified 24 patients who underwent a total of 33 procedures. All children were on KD due to intractable epilepsy. The age of patients ranged from 1 to 15 years. General anesthesia for the scheduled procedures. Patients' demographics, seizure history, type of procedure; perioperative blood chemistry, medications including the anesthesia administered, and postoperative complications. Twenty-four patients underwent a total of 33 procedures. The duration of KD treatment at the time of general anesthesia ranged from 4 days to 8 years. Among the 33 procedures, 3 patients had complications that could be attributable to KD and general anesthesia. A 9-year-old patient experienced increased seizures on postoperative day 0. An 8-year-old patient with hydropcephalus developed metabolic acidosis on postoperative day 1, and a 7-year-old patient's procedure was complicated by respiratory distress and increased seizure activity in the postanesthesia care unit. This study showed that it is relatively safe for children on KD to undergo general anesthesia. The 3 complications attributable to general anesthesia were mild, and the increased seizure frequencies in 2 patients returned back to baseline in 24 hours. Although normal saline is considered more beneficial than lactated Ringer's solution in patients on KD, normal saline should also be administered carefully because of the risk of exacerbating patients' metabolic acidosis. One should be aware of the potential change of the ketogenic status due to drugs given intraoperatively. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Utility Values for Advanced Soft Tissue Sarcoma Health States from the General Public in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Julian F. Guest

    2013-01-01

    Full Text Available Soft tissue sarcomas are a rare type of cancer generally treated with palliative chemotherapy when in the advanced stage. There is a lack of published health utility data for locally advanced “inoperable”/metastatic disease (ASTS, essential for calculating the cost-effectiveness of current and future treatments. This study estimated time trade-off (TTO and standard gamble (SG preference values associated with four ASTS health states (progressive disease, stable disease, partial response, complete response among members of the general public in the UK (n=207. The four health states were associated with decreases in preference values from full health. Complete response was the most preferred health state (mean utility of 0.60 using TTO. The second most preferred health state was partial response followed by stable disease (mean utilities were 0.51 and 0.43, respectively, using TTO. The least preferred health state was progressive disease (mean utility of 0.30 using TTO. The utility value for each state was significantly different from one another (P<0.001. This study demonstrated and quantified the impact that different treatment responses may have on the health-related quality of life of patients with ASTS.

  5. [The medical education and the extended general practice: results of a Brazilian experiment].

    Science.gov (United States)

    Hafner, Maria de Lourdes Marmorato Botta; Moraes, Magali Aparecida Alves de; Marvulo, Marilda Marques Luciano; Braccialli, Luzmarina Aparecida Doretto; Carvalho, Maria Helena Ribeiro de; Gomes, Romeu

    2010-06-01

    This is a qualitative study that is part of an evaluation research of a medicine course with the use of active teaching-learning methodologies based on the triangulation of methods. The aim is to evaluate the results related to the extended general practice concept. The sources of information used in the study include 17 semi-structured interviews with ex-prisoners and a situation that simulated the medical practice, of which seven ex-prisoners and a simulated patient participated. The analysis of the information and the production of the data were based on the method of interpretation of senses, according to the referential hermeneutic-dialectic system. The results point to aspects that justify the extended general practice, evidenced in two themes: the doctor-patient relationship and the patient approach. In conclusion, it is observed that the evaluated medical course brings together the education of the general, humanist, critical and reflexive doctor that may intervene in the different levels of health attention as well as in the individual and collective approach. It is also concluded that there are limits in operating an extended general practice in diverse health situations.

  6. Outcome prioritisation tool for medication review in older patients with multimorbidity: a pilot study in general practice

    OpenAIRE

    van Summeren, Jojanneke JGT; Schuling, Jan; Haaijer-Ruskamp, Flora M.; Denig, Petra

    2017-01-01

    Background Several methods have been developed to conduct and support medication reviews in older persons with multimorbidity. Assessing the patient’s priorities for achieving specific health outcomes can guide the medication review process. Little is known about the impact of conducting such assessments. Aim This pilot study aimed to determine proposed and observed medication changes when using an outcome prioritisation tool (OPT) during a medication review in general practice. Design and se...

  7. Are Clinical Trial Experiences Utilized?: A Differentiated Model of Medical Sites’ Information Transfer Ability

    DEFF Research Database (Denmark)

    Smed, Marie; Schultz, Carsten; Getz, Kenneth A.;

    2015-01-01

    The collaboration with medical professionals in pharmaceutical clinical trials facilitates opportunities to gain valuable market information concerning product functionality issues, as well as issues related to market implementation and adoption. However, previous research on trial management lac...

  8. Medical devices for restless legs syndrome – clinical utility of the Relaxis pad

    OpenAIRE

    Uh, Mitchell

    2015-01-01

    Ulrike H Mitchell Department of Exercise Sciences, Brigham Young University, Provo, UT, USA Abstract: Restless Legs Syndrome or Willis–Ekbom Disease, a neurosensory disorder, can be treated with pharmaceuticals or conservatively. This review focuses on conservative treatments, more specifically on treatments with medical devices. Two modes of action, enhancement of circulation and counter stimulation, are introduced. Medical devices that use enhancement of circulation as their mec...

  9. Is the efficacy of psychopharmacological drugs comparable to the efficacy of general medicine medication?

    Directory of Open Access Journals (Sweden)

    Seemüller Florian

    2012-02-01

    Full Text Available Abstract There is an ongoing debate concerning the risk benefit ratio of psychopharmacologic compounds. With respect to the benefit, recent reports and meta-analyses note only small effect sizes with comparably high placebo response rates in the psychiatric field. These reports together with others lead to a wider, general critique on psychotropic drugs in the scientific community and in the lay press. In a recently published article, Leucht and his colleagues compare the efficacy of psychotropic drugs with the efficacy of common general medicine drugs in different indications according to results from reviewed meta-analyses. The authors conclude that, overall, the psychiatric drugs were generally not less effective than most other medical drugs. This article will highlight some of the results of this systematic review and discuss the limitations and the impact of this important approach on the above mentioned debate.

  10. Making sense of medically unexplained symptoms in general practice: a grounded theory study.

    Science.gov (United States)

    Stone, Louise

    2013-06-01

    Background General practitioners often encounter patients with medically unexplained symptoms. These patients share many common features, but there is little agreement about the best diagnostic framework for describing them. Aims This study aimed to explore how GPs make sense of medically unexplained symptoms. Design Semi-structured interviews were conducted with 24 GPs. Each participant was asked to describe a patient with medically unexplained symptoms and discuss their assessment and management. Setting The study was conducted among GPs from teaching practices across Australia. Methods Participants were selected by purposive sampling and all interviews were transcribed. Iterative analysis was undertaken using constructivist grounded theory methodology. Results GPs used a variety of frameworks to understand and manage patients with medically unexplained symptoms. They used different frameworks to reason, to help patients make sense of their suffering, and to communicate with other health professionals. GPs tried to avoid using stigmatising labels such as 'borderline personality disorder', which were seen to apply a 'layer of dismissal' to patients. They worried about missing serious physical disease, but managed the risk by deliberately attending to physical cues during some consultations, and focusing on coping with medically unexplained symptoms in others. They also used referrals to exclude serious disease, but were wary of triggering a harmful cycle of uncoordinated care. Conclusion GPs were aware of the ethical relevance of psychiatric diagnoses, and attempted to protect their patients from stigma. They crafted helpful explanatory narratives for patients that shaped their experience of suffering. Disease surveillance remained an important role for GPs who were managing medically unexplained symptoms.

  11. Does the presence of medical students affect quality in general practice consultations?

    Science.gov (United States)

    Price, Richard; Spencer, John; Walker, Jeremy

    2008-04-01

    Previous studies have suggested that the patient's experience of a consultation with a doctor is not affected by the presence of medical students. However, no study has looked at the effect of student presence on conventional UK general practice consultations. This study aimed to measure the quality of the consultation as experienced by patients when students are present, to explore patients' attitudes to the presence of medical students, and to look at the relationships between these factors. We conducted a cross-sectional questionnaire study in general practices in north-east England. General practitioners (GPs) from practices teaching fourth and final year students administered questionnaires to patients who were seen in either teaching or non-teaching consultations. The questionnaire comprised previously validated measures of empathy and enablement as measures of quality, attitudinal statements regarding the presence of students, a scale rating pertaining to the patient's degree of acquaintance with the doctor, and items on demographic data. Results showed no significant differences in enablement scores between the 2 groups. Consultations with student presence last longer. Empathy scores were significantly lower in the 'student present' group, but the size of the difference was small. Attitudinal statements regarding the presence of students showed a high proportion of positive responses, and some groupings of negative ones. Further analysis demonstrated some significant links between attitudinal statements and enablement and empathy scores. The quality of general practice consultations was not adversely affected by medical student presence. However, significant numbers of patients who agreed to be seen with a student present were resistant to the student's presence.

  12. Introducing undergraduate medical teaching into general practice: an action research study.

    Science.gov (United States)

    Grant, Andy; Robling, Michael

    2006-11-01

    Following the publication of Tomorrow's Doctors and as a result of increasing numbers of students recruited to medical school it is necessary to involve more general practitioners (family physicians) in undergraduate medical education. Students have responded positively regarding experiences in general practices with a broad spectrum of clinical conditions to be seen and greater involvement in clinical decision-making. This action research study followed a small group general practice in South Wales through the required preparation for undergraduate medical education and its first year of teaching. Preparatory work for the practice focused mainly on summarizing patient notes, setting up a practice library and arranging accommodation for the students. Members of the Primary Health Care Team (PHCT) found that having students in the practice gave them a sense of achievement and enhanced self-worth. Individuals within the practice felt more confident in their professional role and the team ethic within the practice was strengthened. Doctors' anxieties regarding the adequacy of their clinical skills proved unfounded. Patients were reported to feel more included in their care and to have enjoyed hearing their condition being discussed with the students. Students valued the one-to-one teaching, seeing common illnesses and a variety of consulting styles. It is hoped that this paper will be of value to those responsible for recruiting GP practices into undergraduate teaching. It demonstrates benefits for the primary health care team in terms of improved morale and sense of professional self-worth. Patients felt more involved in their care. Generalization from these findings is limited by only one practice having been involved. Undergraduate teaching offers advantages, particularly in terms of professional self-esteem and team morale.

  13. Management of Sigmoid Volvulus in Three General Community Hospitals of the Cuban Medical Mission in Bolivia

    Directory of Open Access Journals (Sweden)

    Jorge Luís Estepa Pérez

    2013-02-01

    Full Text Available Background: Sigmoid volvulus is an emergency that occurs very frequently in the South American Andean area hospitals. It accounts for over 50% of all intestinal obstructions and still retains high mortality rates. Objective: To characterize the management of sigmoid volvulus. Methods: A prospective and descriptive study was conducted including all patients with sigmoid volvulus who attended three general community hospitals of the Cuban medical mission in Bolivia from June 2006 to June 2007 and were treated trough general surgery. We analyzed the following variables: age, sex, medical history, surgical diagnosis, classification and type of surgery, surgery performed, evolution, complications, use of antibiotic-prophylaxis and admission to intensive care units. The information was obtained from medical records, operative reports and a data collector model. Results: Sigmoid volvulus occurred more frequently in the Yapacaní hospital, department of Santa Cruz; the predominant age group was that from 55 to 64 years old as well as the predominant sex was that of males. Chagas disease was detected in most of the patients studied. Among symptoms those that predominated were distension, abdominal pain and stool detention. Decompression, devolvulation and surgical treatment were the processes followed in all cases, being the Rankin-Mikulicz colostomy the most widely used. No patients underwent a second surgery, and there were no mortality rates. Conclusions: Decompression, devolvulation and surgical treatment were the processes followed in all cases, being the Rankin-Mikulicz colostomy the most widely used. Most patients had a satisfactory evolution.

  14. Data availability and model complexity, generality, and utility: a reply to Lonergan

    NARCIS (Netherlands)

    Evans, M.R.; Benton, T.G.; Grimm, V.; Lessells, C.M.; O'Malley, M.A.; Moustakas, A.; Weisberg, M.

    2014-01-01

    Comment on Do simple models lead to generality in ecology? [Trends Ecol Evol. 2013]Do simple models lead to generality in ecology? Evans MR, Grimm V, Johst K, Knuuttila T, de Langhe R, Lessells CM, Merz M, O'Malley MA, Orzack SH, Weisberg M, et al. Trends Ecol Evol. 2013 Oct; 28(10):578-83. Epub 201

  15. Consumption of psychiatric drugs by patients of medical and surgical clinics in a general hospital

    Directory of Open Access Journals (Sweden)

    Flavio Hiroshi Shirama

    2013-07-01

    Full Text Available PURPOSES: to identify the prevalence of the use of psychiatric drugs among patients admitted to medical and surgical clinics of a general hospital, and also the factors related to the consumption of this type of medication. METHOD: this is a transversal, descriptive, correlational study with quantitative analysis. For the collection of data, there was use of structured interviews and also reference to medical files. RESULTS: there was confirmation of a high prevalence of users of psychiatric drugs, which was associated to the female sex, to people who do not practice Roman Catholicism, and admittance to the clinic not covered by the Single Health System (Sistema Único de Saúde - SUS, as well as the presence of common mental disorders. Benzodiazepine drugs were the most commonly used psychiatric drugs. Among the total number of users, there has been the identification of patients who were not aware that they were receiving such medication. Doctors who are not psychiatrists were responsible for most prescriptions of psychiatric drugs. CONCLUSIONS: this signals the need to prepare health professionals to deal with psychological and social problems commonly found in clinical practice, in order to promote the rational use of psychiatric drugs.

  16. Professional training and roles of community pharmacists in malaysia: views from general medical practitioners.

    Science.gov (United States)

    Hassali, Ma; Awaisu, A; Shafie, Aa; Saeed, Ms

    2009-01-01

    This pilot study aimed to explore the perceptions of general medical practitioners (GPs) towards the professional training and roles of community pharmacists. A self-administered questionnaire was distributed to all private clinics (n=160) run by GPs in a northern state of Malaysia. The instrument contained questions to evaluate the practitioners' level of agreement using a 5-point Likert-type scale. Of 160 GPs, 80 returned the questionnaire (response rate 50%). The respondents agreed that: GPs should consider the community pharmacists' recommendations whenever there is/are any problem(s) with the prescriptions given by them (46.3%); community pharmacists are the best healthcare professionals to educate patients about safe and appropriate use of medications (52.5%); the pharmacy profession had undergone a major metamorphosis from a product-oriented profession to a more patient-centred and outcome-oriented one (61.3%); if dispensing separation is implemented, they will work closely with the community pharmacists in monitoring patients' pharmacotherapeutic outcomes (77.5%). The current findings suggest that GPs would support an extension of the role of the community pharmacists in number of activities of patient care activities such as medication counselling. Thus, suggesting potential collaborative care between GPs and community pharmacists towards patient care and the needs to develop and incorporate topics on inter-professional relationship in the current medical and pharmaceutical education curriculums.

  17. PROFESSIONAL TRAINING AND ROLES OF COMMUNITY PHARMACISTS IN MALAYSIA: VIEWS FROM GENERAL MEDICAL PRACTITIONERS

    Directory of Open Access Journals (Sweden)

    SAEED MS

    2009-01-01

    Full Text Available Aim: This pilot study aimed to explore the perceptions of general medical practitioners (GPs towards the professional training and roles of community pharmacists. Methods: A self-administered questionnaire was distributed to all private clinics (n=160 run by GPs in a northern state of Malaysia. The instrument contained questions to evaluate the practitioners’ level of agreement using a 5-point Likert-type scale. Results: Of 160 GPs, 80 returned the questionnaire (response rate 50%. The respondents agreed that: GPs should consider the community pharmacists’ recommendations whenever there is/are any problem(s with the prescriptions given by them (46.3%; community pharmacists are the best healthcare professionals to educate patients about safe and appropriate use of medications (52.5%; the pharmacy profession had undergone a major metamorphosis from a product-oriented profession to a more patient-centred and outcome-oriented one (61.3%; if dispensing separation is implemented, they will work closely with the community pharmacists in monitoring patients’ pharmacotherapeutic outcomes (77.5%. Conclusion: The current findings suggest that GPs would support an extension of the role of the community pharmacists in number of activities of patient care activities such as medication counselling. Thus, suggesting potential collaborative care between GPs and community pharmacists towards patient care and the needs to develop and incorporate topics on inter-professional relationship in the current medical and pharmaceutical education curriculums.

  18. Health care utilization of mexican patients with medically unexplained physical symptoms

    Science.gov (United States)

    Ramírez Aranda, José Manuel; de los Santos Reséndiz, Homero; Lara Duarte, María Yolanda; Pazaran Zanella, Santiago Oscar; Méndez López, Jafet Felipe; Gil Alfaro, Issa; Islas Ruz, Félix Gilberto; Navarrete Floriano, Gloria; Guillen Salomón, Edith; Texon Fernández, Obdulia; Cruz Duarte, Silvia; Romo Salazar, Juan Carlos; Pérez Ruiz, Claudia Elsa; López Salas, Sara de Jesús; Benítez Amaya, Lizbeth; Zapata Gallardo, Javier Nahum

    2016-01-01

    Objective: To determine the prevalence of medically unexplained physical symptoms and the characteristics and use of health services in a group of patients with medically unexplained physical symptoms and a group of patients with other illnesses. Methods: This was a cross-sectional, retrospective and multicenter study. We included 1,043 patients over 18 years of age from 30 primary care units of a government health institution, in 11 states of Mexico, attended by 39 family physicians. The prevalence of medically unexplained physical symptoms was determined and both groups with or without symptoms were compared with regard to drug use, laboratory and other studies, leaves of absence, and referrals in the last six months. The group with medically unexplained physical symptoms was diagnosed using the Patient Health Questionnaire and the diagnostic criteria of Reid et al. Emergency or terminal illnesses were excluded. The chi square test was used with a statistical significance of p < 0.05. Results: Medically unexplained physical symptoms was diagnosed in 73 patients (7.0%). The majority were women (91.8%); their predominant symptom was from the gastrointestinal system in 56 (76.7%). This group had a greater use of clinical studies and referrals to other services (mean 1.1 vs. 0.5; p <0.0001 and 0.6 vs. 0.8; p < 0.01, respectively). Conclusions: The prevalence of medically unexplained physical symptoms was low, but with a greater impact on some health services. This could represent an overload in medical costs. PMID:27821895

  19. Utility and assessment of non-technical skills for rapid response systems and medical emergency teams.

    Science.gov (United States)

    Chalwin, R P; Flabouris, A

    2013-09-01

    Efforts are ongoing to improve outcomes from cardiac arrest and medical emergencies. A promising quality improvement modality is use of non-technical skills (NTS) that aim to address human factors through improvements in performance of leadership, communication, situational awareness and decision-making. Originating in the airline industry, NTS training has been successfully introduced into anaesthesia, surgery, emergency medicine and other acute medical specialities. Some aspects of NTS have already achieved acceptance for cardiac arrest teams. Leadership skills are emphasised in advanced life support training and have shown favourable results when employed in simulated and clinical resuscitation scenarios. The application of NTS in medical emergency teams as part of a rapid response system attending medical emergencies is less certain; however, observations of simulations have also shown promise. This review highlights the potential benefits of NTS competency for cardiac arrest teams and, more importantly, medical emergency teams because of the diversity of clinical scenarios encountered. Discussion covers methods to assess and refine NTS and NTS training to optimise performance in the clinical environment. Increasing attention should be applied to yielding meaningful patient and organisational outcomes from use of NTS. Similarly, implementation of any training course should receive appropriate scrutiny to refine team and institutional performance. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

  20. Fate of manuscripts rejected by a non-English-language general medical journal

    DEFF Research Database (Denmark)

    Vinther, Siri; Rosenberg, Jacob

    2011-01-01

    evaluated. Results Of 198 rejected manuscripts, 21 (10.6%) were eventually published after a median of 685 days (range 209-1463). The majority of these were original research, published in English-language specialty/subspecialty journals. The median number of citations per article was 2-3 (IQR 0...... translation could be a barrier for resubmitting to English-language journals with larger readerships, thus hindering the dissemination of knowledge to the international community.......Objective The objective of this study was to determine whether, where and when manuscripts were published following rejection by the Journal of the Danish Medical Association, a general medical journal published in Danish. Similar previous studies have focused on specialty/subspecialty journals...

  1. Medical consultations in relation to severity of hand eczema in the general population

    DEFF Research Database (Denmark)

    Hald, M.; Berg, N.D.; Elberling, J.

    2008-01-01

    Background Hand eczema is a common disease with a wide severity spectrum. Little information exists concerning the association between the severity of hand eczema and medical consultations. Objectives To describe the self-rated severity of hand eczema in a general population and the relationship...... to seeking medical attention. Methods A questionnaire on self-reported hypersensitivity including two questions on hand eczema was sent to a random sample of 6000 individuals, aged 18-69 years, living in Copenhagen, Denmark. A total of 4242 individuals (71%) answered the questionnaire. All individuals who...... reported hand eczema (n = 752) within the previous 12 months received a more detailed questionnaire focused on hand eczema and a previously validated photographic guide with four groups of severity ranging from almost clear to very severe. Results Five hundred and sixty-four individuals (75%) returned...

  2. The Effect of the General Data Protection Regulation on Medical Research

    Science.gov (United States)

    2017-01-01

    Background The enactment of the General Data Protection Regulation (GDPR) will impact on European data science. Particular concerns relating to consent requirements that would severely restrict medical data research have been raised. Objective Our objective is to explain the changes in data protection laws that apply to medical research and to discuss their potential impact. Methods Analysis of ethicolegal requirements imposed by the GDPR. Results The GDPR makes the classification of pseudonymised data as personal data clearer, although it has not been entirely resolved. Biomedical research on personal data where consent has not been obtained must be of substantial public interest. Conclusions The GDPR introduces protections for data subjects that aim for consistency across the EU. The proposed changes will make little impact on biomedical data research. PMID:28235748

  3. Series: Utilization of Differential Equations and Methods for Solving Them in Medical Physics (4).

    Science.gov (United States)

    Murase, Kenya

    Partial differential equations are often used in the field of medical physics. In this (final) issue, the methods for solving the partial differential equations were introduced, which include separation of variables, integral transform (Fourier and Fourier-sine transforms), Green's function, and series expansion methods. Some examples were also introduced, in which the integral transform and Green's function methods were applied to solving Pennes' bioheat transfer equation and the Fourier series expansion method was applied to Navier-Stokes equation for analyzing the wall shear stress in blood vessels.Finally, the author hopes that this series will be helpful for people who engage in medical physics.

  4. Antibiotic prescription patterns of South African general medical practitioners for treatment of acute bronchitis.

    Science.gov (United States)

    Ncube, N B Q; Solanki, G C; Kredo, T; Lalloo, R

    2017-01-30

    Antibiotic resistance is a significant public health problem. Prudent use of antibiotics is crucial in reducing this resistance. Acute bronchitis is a common reason for consultations with general medical practitioners, and antibiotics are often prescribed even though guidelines recommend not prescribing them for uncomplicated acute bronchitis. To analyse the antibiotic prescription patterns of South African (SA) general medical practitioners in the treatment of acute bronchitis. The 2013 claims for members of 11 health insurance schemes were analysed to assess antibiotic prescription patterns for patients diagnosed with acute bronchitis. The patterns were assessed by type of bronchitis, chronic health status of the patients, sex and age group. The types of antibiotic prescribed were also analysed. Of 166 821 events analysed, an antibiotic was prescribed in more than half (52.9%). There were significant differences by type of bronchitis and chronic health status. Patients with viral bronchitis were more likely to be prescribed an antibiotic than those with bacterial bronchitis (odds ratio (OR) 1.17, 95% confidence interval (CI) 1.08 - 1.26). Patients with a chronic illness were less likely to be prescribed an antibiotic than those without (OR 0.58, 95% CI 0.57 - 0.60). More than 70% of the antibiotics prescribed were cephalosporins, penicillins and other beta-lactams. Prescription rates of antibiotics for acute bronchitis by SA general medical practitioners are high. There is an urgent need to follow the guidelines for antibiotic use for acute bronchitis to reduce the likelihood of increasing resistance to available antibiotics.

  5. Primary medication non-adherence after discharge from a general internal medicine service.

    Directory of Open Access Journals (Sweden)

    Brooks A Fallis

    Full Text Available BACKGROUND: Medication non-adherence frequently leads to suboptimal patient outcomes. Primary non-adherence, which occurs when a patient does not fill an initial prescription, is particularly important at the time of hospital discharge because new medications are often being prescribed to treat an illness rather than for prevention. METHODS: We studied older adults consecutively discharged from a general internal medicine service at a large urban teaching hospital to determine the prevalence of primary non-adherence and identify characteristics associated with primary non-adherence. We reviewed electronic prescriptions, electronic discharge summaries and pharmacy dispensing data from April to August 2010 for drugs listed on the public formulary. Primary non-adherence was defined as failure to fill one or more new prescriptions after hospital discharge. In addition to descriptive analyses, we developed a logistical regression model to identify patient characteristics associated with primary non-adherence. RESULTS: There were 493 patients eligible for inclusion in our study, 232 of whom were prescribed new medications. In total, 66 (28% exhibited primary non-adherence at 7 days after discharge and 55 (24% at 30 days after discharge. Examples of medications to which patients were non-adherent included antibiotics, drugs for the management of coronary artery disease (e.g. beta-blockers, statins, heart failure (e.g. beta-blockers, angiotensin converting enzyme inhibitors, furosemide, stroke (e.g. statins, clopidogrel, diabetes (e.g. insulin, and chronic obstructive pulmonary disease (e.g. long-acting bronchodilators, prednisone. Discharge to a nursing home was associated with an increased risk of primary non-adherence (OR 2.25, 95% CI 1.01-4.95. CONCLUSIONS: Primary non-adherence after medications are newly prescribed during a hospitalization is common, and was more likely to occur in patients discharged to a nursing home.

  6. Personalised Medical Reference to General Practice Notebook (GPnotebook - an evolutionary tale

    Directory of Open Access Journals (Sweden)

    James McMorran

    2002-09-01

    What has happened to this resource now? This brief paper outlines how the developers of the reference resource have improved on the design and content of the medical database. Now the reference resource is an Internet-based resource called General Practice Notebook (www.gpnotebook.co.uk and is currently attracting 5000 to 9000 page views per day and containing over 30 000 index terms in a complex web structure of over 60 000 links. This paper describes the evolutionary process that has occurred over the last decade.

  7. Pediatric Type 1 and 2 Diabetes Mellitus : Epidemiology, Comorbidities, and Medication Utilization

    NARCIS (Netherlands)

    Fazeli Farsani, S.

    2015-01-01

    The numbers of patients with diabetes mellitus (type 1 and type 2) are increasing globally, both in adults and children. Pediatric diabetes mellitus is an important health concern, since this disease has significant effects on health and quality of life, social function, use of medical services and

  8. Pediatric Type 1 and 2 Diabetes Mellitus : Epidemiology, Comorbidities, and Medication Utilization

    NARCIS (Netherlands)

    Fazeli Farsani, S.

    2015-01-01

    The numbers of patients with diabetes mellitus (type 1 and type 2) are increasing globally, both in adults and children. Pediatric diabetes mellitus is an important health concern, since this disease has significant effects on health and quality of life, social function, use of medical services and

  9. Utilizing uncoded consultation notes from electronic medical records for predictive modeling of colorectal cancer

    NARCIS (Netherlands)

    Hoogendoorn, Mark; Szolovits, Peter; Moons, Leon M G; Numans, ME

    2016-01-01

    OBJECTIVE: Machine learning techniques can be used to extract predictive models for diseases from electronic medical records (EMRs). However, the nature of EMRs makes it difficult to apply off-the-shelf machine learning techniques while still exploiting the rich content of the EMRs. In this paper, w

  10. Nonadherence to antihypertensive medications and associated factors in general medicine clinics

    Directory of Open Access Journals (Sweden)

    Al Ghobain M

    2016-08-01

    Full Text Available Mohammed Al Ghobain,1,2 H Alhashemi,1,2 A Aljama,3 S Bin Salih,1,2 Z Assiri,4 A Alsomali,4 Gamal Mohamed5 1Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, 2King Abdullah International Medical Research Centre, 3Department of Medicine, King Abdulaziz Medical City, 4College of Nursing, 5College of Public Health, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia Objectives: Nonadherence to antihypertensive medications has not been assessed in the Saudi population. The aim of this study was to address and evaluate the magnitude of nonadherence among hypertensive patients and the risk factors associated with it. Methods: A cross-sectional survey was conducted on hypertensive patients who attended the general internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia, using a questionnaire that was modified after reviewing the literature. Hypertensive patients were labeled as nonadherent if they missed their medications for a total of 7 days during the previous month. Results: A total of 302 patients participated in the study, of whom 63% were females with a mean age of 64 years, and 64% were illiterate. The prevalence of nonadherence to medications among hypertensive patients was found to be 12.3%. Poor disease knowledge was reported in 80% of patients, while 66% of the patients had poor monitoring of their disease. Younger age (≤65 years, poor monitoring, and uncontrolled blood pressure (BP ≥140/90 mmHg were the predictor factors associated with nonadherence (odds ratio [OR] =2.04, P=0.025; OR=2.39, P=0.004; and OR=2.86, P=0.003, respectively. Conclusion: Nonadherence to antihypertensive medications is lower than that previously reported in the literature. Younger age, uncontrolled BP, and poor monitoring are the main risk factors associated with nonadherence. Keywords: nonadherence, hypertension, Saudi Arabia, uncontrolled blood

  11. 21 CFR 862.2050 - General purpose laboratory equipment labeled or promoted for a specific medical use.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false General purpose laboratory equipment labeled or... TOXICOLOGY DEVICES Clinical Laboratory Instruments § 862.2050 General purpose laboratory equipment labeled or promoted for a specific medical use. (a) Identification. General purpose laboratory equipment labeled...

  12. Medical Student Attitudes to the Autopsy and Its Utility in Medical Education: A Brief Qualitative Study at One UK Medical School

    Science.gov (United States)

    Bamber, Andrew R.; Quince, Thelma A.; Barclay, Stephen I. G.; Clark, John D. A.; Siklos, Paul W. L.; Wood, Diana F.

    2014-01-01

    Attending postmortems enables students to learn anatomy and pathology within a clinical context, provides insights into effects of treatment and introduces the reality that patients die. Rates of clinical autopsies have declined and medical schools have cut obligatory autopsy sessions from their curricula making it difficult to assess medical…

  13. Seeking Medical Information Using Mobile Apps and the Internet: Are Family Caregivers Different from the General Public?

    Science.gov (United States)

    Kim, Hyunmin; Paige Powell, M; Bhuyan, Soumitra S; Bhuyan, Soumitra Sudip

    2017-03-01

    Family caregivers play an important role to care cancer patients since they exchange medical information with health care providers. However, relatively little is known about how family caregivers seek medical information using mobile apps and the Internet. We examined factors associated with medical information seeking by using mobile apps and the Internet among family caregivers and the general public using data from the 2014 Health Information National Trends Survey 4 Cycle 1. The study sample consisted of 2425 family caregivers and 1252 non-family caregivers (the general public). Guided by Comprehensive Model of Information Seeking (CMIS), we examined related factors' impact on two outcome variables for medical information seeking: mobile apps use and Internet use with multivariate logistic regression analyses. We found that online medical information seeking is different between family caregivers and the general public. Overall, the use of the Internet for medical information seeking is more common among family caregivers, while the use of mobile apps is less common among family caregivers compared with the general public. Married family caregivers were less likely to use mobile apps, while family caregivers who would trust cancer information were more likely to use the Internet for medical information seeking as compared to the general public. Medical information seeking behavior among family caregivers can be an important predictor of both their health and the health of their cancer patients. Future research should explore the low usage of mobile health applications among family caregiver population.

  14. Developing a reproducible non-line-of-sight experimental setup for testing wireless medical device coexistence utilizing ZigBee.

    Science.gov (United States)

    LaSorte, Nickolas J; Rajab, Samer A; Refai, Hazem H

    2012-11-01

    The integration of heterogeneous wireless technologies is believed to aid revolutionary healthcare delivery in hospitals and residential care. Wireless medical device coexistence is a growing concern given the ubiquity of wireless technology. In spite of this, a consensus standard that addresses risks associated with wireless heterogeneous networks has not been adopted. This paper serves as a starting point by recommending a practice for assessing the coexistence of a wireless medical device in a non-line-of-sight environment utilizing 802.15.4 in a practical, versatile, and reproducible test setup. This paper provides an extensive survey of other coexistence studies concerning 802.15.4 and 802.11 and reports on the authors' coexistence testing inside and outside an anechoic chamber. Results are compared against a non-line-of-sight test setup. Findings relative to co-channel and adjacent channel interference were consistent with results reported in the literature.

  15. In-silico ADME models: a general assessment of their utility in drug discovery applications.

    Science.gov (United States)

    Gleeson, M Paul; Hersey, Anne; Hannongbua, Supa

    2011-01-01

    ADME prediction is an extremely challenging area as many of the properties we try to predict are a result of multiple physiological processes. In this review we consider how in-silico predictions of ADME processes can be used to help bias medicinal chemistry into more ideal areas of property space, minimizing the number of compounds needed to be synthesized to obtain the required biochemical/physico-chemical profile. While such models are not sufficiently accurate to act as a replacement for in-vivo or in-vitro methods, in-silico methods nevertheless can help us to understand the underlying physico-chemical dependencies of the different ADME properties, and thus can give us inspiration on how to optimize them. Many global in-silico ADME models (i.e generated on large, diverse datasets) have been reported in the literature. In this paper we selectively review representatives from each distinct class and discuss their relative utility in drug discovery. For each ADME parameter, we limit our discussion to the most recent, most predictive or most insightful examples in the literature to highlight the current state of the art. In each case we briefly summarize the different types of models available for each parameter (i.e simple rules, physico-chemical and 3D based QSAR predictions), their overall accuracy and the underlying SAR. We also discuss the utility of the models as related to lead generation and optimization phases of discovery research.

  16. Forward-backward generalized sidelobe canceler beamforming applied to medical ultrasound imaging

    Science.gov (United States)

    Li, Jiake; Chen, Xiaodong; Wang, Yi; Chen, Xiaoshuai; Yu, Daoyin

    2017-01-01

    For adaptive ultrasound imaging, accurate estimation of the covariance matrix is of great importance, and it has a fundamental influence on the performance of the adaptive beamformer. In this paper, a new forward-backward generalized sidelobe canceler (FBGSC) approach is proposed for medical ultrasound imaging, which uses forward and backward subaperture averaging to accurate estimate the covariance matrix. And resulted from accurate estimating of covariance matrix, FBGSC can achieve better lateral resolution and contrast without preprocessing algorithms. Field II is applied to obtain the simulated echo data of scattering points and a circular cyst. Beamforming responses of scattering points show that FBGSC can improve the lateral resolution by 55.7% and 66.6% compared with synthetic aperture (SA) and delay-and-sum (DS), respectively. Similarly, the simulated results of circular cyst show that FBGSC can obtain better beamforming responses than traditional adaptive beamformers. Finally, an experiment is conducted based on the real echo data of a medical ultrasound system. Results demonstrate that the FBGSC can improve the imaging quality of medical ultrasound imaging system, with lower computational demand and higher reliability.

  17. Utilization of never-medicated bipolar disorder patients towards development and validation of a peripheral biomarker profile.

    Directory of Open Access Journals (Sweden)

    Catherine L Clelland

    Full Text Available There are currently no biological tests that differentiate patients with bipolar disorder (BPD from healthy controls. While there is evidence that peripheral gene expression differences between patients and controls can be utilized as biomarkers for psychiatric illness, it is unclear whether current use or residual effects of antipsychotic and mood stabilizer medication drives much of the differential transcription. We therefore tested whether expression changes in first-episode, never-medicated BPD patients, can contribute to a biological classifier that is less influenced by medication and could potentially form a practicable biomarker assay for BPD. We employed microarray technology to measure global leukocyte gene expression in first-episode (n=3 and currently medicated BPD patients (n=26, and matched healthy controls (n=25. Following an initial feature selection of the microarray data, we developed a cross-validated 10-gene model that was able to correctly predict the diagnostic group of the training sample (26 medicated patients and 12 controls, with 89% sensitivity and 75% specificity (p<0.001. The 10-gene predictor was further explored via testing on an independent cohort consisting of three pairs of monozygotic twins discordant for BPD, plus the original enrichment sample cohort (the three never-medicated BPD patients and 13 matched control subjects, and a sample of experimental replicates (n=34. 83% of the independent test sample was correctly predicted, with a sensitivity of 67% and specificity of 100% (although this result did not reach statistical significance. Additionally, 88% of sample diagnostic classes were classified correctly for both the enrichment (p=0.015 and the replicate samples (p<0.001. We have developed a peripheral gene expression biomarker profile, that can classify healthy controls from patients with BPD receiving antipsychotic or mood stabilizing medication, which has both high sensitivity and specificity

  18. Air pollution and general practitioner access and utilization: a population based study in Sarnia, 'Chemical Valley,' Ontario

    Directory of Open Access Journals (Sweden)

    Atari Dominic O

    2011-08-01

    Full Text Available Abstract Background Health impacts of poor environmental quality have been identified in studies around the world and in Canada. While many of the studies have identified associations between air pollution and mortality or morbidity, few have focused on the role of health care as a potential moderator of impacts. This study assessed the determinants of health care access and utilization in the context of ambient air pollution in Sarnia, Ontario, Canada. Methods Residents of Sarnia participated in a Community Health Study administered by phone, while several ambient air pollutants including nitrogen dioxide (NO2, sulphur dioxide (SO2 and the volatile organic compounds benzene, toluene, ethylbenzene, mp- and o-xylene (BTEX were monitored across the city. Land Use Regression models were used to estimate individual exposures to the measured pollutants and logistic regression models were utilized to assess the relative influence of environmental, socioeconomic and health related covariates on general practitioner access and utilization outcomes. Results The results show that general practitioner use increased with levels of exposure to nitrogen dioxide (NO2- Odds Ratio [OR]: 1.16, p 2- OR: 1.61, p 2 and SO2. Respondents without regular care living in high pollution areas were also more likely to report travelling or waiting for care in excess of 20 minutes (OR: 3.28, p p > 0.05. Conclusions This study provides evidence for inequitable health care access and utilization in Sarnia, with particular relevance to its situation as a sentinel high exposure environment. Levels of exposure to pollution appears to influence utilization of health care services, but poor access to primary health care services additionally burden certain groups in Sarnia, Ontario, Canada.

  19. A Study of Alternate Approaches to Utilization Review of Laboratory Services within an Army Medical Center

    Science.gov (United States)

    1983-06-06

    not known 5. Outplacement 6. Administrative discharge delay 7. Other (EKG, EEG, etc.) OTHER 1. Patient/family pressure 2. Teaching 3. Research 23...return as ordered or next weekday a. Routine lab tests and X-ray: same 4. Outplacement : delay, if any, is count- day if ordered in a.m. or next ed from...medical complica- tion) interferes 5. Outplacement : delay, if any, is counted from the day after disposi- tion request is noted except where unusual

  20. [General information system through whole hospital and electronic medical record system].

    Science.gov (United States)

    Goto, Takaaki

    2006-02-01

    A new system has been introduced and implemented at the Nagoya City University Hospital since January 2004 in order to improve services for patients and general operation for management of the hospital. General Information System has been consisted with Electronic Medical Record System (EMRS), which is the core of all system and divisional system such as Clinical Laboratory Tests, Images, Medical Accounting and so on. A new system has been built and operated to work with the EMRS at the Department of Central Clinical Laboratory (CCL). To cooperate with the new system, we have constructed and operated directly the EMRS such as automatic registration the latest information on infectious diseases and blood transfusions, clinical reports on laboratory test through the hospital news and/or e-mail, introducing laboratory pre test before the consultation, rapid reports of panic values to the doctor in charge of the patients directly, the new system build up a closer cooperation between division of blood transfusion division and that of immuno-chemistry in CCL through EMRS. The new system has been brought not only efficiency and strengthen of function in CCL but also strengthen the service to patients in the hospital.

  1. Utilization of potentially inappropriate medications in elderly patients in a tertiary care teaching hospital in India

    Directory of Open Access Journals (Sweden)

    Binit N Jhaveri

    2014-01-01

    Full Text Available Aim: To evaluate the use of potentially inappropriate medicines in elderly inpatients in a tertiary care teaching hospital. Materials and Methods: Retrospective analysis was performed for cases of elderly patients admitted between January 2010 and December 2010. Data on age, gender, diagnosis, duration of hospital stay, treatment, and outcome were collected. Prescriptions were assessed for the use of potentially inappropriate medications in geriatric patients by using American Geriatric Society Beer′s criteria (2012 and PRISCUS list (2010. Results: A total of 676 geriatric patients (52.12% females were admitted in the medicine ward. The average age of geriatric patients was 72.69 years. According to Beer′s criteria, at least one inappropriate medicine was prescribed in 590 (87.3% patients. Metoclopramide (54.3%, alprazolam (9%, diazepam (8%, digoxin > 0.125 mg/day (5%, and diclofenac (3.7% were the commonly used inappropriate medications. Use of nonsteroidal anti-inflammatory drugs (NSAIDs in heart and renal failure patients was the commonly identified drug-disease interaction. According to PRISCUS list, at least one inappropriate medication was prescribed in 210 (31.06% patients. Conclusion: Use of inappropriate medicines is highly prevalent in elderly patients.

  2. The utility of reflective writing after a palliative care experience: can we assess medical students' professionalism?

    Science.gov (United States)

    Braun, Ursula K; Gill, Anne C; Teal, Cayla R; Morrison, Laura J

    2013-11-01

    Medical education leaders have called for a curriculum that proactively teaches knowledge, skills, and attitudes required for professional practice and have identified professionalism as a competency domain for medical students. Exposure to palliative care (PC), an often deeply moving clinical experience, is an optimal trigger for rich student reflection, and students' reflective writings can be explored for professional attitudes. Our aim was to evaluate the merit of using student reflective writing about a PC clinical experience to teach and assess professionalism. After a PC patient visit, students wrote a brief reflective essay. We explored qualitatively if/how evidence of students' professionalism was reflected in their writing. Five essays were randomly chosen to develop a preliminary thematic structure, which then guided analysis of 30 additional, randomly chosen essays. Analysts coded transcripts independently, then collaboratively, developed thematic categories, and selected illustrative quotes for each theme and subtheme. Essays revealed content reflecting more rich information about students' progress toward achieving two professionalism competencies (demonstrating awareness of one's own perspectives and biases; demonstrating caring, compassion, empathy, and respect) than two others (displaying self-awareness of performance; recognizing and taking actions to correct deficiencies in one's own behavior, knowledge, and skill). Professional attitudes were evident in all essays. The essays had limited use for formal summative assessment of professionalism competencies. However, given the increasing presence of PC clinical experiences at medical schools nationwide, we believe this assessment strategy for professionalism has merit and deserves further investigation.

  3. Utilizing national and international registries to enhance pre-market medical device regulatory evaluation.

    Science.gov (United States)

    Yue, Lilly Q; Campbell, Gregory; Lu, Nelson; Xu, Yunling; Zuckerman, Bram

    2016-01-01

    Regulatory decisions are made based on the assessment of risk and benefit of medical devices at the time of pre-market approval and subsequently, when post-market risk-benefit balance needs reevaluation. Such assessments depend on scientific evidence obtained from pre-market studies, post-approval studies, post-market surveillance studies, patient perspective information, as well as other real world data such as national and international registries. Such registries provide real world evidence and are playing a more and more important role in enhancing the safety and effectiveness evaluation of medical devices. While these registries provide large quantities of data reflecting real world practice and can potentially reduce the cost of clinical trials, challenges arise concerning (1) data quality adequate for regulatory decision-making, (2) bias introduced at every stage and aspect of study, (3) scientific validity of study designs, and (4) reliability and interpretability of study results. This article will discuss related statistical and regulatory challenges and opportunities with examples encountered in medical device regulatory reviews.

  4. The Effect of Student Working Group Establishment on Teaching General Embryology Course to Medical Students

    Directory of Open Access Journals (Sweden)

    Mozafar Khazaei

    2012-11-01

    Full Text Available Introduction: Quantitative and qualitative enhancement of educational activities is an essential issue. Learners’ cooperation in the teaching process in order to increase teaching effectiveness and promotion is considered significant. The aim of the present study was to determine the effect of establishment of student working group on the teaching general embryology course to medical students.Methods: Ten students (1% of medical embryology course were selected to analyze the topics to be taught before each session according to lesson plan, and observe the whole teaching process during lesson presentation. Then, having asked the other students’ viewpoints and discussing with one another, they provided the teacher with a written report on the strengths and weaknesses of the teaching and its problems. The teacher analyzed the problems proposed by the working group to improve teaching process in the next session. At the end of the semester, a questionnaire was administered to all the participants. Data were analyzed using descriptive statistics.Results: The mean of students’ scores was 74.26%. The most important findings obtained in this study included positive role of film projection in teaching the materials (95.34%, significance of presentation of various pictures from different books (88.4%, changing students’ attitude toward application of embryology in different diseases (86%, and repetition of previous session’s pictures (83.75%. The weak points mentioned, however, were physical problems of the classroom and deficiency of audio visual equipment.Conclusion: Student working group has a positive impact on the teaching medical general embryology.

  5. Accreditation Council for Graduate Medical Education Case Log: General Surgery Resident Thoracic Surgery Experience

    Science.gov (United States)

    Kansier, Nicole; Varghese, Thomas K.; Verrier, Edward D.; Drake, F. Thurston; Gow, Kenneth W.

    2014-01-01

    Background General surgery resident training has changed dramatically over the past 2 decades, with likely impact on specialty exposure. We sought to assess trends in general surgery resident exposure to thoracic surgery using the Accreditation Council for Graduate Medical Education (ACGME) case logs over time. Methods The ACGME case logs for graduating general surgery residents were reviewed from academic year (AY) 1989–1990 to 2011–2012 for defined thoracic surgery cases. Data were divided into 5 eras of training for comparison: I, AY89 to 93; II, AY93 to 98; III, AY98 to 03; IV, AY03 to 08; V, AY08 to 12. We analyzed quantity and types of cases per time period. Student t tests compared averages among the time periods with significance at a p values less than 0.05. Results A total of 21,803,843 general surgery cases were reviewed over the 23-year period. Residents averaged 33.6 thoracic cases each in period I and 39.7 in period V. Thoracic cases accounted for nearly 4% of total cases performed annually (period I 3.7% [134,550 of 3,598,574]; period V 4.1% [167,957 of 4,077,939]). For the 3 most frequently performed procedures there was a statistically significant increase in thoracoscopic approach from period II to period V. Conclusions General surgery trainees today have the same volume of thoracic surgery exposure as their counterparts over the last 2 decades. This maintenance in caseload has occurred in spite of work-hour restrictions. However, general surgery graduates have a different thoracic surgery skill set at the end of their training, due to the predominance of minimally invasive techniques. Thoracic surgery educators should take into account these differences when training future cardiothoracic surgeons. PMID:24968766

  6. EFFECT OF SHORT-TERM YOGA PRACTICES ON PSYCHOLOGICA L GENERAL WELL BEING IN MEDICAL STUDENTS

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    Manjula

    2013-03-01

    Full Text Available Yoga is assuming importance in improving mental healt h and quality of life and in the treatment of a number of psychiatric and psychosomatic disorder s. Medical students are foundation of the medical profession; hence they must be aware of the alternative and adjunct therapy for the betterment of their patients. One of the most benefi cial alternative therapies is Yoga therapy. Medical students must know how yoga is useful for t heir patients. Keeping this objective in mind, the present study was conducted on medical stu dents to make them aware what yoga is and to encourage them to incorporate yoga in their l ife and to use it for the benefits of their patients as an adjunct to the medicinal treatment. T he study was conducted on healthy medical students (21 males and 15 females of age group 17-2 1 years in the department of physiology, Mahatma Gandhi Memorial Medical College, and Mahara ja Yashwantrao Hospital, Indore. After obtaining an informed consent; and satisfying the i nclusion and exclusion criteria, the psychological well being of the subjects was assesse d by “Psychological General Well Being Schedule Score (Sajatovic 2003” on the first day b efore the subjects started yoga practices. The students performed the yoga practices in the morning for one hour, six days in a week, for four weeks under expert’s observation. The yoga practices consisted of Prayer, Omkar recitation, asana, and Pranayama. Psychological well being was assessed using the same schedule score on the last day of yoga programme. Data thus collected were compiled, tabulated and analyzed by using students’ ‘t’ test. There was highly signific ant improvement in psychological well being of the students as denoted by p value of <.0.001. Concl usion: There is a marked improvement in the psychological well being scores of the students after performing short-term yoga practices. By extending these results we suggest that short-te rm yoga practices can therefore

  7. Factors associated with the choice of general medicine as a career among Japanese medical students

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    Ryuichi Kawamoto

    2016-05-01

    Full Text Available Background: In Japan, there is a shortage of young physicians in various specialties; the present situation of general medicine or family medicine (GM/FM in particular is risky. The factors influencing the career choice of Japanese medical students are poorly understood. This study aims to identify factors related to choosing GM/FM as a career. Methods: The study was designed as a cross-sectional survey. Students at one medical school in Japan filled out a questionnaire. Students were asked to state their intended medical specialty, and they rated the importance of specific individual and occupational aspects using a 4-point likert scale. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach‘s alpha coefficients; biserial correlations between the factors and career choices were calculated. Furthermore, multiple linear regression analysis was performed using career choice (GM/FM vs. others as the criterion variable and the factors plus demographic characteristics as confounding variables. Results: Factor analysis produced six factors that explained future career plans. Medical students in this study had a positive and realistic idea about GM/FM, but only 18.8% of them chose GM/FM first as a career. The significant variables associated with choosing GM/FM first as a career were: ‘Admission from hometown’ (β=0.189, P=0.001, ‘Student preparing for the entrance exam’ (β=0.172; P=0.001, ‘Intent for rural practice’ (β=0.123, P=0.016, and ‘Work–life balance’ (β=0.126, P=0.013. While significant variables that were negatively associated with choosing GM/FM were ‘Presence of medical relatives’ (β=−0.107, P=0.037 and ‘Scientific orientation’ (β=−0.125, P=0.013. Conclusions: Strategies have been suggested, such as recruiting medical students with significant variables that were associated with choosing GM/FM first as a career. By engaging students early in their

  8. The Bambuí Health and Aging Study (BHAS: private health plan and medical care utilization by older adults

    Directory of Open Access Journals (Sweden)

    Lima-Costa Maria Fernanda F.

    2002-01-01

    Full Text Available The aim of this cross sectional study was to investigate whether holding a private health plan affects the consumption of medical services (hospitalization and visits to a doctor and use of medications by older adults. All residents in Bambuí town (Minas Gerais, Brazil aged > or = 60 years (n = 1,742 were selected. From these, 92.2% were interviewed and 85.9% were examined (blood tests and physical measurements. After adjustments for counfounders, those under exclusive public coverage (n = 1,296, compared with those holding a private health plan (n = 310, presented some evidence of having worse health status, reported less visits to a doctor, and used a small number of prescribed medications. The main explanation for the aged holding a private health plan was economic, not health. Even though those who had only public health coverage complained more in relation to medical care (70.9%, an important proportion of the aged with a private health care plan presented some kind of complaint (45.2%. Another worrying factor was the difficulty to acquire medication because of financial problems (47.2 and 25.2% reported, respectively. Further investigations are needed to verify whether our results can be generalized to other communities of the country.

  9. General Utility of Brown Rice%糙米的综合利用

    Institute of Scientific and Technical Information of China (English)

    王赫男; 王静

    2012-01-01

    Brown rice nowadays is an healthy grain that accepted by people by reason of its rich basic nu- tritions and funcional composition than milling rice. The paper aims that how to make use of the brown rice Systematicly, the high nutrition value and application potential and the problem in edible quality like the odor, taste, sensory deficiencies as well as improving methods for these problems and its products processing and utilization of the status was introduced. Besides, the paper discussesd that the issues like storage of brown rice, the standard-settings of nutritions as well as how to form a system of brown rice products, for specific issues, the prospects of comprehensive development and utilization of the brown rice was discussed.%糙米因含有比精白米更多的基本营养素及主要功能性成分而成为当今人们公认的健康谷物.以综合利用糙米为目的,介绍了糙米及发芽糙米丰富的营养成分情况,糙米食用品质所存在的气味、口感、感官等方面的缺陷以及这些问题的改良方法,糙米及其制品的加工利用的研究现状.同时进一步探讨糙米改良前后所存在的储运、营养素标准制订、糙米制品如何形成体系的一些较宏观的问题,针对具体问题,对糙米的综合开发利用的前景进行展望.

  10. Rewards, costs and challenges: the general practitioner's experience of teaching medical students.

    Science.gov (United States)

    Sturman, Nancy; Régo, Patricia; Dick, Marie-Louise

    2011-07-01

    Medical student attachments in general practices play an important role in undergraduate medical education internationally. The recruitment by universities of new teaching practices or an increase in the teaching commitment of existing practices will be necessary to address rising medical student numbers. General practitioners (GPs) are likely to weigh the perceived rewards of practice-based teaching against the perceived costs and challenges in deciding whether to accept a student placement and how to teach. These aspects of the 'lived experience' of the GP-teacher have not been adequately investigated. This study aims to enhance understanding of the GP clinical teacher experience in order to inform strategies for the recruitment, retention, training and support of teaching general practices. Sixty GP clinical teachers in Brisbane-based urban teaching general practices were interviewed individually face-to-face by the principal investigator, using a semi-structured interview plan. Representativeness was ensured through quota sampling. The interview data were analysed thematically by two of the investigators independently, following member checking of interview transcripts. The results demonstrate a number of key inter-related perceived rewards, costs and challenges of teaching, including intellectual stimulation, cognitive fatigue and student characteristics. The findings extend reports in the previous literature by offering a richer description of current GP-teacher experience. Participants identified teaching rewards in a manner largely consistent with previous research, with the exception of enhanced practice morale and teamwork. Findings confirm that reduced productivity and increased time pressures remain key perceived negative impacts of teaching, but also reveal a number of other important costs and challenges. They emphasise the diversity of GP experience and practice cultures, and the need for teaching to enhance both GP and patient perceptions of

  11. Interference Calculus A General Framework for Interference Management and Network Utility Optimization

    CERN Document Server

    Schubert, Martin

    2012-01-01

    This book develops a mathematical framework for modeling and optimizing interference-coupled multiuser systems. At the core of this framework is the concept of general interference functions, which provides a simple means of characterizing interdependencies between users. The entire analysis builds on the two core axioms scale-invariance and monotonicity. The proposed network calculus has its roots in power control theory and wireless communications. It adds theoretical tools for analyzing the typical behavior of interference-coupled networks. In this way it complements existing game-theoretic approaches. The framework should also be viewed in conjunction with optimization theory. There is a fruitful interplay between the theory of interference functions and convex optimization theory. By jointly exploiting the properties of interference functions, it is possible to design algorithms that outperform general-purpose techniques that only exploit convexity. The title “network calculus” refers to the fact tha...

  12. Evaluating the Impact of Parent-Reported Medical Home Status on Children's Health Care Utilization, Expenditures, and Quality: A Difference-in-Differences Analysis with Causal Inference Methods.

    Science.gov (United States)

    Han, Bing; Yu, Hao; Friedberg, Mark W

    2017-04-01

    To evaluate the effects of the parent-reported medical home status on health care utilization, expenditures, and quality for children. Medical Expenditure Panel Survey (MEPS) during 2004-2012, including a total of 9,153 children who were followed up for 2 years in the survey. We took a causal difference-in-differences approach using inverse probability weighting and doubly robust estimators to study how changes in medical home status over a 2-year period affected children's health care outcomes. Our analysis adjusted for children's sociodemographic, health, and insurance statuses. We conducted sensitivity analyses using alternative statistical methods, different approaches to outliers and missing data, and accounting for possible common-method biases. Compared with children whose parents reported having medical homes in both years 1 and 2, those who had medical homes in year 1 but lost them in year 2 had significantly lower parent-reported ratings of health care quality and higher utilization of emergency care. Compared with children whose parents reported having no medical homes in both years, those who did not have medical homes in year 1 but gained them in year 2 had significantly higher ratings of health care quality, but no significant differences in health care expenditures and utilization. Having a medical home may help improve health care quality for children; losing a medical home may lead to higher utilization of emergency care. © Health Research and Educational Trust.

  13. 76 FR 65200 - General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee: Notice of...

    Science.gov (United States)

    2011-10-20

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration General and Plastic Surgery Devices Panel of the Medical... and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee scheduled for December...

  14. Student evaluation of an OSCE in General Medicine at Mamata Medical College, Andhra Pradesh

    Directory of Open Access Journals (Sweden)

    Dharma Rao V, Pramod Kumar Reddy M, Rajaneesh Reddy M, HanumiahA, Shyam Sunder P, Narasingha Reddy T, Kishore Babu SPV

    2014-04-01

    Full Text Available The assessment of student’s clinical competence is of paramount importance, and there are several means of evaluating student performance in medical examinations. The OSCE is an approach to student assessment in which aspects of clinical competence are evaluated in a comprehensive, consistent and structured manner with close attention to the objectivity of the process. The faculty of general medicine in collaboration with other clinical departments, Mamata Medical College, Khammam first implemented the objective structured clinical examination (OSCE in the final MBBS Part-II examination during the internal assessment examination for the 2011-2012 academic years. The study was set out to explore student acceptance of the OSCE as part of an evaluation of final MBBS students. A self-administered questionnaire was completed by successive groups of students immediately after the OSCE. Main outcome measures were student perception of examination attributes, which included the quality of instructions and organization, the quality of performance, authenticity and transparency of the process, and usefulness of the OSCE as an assessment instrument compared to other formats. There was an overwhelming acceptance of OSCE in general medicine with respect to comprehensiveness (90% transparency (90% & authenticity of required tasks. Students felt that it was a useful form of examination. Student’s feedback was invaluable in influencing faculty teaching curriculum direction and appreciation of student opinion and overall the students were agreeable with newer form of OSCE. The majority of the students felt that OSCE is a fair assessment tool compared to traditional long and short cases and it covers a wide range of knowledge and clinical skills in general medicine.

  15. An assessment of medical doctors′ perception of possible interrelationship between oral and general health

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    O I Opeodu

    2014-01-01

    Full Text Available Background: The possibility of some systemic diseases having oral manifestation is well established with the recent discovery that some oral diseases also adversely affect the general health of an individual. The question is, is the relationship casual or causal? Aim: To assess the perception of medical doctors concerning the possible link of oral diseases as causal/confounding factors of systemic diseases. Materials and Methods: A cross-sectional survey of 250 medical doctors was carried out in three tertiary health institutions in Nigeria. Questionnaires were distributed to resident doctors to assess their perception as to the possibility of any causal relationship between the general systemic diseases and oral diseases. Results: Two-hundred and seven completely filled questionnaires were returned out of the 250 distributed. Over 50% of the respondents strongly agreed to the fact that there is a link between oral diseases and conditions such as diabetes mellitus, rheumatic heart disease, valvular heart disease, and human immunodeficiency virus/acquired immune deficiency syndrome HIV/AIDS. Hypertension and premature low birth weight has the highest percentage (18.8% of respondents strongly disagreeing with the possibility of having any link with the state of the oral health. There was a statistically significant difference in the perception of the possible link between the state of oral health and myocardial infarction between male and female respondents (P < 0.04 and also when the age-groups were considered in relationship with valvular heart disease (P < 0.02. Conclusion: This study revealed that doctors′ perception of the influence of dental disease/condition on the general state of patients′ health was deficient and, therefore, require improvement through health education and awareness.

  16. Reliability of Mini-CEX Assessment of Medical Students in General Practice Clinical Attachments.

    Science.gov (United States)

    Eggleton, Kyle; Goodyear-Smith, Felicity; Paton, Lois; Falloon, Karen; Wong, Chris; Lack, Liza; Kennelly, John; Fishman, Tana; Moyes, Simon A

    2016-09-01

    Mini Clinical Evaluation eXercise (mini-CEX) involves observation of routine clinical encounters, initially developed to assess clinical competencies of postgraduate doctors. This study aimed to measure its inter-rater reliability in assessment of medical students in general practice settings. General practitioners (GPs) supervising medical students were invited to complete online teaching on how to conduct a mini-CEX. This included three randomly presented scripted films of clinical scenarios representing different levels of student performance. Consenting participants completed an online mini-CEX. Mean marks were calculated for each case, Intraclass Correlation Coefficients (ICC) for overall clinical and four individual competencies, one-way analysis of variance to compare scores, and internal consistency measured by Cronbach's alpha. RESULTS were collated for the first 100 completing GPs, majority aged 40-59 years (71%), male (59%), New Zealand European (58%). Forty-four percent were in rural practice, with 21 mean years in practice. Mean mini-CEX grades increased as standardized performance increased, indicating that GPs reliably agreed about ranking of student performance from poor to very good. The intraclass correlation coefficient (ICC) for overall clinical competency was 0.78 (95% confidence interval 0.48-0.99), indicating good reliability regarding their agreement with each other. A Cronbach's alpha calculated with the overall scores was 0.85, indicating good internal consistency. Mini-CEXs in undergraduate general practice attachments provide a reliable measure of assessing performance. However, they may be less useful in identifying exceptional performance or weaknesses in key competencies. In addition, caution must be applied in relying upon mini-CEXs to supply a summative assessment.

  17. [Series: Utilization of Differential Equations and Methods for Solving Them in Medical Physics (2)].

    Science.gov (United States)

    Murase, Kenya

    2015-01-01

    In this issue, symbolic methods for solving differential equations were firstly introduced. Of the symbolic methods, Laplace transform method was also introduced together with some examples, in which this method was applied to solving the differential equations derived from a two-compartment kinetic model and an equivalent circuit model for membrane potential. Second, series expansion methods for solving differential equations were introduced together with some examples, in which these methods were used to solve Bessel's and Legendre's differential equations. In the next issue, simultaneous differential equations and various methods for solving these differential equations will be introduced together with some examples in medical physics.

  18. A pilot study exploring awareness among general public toward issues related to medication safety in the state of Penang, Malaysia

    OpenAIRE

    Mohamed Azmi Hassali; Shafie, Asrul A.; Fahad Saleem; Harith Al-Qazaz; Imran Masood; Muhammad Atif; Hisham Aljadhey

    2012-01-01

    Context: A better understanding of medication safety ensures better health state among healthcare consumers. Aim: The study aims to assess general public awareness toward issues related to medication safety. Settings and Design: A cross-sectional study was conducted among general public selected conveniently in the state of Penang, Malaysia. Materials and methods: A total of 500 respondents were approached and 476 consumers participated in the survey giving a response rate of 95.2%. Statistic...

  19. A Health Assessment Survey of Veteran Students: Utilizing a Community College-Veterans Affairs Medical Center Partnership.

    Science.gov (United States)

    Misra-Hebert, Anita D; Santurri, Laura; DeChant, Richard; Watts, Brook; Sehgal, Ashwini R; Aron, David C

    2015-10-01

    To assess health status among student veterans at a community college utilizing a partnership between a Veterans Affairs Medical Center and a community college. Student veterans at Cuyahoga Community College in Cleveland, Ohio, in January to April 2013. A health assessment survey was sent to 978 veteran students. Descriptive analyses to assess prevalence of clinical diagnoses and health behaviors were performed. Logistic regression analyses were performed to assess for independent predictors of functional limitations. 204 students participated in the survey (21% response rate). Self-reported depression and unhealthy behaviors were high. Physical and emotional limitations (45% and 35%, respectively), and pain interfering with work (42%) were reported. Logistic regression analyses confirmed the independent association of self-reported depression with functional limitation (odds ratio [OR] = 3.3, 95% confidence interval [CI] 1.4-7.8, p student veterans at a community college. A partnership between a Veterans Affairs Medical Center and a community college can be utilized to help understand the health needs of veteran students. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  20. Longitudinal analysis on utilization of medical document management system in a hospital with EPR implementation.

    Science.gov (United States)

    Kuwata, Shigeki; Yamada, Hitomi; Park, Keunsik

    2011-01-01

    Document management systems (DMS) have widespread in major hospitals in Japan as a platform to digitize the paper-based records being out of coverage by EPR. This study aimed to examine longitudinal trends of actual use of DMS in a hospital in which EPR had been in operation, which would be conducive to planning the further information management system in the hospital. Degrees of utilization of electronic documents and templates with DMS were analyzed based on data extracted from a university-affiliated hospital with EPR. As a result, it was found that the number of electronic documents as well as scanned documents circulating at the hospital tended to increase. The result indicated that replacement of paper-based documents with electronic documents did not occur. Therefore it was anticipated that the need for DMS would continue to increase in the hospital. The methods used this study to analyze the trend of DMS utilization would be applicable to other hospitals with with a variety of DMS implementation, such as electronic storage by scanning documents or paper preservation that is compatible with EPR.

  1. The clinical utility of QSM: disease diagnosis, medical management, and surgical planning.

    Science.gov (United States)

    Eskreis-Winkler, Sarah; Zhang, Yan; Zhang, Jingwei; Liu, Zhe; Dimov, Alexey; Gupta, Ajay; Wang, Yi

    2017-04-01

    Quantitative susceptibility mapping (QSM) is an MR technique that depicts and quantifies magnetic susceptibility sources. Mapping iron, the dominant susceptibility source in the brain, has many important clinical applications. Herein, we review QSM applications in the diagnosis, medical management, and surgical treatment of disease. To assist in early disease diagnosis, QSM can identify elevated iron levels in the motor cortex of amyotrophic lateral sclerosis patients, in the substantia nigra of Parkinson's disease (PD) patients, in the globus pallidus, putamen, and caudate of Huntington's disease patients, and in the basal ganglia of Wilson's disease patients. Additionally, QSM can distinguish between hemorrhage and calcification, which could prove useful in tumor subclassification, and can measure microbleeds in traumatic brain injury patients. In guiding medical management, QSM can be used to monitor iron chelation therapy in PD patients, to monitor smoldering inflammation of multiple sclerosis (MS) lesions after the blood-brain barrier (BBB) seals, to monitor active inflammation of MS lesions before the BBB seals without using gadolinium, and to monitor hematoma volume in intracerebral hemorrhage. QSM can also guide neurosurgical treatment. Neurosurgeons require accurate depiction of the subthalamic nucleus, a tiny deep gray matter nucleus, prior to inserting deep brain stimulation electrodes into the brains of PD patients. QSM is arguably the best imaging tool for depiction of the subthalamic nucleus. Finally, we discuss future directions, including bone QSM, cardiac QSM, and using QSM to map cerebral metabolic rate of oxygen. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  2. Physical Health, Medication, and Healthcare Utilization among 70-Year-Old People with Schizophrenia

    DEFF Research Database (Denmark)

    Brink, Maria; Green, Anders; Bojesen, Anders Bo

    2017-01-01

    to their longevity. DESIGN: A nationwide register-based case-control study comparing 70-year-olds with and without schizophrenia. SETTING: Cases were drawn from the Danish Psychiatric Central Register. Age- and sex-matched controls were drawn from the general population via the Civil Registration System...

  3. Patients taking medications for bipolar disorder are more prone to metabolic syndrome than Korea's general population.

    Science.gov (United States)

    Lee, Nam Young; Kim, Se Hyun; Cho, Belong; Lee, Yeon Ji; Chang, Jae Seung; Kang, Ung Gu; Kim, Yong Sik; Ahn, Yong Min

    2010-10-01

    reduced HDL-cholesterol than the control group. The prevalence of MetS in patients taking medication for bipolar disorder was higher than that in the general population. Obesity and dyslipidemia were particularly prevalent in patients with bipolar disorder.

  4. Impact Analysis of Generalized Audit Software (GAS Utilization to Auditor Performances

    Directory of Open Access Journals (Sweden)

    Aries Wicaksono

    2016-09-01

    Full Text Available This study aimed to understand whether the use of Generalized Audit Software (GAS in the audit process have an impact on the auditors performance and to acquire conclusions in the evaluation form towards GAS audit process to provide a positive impact on the performance of auditors. The models used to evaluate the impact of GAS were Quantity of Work, Quality of Work, Job Knowledge, Creativeness, Cooperation, Dependability, Initiative, and Personal Qualities. The method used in this research was a qualitative method of analytical descriptive and evaluative, by analyzing the impact of the GAS implementation to the components of the user’s performance. The results indicate that the use of GAS has a positive impact on user’s performance components.

  5. [The present status and future prospects of application of digital medical technology in general surgery in China].

    Science.gov (United States)

    Fang, C H; LauWan, Y Y; Cai, W

    2017-01-01

    It has been almost 10 years since digital medical technology has started to becommonly used in general surgery in China.Led by advances in three dimensional(3D) visualization technology, virtual reality, simulation surgery, and 3D printing, digital medical technology have played important roles in changing the current practice of general surgery in China to become more effective by improving diagnostic accuracy and a better choice of therapeutic procedure with a resultant increased surgical success rate and a decreased surgical risks.Furthermore, education of medical students and young doctors become better and easier.

  6. Assessment of depression in medical patients: A systematic review of the utility of the Beck Depression Inventory-II

    Directory of Open Access Journals (Sweden)

    Yuan-Pang Wang

    2013-09-01

    Full Text Available To perform a systematic review of the utility of the Beck Depression Inventory for detecting depression in medical settings, this article focuses on the revised version of the scale (Beck Depression Inventory-II, which was reformulated according to the DSM-IV criteria for major depression. We examined relevant investigations with the Beck Depression Inventory-II for measuring depression in medical settings to provide guidelines for practicing clinicians. Considering the inclusion and exclusion criteria seventy articles were retained. Validation studies of the Beck Depression Inventory-II, in both primary care and hospital settings, were found for clinics of cardiology, neurology, obstetrics, brain injury, nephrology, chronic pain, chronic fatigue, oncology, and infectious disease. The Beck Depression Inventory-II showed high reliability and good correlation with measures of depression and anxiety. Its threshold for detecting depression varied according to the type of patients, suggesting the need for adjusted cut-off points. The somatic and cognitive-affective dimension described the latent structure of the instrument. The Beck Depression Inventory-II can be easily adapted in most clinical conditions for detecting major depression and recommending an appropriate intervention. Although this scale represents a sound path for detecting depression in patients with medical conditions, the clinician should seek evidence for how to interpret the score before using the Beck Depression Inventory-II to make clinical decisions.

  7. Collaboration with general practitioners: preferences of medical specialists – a qualitative study

    Directory of Open Access Journals (Sweden)

    Slaets Joris PJ

    2006-12-01

    Full Text Available Abstract Background Collaboration between general practitioners (GPs and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates medical specialists to initiate and continue participating with GPs in new collaborative care models. The following question is addressed in this study: What motivates medical specialists to initiate and sustain new models for collaborating with GPs? Methods We conducted semi-structured interviews with eighteen medical specialists in the province of Groningen, in the North of The Netherlands. The sampling criteria were age, gender, type of hospital in which they were practicing, and specialty. The interviews were recorded, fully transcribed, and analysed by three researchers working independently. The resulting motivational factors were grouped into categories. Results 'Teaching GPs' and 'regulating patient flow' (referrals appeared to dominate when the motivational factors were considered. In addition, specialists want to develop relationships with the GPs on a more personal level. Most specialists believe that there is not much they can learn from GPs. 'Lack of time', 'no financial compensation', and 'no support from colleagues' were considered to be the main concerns to establishing collaborative care practices. Additionally, projects were often experienced as too complex and time consuming whereas guidelines were experienced as too restrictive. Conclusion Specialists are particularly interested in collaborating because the GP is the gatekeeper for access to secondary health care resources. Specialists feel that they are able to teach the GPs something, but they do not feel that they have anything to learn from the GPs. With respect to professional expertise, therefore, specialists do not consider GPs as equals. Once personal relationships with the GPs have been established, an

  8. An Outbreak of SARS in a Diabetes Room of a General Hospital without Infected Medical Staff

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    Objective To investigate the epidemiologic features of an outbreak of SARS that occurred in a single diabetes room of a general hospital in Beijing in late March 2003. Methods Field investigation was carried out in the ward, the nursing log and the hospitalization medical record of correlative patients were consulted. SARS-CoV in serum specimen from SARS patient was detected by PCR. Results The room where SARS outbreak occurred was on the 13th lfoor of the 16-story main ward building. There were 6 beds in the room, living with 6 female patients (aged 45-67) who were all hospitalized due to type 2 diabetes. On March 24, 2003, Patient 1 began to have a fever and cough, chest X-ray showed pneumonia. Five and six days later, Patient 2 and Patient 3 began to have a fever, respectively. Finally, all of these 3 patients died. Their beds were all at the same side of the room, and the other 3 patients at the opposite side were not infected. Serum SARS CoV-RNA of the Patient 3 was positive by nest-PCR. The daughter-in-law of Patient 1 who accompanied Patient 1 by the bedside several days, mainly near the window, upwind of Patient 1, was not infected. Medical staff, family members and visitors of the 6 patients were not infected. Conclusions This outbreak was not transmitted by aerosol. The distance droplets travels could be up to 3.43 meters. Droplet spread has direction, and the droplets direction of propagation is closely related with the wind direction and speed. Those at the downwind position of SARS patients were susceptible to be infected. Medical staff wore face masks and good natural ventilation of this ward building may be important reasons for the prevention of infection.

  9. Neurasthenia, Generalized Anxiety Disorder, and the Medicalization of Worry in a Vietnamese Psychiatric Hospital.

    Science.gov (United States)

    Tran, Allen L

    2017-06-01

    This article examines two forms of the medicalization of worry in an outpatient psychiatric clinic in Ho Chi Minh City, Vietnam. Biomedical psychiatrists understand patients' symptoms as manifestations of the excessive worry associated with generalized anxiety disorder (GAD). Drawing on an ethnopsychology of emotion that reflects increasingly popular models of neoliberal selfhood, these psychiatrists encourage patients to frame psychic distress in terms of private feelings to address the conditions in their lives that lead to chronic anxiety. However, most patients attribute their symptoms to neurasthenia instead of GAD. Differences between doctors' and patients' explanatory models are not just rooted in their understandings of illness but also in their respective conceptualizations of worry in terms of emotion and sentiment. Patients with neurasthenia reject doctors' attempts to psychologize distress and maintain a model of worry that supports a sense of moral selfhood based on notions of obligation and sacrifice. © 2016 by the American Anthropological Association.

  10. Fate of manuscripts rejected by a non-English-language general medical journal

    DEFF Research Database (Denmark)

    Vinther, Siri; Rosenberg, Jacob

    2011-01-01

    Objective The objective of this study was to determine whether, where and when manuscripts were published following rejection by the Journal of the Danish Medical Association, a general medical journal published in Danish. Similar previous studies have focused on specialty/subspecialty journals p...... translation could be a barrier for resubmitting to English-language journals with larger readerships, thus hindering the dissemination of knowledge to the international community....... evaluated. Results Of 198 rejected manuscripts, 21 (10.6%) were eventually published after a median of 685 days (range 209-1463). The majority of these were original research, published in English-language specialty/subspecialty journals. The median number of citations per article was 2-3 (IQR 0.......5-9.5, depending on the database searched). Conclusions 10.6% of the rejected manuscripts were eventually published in other journals, mainly English-language specialty journals. This proportion was considerably lower than that for other journals that have studied the fate of rejected manuscripts. Manuscript...

  11. Motivation and job satisfaction among medical and nursing staff in a Cyprus public general hospital

    Science.gov (United States)

    2010-01-01

    Background The objective of this study was to investigate how medical and nursing staff of the Nicosia General Hospital is affected by specific motivation factors, and the association between job satisfaction and motivation. Furthermore, to determine the motivational drive of socio-demographic and job related factors in terms of improving work performance. Methods A previously developed and validated instrument addressing four work-related motivators (job attributes, remuneration, co-workers and achievements) was used. Two categories of health care professionals, medical doctors and dentists (N = 67) and nurses (N = 219) participated and motivation and job satisfaction was compared across socio-demographic and occupational variables. Results The survey revealed that achievements was ranked first among the four main motivators, followed by remuneration, co-workers and job attributes. The factor remuneration revealed statistically significant differences according to gender, and hospital sector, with female doctors and nurses and accident and emergency (A+E) outpatient doctors reporting greater mean scores (p 55 years of age reported higher job satisfaction when compared to the other groups. Conclusions The results are in agreement with the literature which focuses attention to management approaches employing both monetary and non-monetary incentives to motivate health care professionals. Health care professionals tend to be motivated more by intrinsic factors, implying that this should be a target for effective employee motivation. Strategies based on the survey's results to enhance employee motivation are suggested. PMID:21080954

  12. [A mourning case that referred with sexual identity disorder secondary to a general medical condition].

    Science.gov (United States)

    Yilmaz, Ayşegül; Ceri, Ozge; Tatlidil, Elif; Koçak, Orhan Murat; Soykan, Atilla

    2009-01-01

    D.G. was a 59-year-old male patient who was retired and married, and had 3 children. He reported no psychopathology prior to a myocardial infarction he had in 1996. Following bypass surgery he had erectile dysfunction. Subsequently, gynecomastia developed as a side effect of spironolactone and digoxin treatment. After a long period of depression he claimed was caused by non-adaptation to the changes in his body, he realized differences about himself; he began to feel like a woman. Upon referral to our clinic, he said that he had decided to continue his life as a woman and wished to get pink colored (as opposed to blue for male) identity card issued by the Turkish Government for female Turkish citizens. He reported that his wish was to learn how to become a woman. This is the first case in the medical literature defined as sexual identity disorder secondary to a general medical condition. The case is discussed in terms of pathological grief reaction.

  13. Motivation and job satisfaction among medical and nursing staff in a Cyprus public general hospital

    Directory of Open Access Journals (Sweden)

    Kontodimopoulos Nick

    2010-11-01

    Full Text Available Abstract Background The objective of this study was to investigate how medical and nursing staff of the Nicosia General Hospital is affected by specific motivation factors, and the association between job satisfaction and motivation. Furthermore, to determine the motivational drive of socio-demographic and job related factors in terms of improving work performance. Methods A previously developed and validated instrument addressing four work-related motivators (job attributes, remuneration, co-workers and achievements was used. Two categories of health care professionals, medical doctors and dentists (N = 67 and nurses (N = 219 participated and motivation and job satisfaction was compared across socio-demographic and occupational variables. Results The survey revealed that achievements was ranked first among the four main motivators, followed by remuneration, co-workers and job attributes. The factor remuneration revealed statistically significant differences according to gender, and hospital sector, with female doctors and nurses and accident and emergency (A+E outpatient doctors reporting greater mean scores (p 55 years of age reported higher job satisfaction when compared to the other groups. Conclusions The results are in agreement with the literature which focuses attention to management approaches employing both monetary and non-monetary incentives to motivate health care professionals. Health care professionals tend to be motivated more by intrinsic factors, implying that this should be a target for effective employee motivation. Strategies based on the survey's results to enhance employee motivation are suggested.

  14. Accounting for medical variation: the case of prescribing activity in a New Zealand general practice sample.

    Science.gov (United States)

    Davis, P B; Yee, R L; Millar, J

    1994-08-01

    Medical practice variation is extensive and well documented, particularly for surgical interventions, and raises important questions for health policy. To date, however, little work has been carried out on interpractitioner variation in prescribing activity in the primary care setting. An analytical model of medical variation is derived from the literature and relevant indicators are identified from a study of New Zealand general practice. The data are based on nearly 9,500 completed patient encounter records drawn from over a hundred practitioners in the Waikato region of the North Island, New Zealand. The data set represents a 1% sample of all weekday general practice office encounters in the Hamilton Health District recorded over a 12-month period. Overall levels of prescribing, and the distribution of drug mentions across diagnostic groupings, are broadly comparable to results drawn from international benchmark data. A multivariate analysis is carried out on seven measures of activity in the areas of prescribing volume, script detail, and therapeutic choice. The analysis indicates that patient, practitioner and practice attributes exert little systematic influence on the prescribing task. The principal influences are diagnosis, followed by practitioner identity. The pattern of findings suggests also that the prescribing task cannot be viewed as an undifferentiated activity. It is more usefully considered as a process of decision-making in which 'core' judgements--such as the decision to prescribe and the choice of drug--are highly predictable and strongly influenced by diagnosis, while 'peripheral' features of the task--such as choosing a combination drug or prescribing generically--are less determinate and more subject to the exercise of clinical discretion.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Corrections for criterion reliability in validity generalization: The consistency of Hermes, the utility of Midas

    Directory of Open Access Journals (Sweden)

    Jesús F. Salgado

    2016-04-01

    Full Text Available There is criticism in the literature about the use of interrater coefficients to correct for criterion reliability in validity generalization (VG studies and disputing whether .52 is an accurate and non-dubious estimate of interrater reliability of overall job performance (OJP ratings. We present a second-order meta-analysis of three independent meta-analytic studies of the interrater reliability of job performance ratings and make a number of comments and reflections on LeBreton et al.s paper. The results of our meta-analysis indicate that the interrater reliability for a single rater is .52 (k = 66, N = 18,582, SD = .105. Our main conclusions are: (a the value of .52 is an accurate estimate of the interrater reliability of overall job performance for a single rater; (b it is not reasonable to conclude that past VG studies that used .52 as the criterion reliability value have a less than secure statistical foundation; (c based on interrater reliability, test-retest reliability, and coefficient alpha, supervisor ratings are a useful and appropriate measure of job performance and can be confidently used as a criterion; (d validity correction for criterion unreliability has been unanimously recommended by "classical" psychometricians and I/O psychologists as the proper way to estimate predictor validity, and is still recommended at present; (e the substantive contribution of VG procedures to inform HRM practices in organizations should not be lost in these technical points of debate.

  16. Emergency radiology elective improves second-year medical students' perceived confidence and knowledge of appropriate imaging utilization.

    Science.gov (United States)

    Leschied, Jessica R; Knoepp, Ursula S; Hoff, Carrie Nicole; Mazza, Michael B; Klein, Katherine A; Mullan, Patricia B; Kelly, Aine M

    2013-09-01

    Given recent advances in and wider availability of complex imaging, physicians are expected to understand imaging appropriateness. We introduced second-year medical students to the American College of Radiology Appropriateness Criteria (ACR-AC) in an interactive case-based elective to demonstrate their use in imaging for common emergency department clinical complaints. Prospective pre- and post-test design assessed second-year medical students' performance on case-based knowledge applications and self-assessed confidence related to ACR-AC guidelines compared to second-year students participating in a different concurrent radiology elective. Students participated in a 3-day elective covering the ACR-AC, comparative effective imaging, and risks associated with imaging radiation exposure, with outcomes of perceived confidence using a 5-point Likert scale and knowledge of ACR-AC using case-based multiple choice questions. Analysis included computing mean scores and assessing effect sizes for changes in knowledge. Before the elective, 24 students scored an average of 3.45 questions correct of 8 (43.1%). On course completion, students scored an average of 5.3 questions correct of the same questions (66.3%) (P .85; effect size = 0.008). Students' confidence in ordering appropriate imaging improved nearly 2-fold from a range of 1.9 to 3.2 (on a scale of 1.0 to 5.0) to a range of 3.7 to 4.5. Following a short radiology elective, second-year medical students improved their knowledge of appropriate image utilization and perceived awareness of the indications, contraindications, and effects of radiation exposure related to medical imaging. Copyright © 2013 AUR. Published by Elsevier Inc. All rights reserved.

  17. 21 CFR 880.6260 - Filtering facepiece respirator for use by the general public in public health medical emergencies.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Filtering facepiece respirator for use by the... Filtering facepiece respirator for use by the general public in public health medical emergencies. (a) Identification. A filtering facepiece respirator for use by the general public in public health...

  18. 76 FR 39882 - General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Notice of...

    Science.gov (United States)

    2011-07-07

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration General and Plastic Surgery Devices Panel of the Medical... Administration (FDA). The meeting will be open to the public. Name of Committee: General and Plastic...

  19. 78 FR 30928 - General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Notice of...

    Science.gov (United States)

    2013-05-23

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration General and Plastic Surgery Devices Panel of the Medical... Administration (FDA). The meeting will be open to the public. Name of Committee: General and Plastic...

  20. 76 FR 62419 - General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Notice of...

    Science.gov (United States)

    2011-10-07

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration General and Plastic Surgery Devices Panel of the Medical... Administration (FDA). The meeting will be open to the public. Name of Committee: General and Plastic...

  1. 75 FR 47606 - General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Notice of...

    Science.gov (United States)

    2010-08-06

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration General and Plastic Surgery Devices Panel of the Medical.... ACTION: Notice. SUMMARY: The meeting of the General and Plastic Surgery Devices Panel of the...

  2. 76 FR 14415 - General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Notice of...

    Science.gov (United States)

    2011-03-16

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration General and Plastic Surgery Devices Panel of the Medical... Administration (FDA). The meeting will be open to the public. Name of Committee: General and Plastic...

  3. 78 FR 16684 - General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Notice of...

    Science.gov (United States)

    2013-03-18

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration General and Plastic Surgery Devices Panel of the Medical... Administration (FDA). The meeting will be open to the public. Name of Committee: General and Plastic...

  4. 77 FR 20642 - General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Notice of...

    Science.gov (United States)

    2012-04-05

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration General and Plastic Surgery Devices Panel of the Medical... Administration (FDA). The meeting will be open to the public. Name of Committee: General and Plastic...

  5. 75 FR 49940 - General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee; Notice of...

    Science.gov (United States)

    2010-08-16

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration General and Plastic Surgery Devices Panel of the Medical... Administration (FDA). The meeting will be open to the public. Name of Committee: General and Plastic...

  6. The Difference in the Online Medical Information Searching Behaviors of Hospital Patients and Their Relatives versus the General Public

    Science.gov (United States)

    Wang, Hung-Yuan; Liang, Jyh-Chong; Tsai, Chin-Chung

    2014-01-01

    The purpose of this study is two-fold: to explore the differences in online medical information searching behaviors, including evaluative standards and search strategies, of the general public (general group) and those of hospital patients and their relatives (hospital group); and to compare the predictive relationship between the evaluative…

  7. Monitoring the organization and dynamics of bovine hippocampal membranes utilizing Laurdan generalized polarization.

    Science.gov (United States)

    Mukherjee, Soumi; Chattopadhyay, Amitabha

    2005-08-01

    Organization and dynamics of cellular membranes in the nervous system are crucial for the function of neuronal membrane receptors. The lipid composition of neuronal cells is unique and has been correlated with the increased complexity in the organization of the nervous system during evolution. Previous work from our laboratory has established bovine hippocampal membranes as a convenient natural source for studying neuronal receptors such as the G-protein coupled serotonin1A receptor. In this paper, we have explored the organization and dynamics of bovine hippocampal membranes using the amphiphilic environment-sensitive fluorescent probe Laurdan. Our results show that the emission spectra of Laurdan display an additional red shifted peak as a function of increasing temperature in native as well as cholesterol-depleted membranes and liposomes made from lipid extracts of the native membrane. Interestingly, wavelength dependence of Laurdan generalized polarization (GP) in native membranes indicates the presence of an ordered gel-like phase at low temperatures, whereas characteristics of the liquid-ordered phase are observed at high temperatures. Similar experiments performed using cholesterol-depleted membranes show fluidization of the membrane with increasing cholesterol depletion. In addition, results from fluorescence polarization of DPH indicate that the hippocampal membrane is fairly ordered even at physiological temperature. The temperature dependence of Laurdan excitation GP provides a measure of the apparent thermal transition temperature and extent of cooperativity in these membranes. Analysis of time-resolved fluorescence measurements of Laurdan shows reduction in mean fluorescence lifetime with increasing temperature due to change in environmental polarity. These results constitute novel information on the dynamics of hippocampal membranes and its modulation by cholesterol depletion monitored using Laurdan fluorescence.

  8. Utilization and spending trends for antiretroviral medications in the U.S. Medicaid program from 1991 to 2005

    Directory of Open Access Journals (Sweden)

    Li Xing

    2007-10-01

    Full Text Available Abstract Background HIV/AIDS incidence and mortality rates have decreased in the U.S. since 1996. Accompanying the longer life spans of those diagnosed with the disease, however, is a tremendous rise in expenditures on medication. The objective of this study is to describe the trends in utilization of, spending on, and market shares of antiretroviral medications in the U.S. Medicaid Program. Antiretroviral drugs include nucleoside reverse transcriptase inhibitors (NRTIs, protease inhibitors (PIs, nonnucleoside reverse transcriptase inhibitors (NNRTIs, and fusion inhibitors (FIs. Methods Utilization and payment data from 1991 to 2005 are provided by the Centers for Medicare & Medicaid Services. Descriptive summary analyses were used to assess quarterly prescription numbers and amounts of payment. Results The total number of prescriptions for antiretrovirals increased from 168,914 in 1991 to 2.0 million in 1998, and 3.0 million in 2005, a 16.7-fold increase over 15 years. The number of prescriptions for NRTIs reached 1.6 million in 2005. Prescriptions for PIs increased from 114 in 1995 to 932,176 in 2005, while the number of prescriptions for NNRTIs increased from 1,339 in 1996 to 401,272 in 2005. The total payment for antiretroviral drugs in the U.S. Medicaid Program increased from US$ 30.6 million in 1991 to US$ 1.6 billion in 2005, a 49.8-fold increase. In 2005, NRTIs as a class had the highest payment market share. These drugs alone accounted for US$ 787.9 million in Medicaid spending (50.8 percent of spending on antiretrovirals. Payment per prescription for each drug, with the exception of Agenerase®, increased, at least somewhat, over time. The relatively expensive drugs in 2005 included Trizivir® ($1040 and Combivir® ($640, as well as Reyataz® ($750, Lexiva® ($700, Sustiva® ($420, Viramune® ($370, and Fuzeon® ($1914. Conclusion The tremendous growth in antiretroviral spending is due primarily to rising utilization, secondarily to

  9. [Burnout syndrome in medical residents at the General Hospital of Durango, México].

    Science.gov (United States)

    Terrones-Rodríguez, Jovany Francisco; Cisneros-Pérez, Vicente; Arreola-Rocha, José Jesús

    2016-01-01

    The burnout syndrome is commonly spread among health workers and students, due to the excessive demands they feel on their workspaces. Depersonalization, emotional exhaustion and personal accomplishment are the areas assessed. To determine the prevalence of burnout syndrome in medical residents at the General Hospital of Durango; a descriptive, prolective, cross-sectional study was designed and applied to residents of different specialties of the General Hospital of Durango who agreed to participate, the "Maslach Burnout Inventory" was applied. We surveyed 116 residents, 43.1 % (50) women and 56.89 % (66) men. The overall prevalence was 89.66 % (95 % CI: 82.63- 94.54). Affected in a single area the 48.28 % (95 % CI: 38.90-57.74), in two areas the 35.34 % (95 % CI: 26.69-44.76) and in the three areas 6.03 % (95 % CI: 2.46-12.04). Stratified by areas, high emotional exhaustion was 41.38 % (95 % CI: 32.31-50.90), high depersonalization in 54.31 % (95 % CI: 44.81-63.59), and low personal accomplishment 41.38 % (95 % CI: 32.31-50.90). The prevalence is higher than the reported. The most frequently affected is depersonalization, followed by emotional exhaustion and finally the personal accomplishment. In the areas of Gynecology and obstetrics, Internal medicine, Pediatrics and Orthopedics, the 100 % of the residents are affected.

  10. General Medical Practitioners Need to Be Aware of the Theories on Which Our Work Depend

    Science.gov (United States)

    Thomas, Paul

    2006-01-01

    When general practitioners and family physicians listen, reflect, and diagnose, we use 3 different theories of knowledge. This essay explores these theories to highlight an approach to clinical practice, inquiry, and learning that can do justice to the complex and uncertain world we experience. The following points are made: (1) A variety of approaches to research and audit are needed to illuminate the richness of experience witnessed by general medical practitioners. (2) Evidence about the past cannot predict the future except in simple, short-term, or slowly changing situations. (3) We consciously or unconsciously weave together evidence generated through 3 fundamental theories of knowledge, termed postpositivism, critical theory, and constructivism, to make sense of everyday experience. We call it listening, reflecting, and diagnosing. (4) These 3 fundamental theories of knowledge highlight different aspects within a world that is more complex, integrated, and changing than any single theory can reveal on its own; they frame what we see and how we act in everyday situations. (5) Moving appropriately between these different theories helps us to see a fuller picture and provides a framework for improving our skills as clinicians, researchers, and learners. (6) Narrative unity offers a way to bring together different kinds of evidence to understand the overall health of patients and of communities; evidence of all kinds provides discrete snapshots of more complex stories in evolution. (7) We need to understand these issues so we can create an agenda for clinical practice, inquiry, and learning appropriate to our discipline. PMID:17003147

  11. Electronic medical record data to identify variables associated with a fibromyalgia diagnosis: importance of health care resource utilization

    Directory of Open Access Journals (Sweden)

    Masters ET

    2015-03-01

    Full Text Available Elizabeth T Masters,1 Jack Mardekian,1 Birol Emir,1 Andrew Clair,1 Max Kuhn,2 Stuart L Silverman,31Pfizer, Inc., New York, NY, 2Pfizer, Inc., Groton, CT, 3Cedars-Sinai Medical Center, Los Angeles, CA, USABackground: Diagnosis of fibromyalgia (FM is often challenging. Identifying factors associated with an FM diagnosis may guide health care providers in implementing appropriate diagnostic and management strategies.Methods: This retrospective study used the de-identified Humedica electronic medical record (EMR database to identify variables associated with an FM diagnosis. Cases (n=4,296 were subjects ≥18 years old with ≥2 International Classification of Diseases, Ninth Revision (ICD-9 codes for FM (729.1 ≥30 days apart during 2012, associated with an integrated delivery network, with ≥1 encounter with a health care provider in 2011 and 2012. Controls without FM (no-FM; n=583,665 did not have the ICD-9 codes for FM. Demographic, clinical, and health care resource utilization variables were extracted from structured EMR data. Univariate analysis identified variables showing significant differences between the cohorts based on odds ratios (ORs.Results: Consistent with FM epidemiology, FM subjects were predominantly female (78.7% vs 64.5%; P<0.0001 and slightly older (mean age 53.3 vs 52.7 years; P=0.0318. Relative to the no-FM cohort, the FM cohort was characterized by a higher prevalence of nearly all evaluated comorbidities; the ORs suggested a higher likelihood of an FM diagnosis (P<0.0001, especially for musculoskeletal and neuropathic pain conditions (OR 3.1 for each condition. Variables potentially associated with an FM diagnosis included higher levels of use of specific health care resources including emergency-room visits, outpatient visits, hospitalizations, and medications. Units used per subject for emergency-room visits, outpatient visits, hospitalizations, and medications were also significantly higher in the FM cohort (P<0

  12. The utility of a Personal Values Report for medical decision-making.

    Science.gov (United States)

    Henderson, W; Corke, C

    2015-09-01

    Our aim was to determine if a patient's Personal Values Report (PVR) has a positive impact on a doctor's decisions regarding treatment. We conducted a prospective cohort study delivering a short, web-based hypothetical case-centred questionnaire to intensive care doctors practising in Australia and New Zealand. One hundred and twenty-four intensive care consultants and registrars agreed to participate in an online questionnaire in two routine mailings between November 2013 and February 2014. We evaluated the effect of a PVR on clinical decision-making in a case-based scenario. In addition, participants rated the utility of the PVR on their decision-making process. Participants were presented with a difficult scenario in a frail elderly man where death was almost inevitable without aggressive support but survival with severe disability was possible with significant intervention. Most doctors (52.4%) elected to continue ventilation and admit to ICU. After the PVR was made available, only 8.1% of doctors continued to choose to admit the patient to the ICU. In all cases where admission to the ICU was chosen after seeing the PVR, the admission to the ICU was stated to be to permit family to arrive before withdrawing support (an approach which was consistent with the values stated in the PVR). One hundred and twenty-one of the 124 participants (97.6%) agreed or strongly agreed that the PVR helped them get an understanding of the patient's wishes, whereas none of the participants (0%) were unsure, disagreed or strongly disagreed with this statement. The remaining 2.4% did not answer the question. It is surmised that PVRs pre-written by patients are potentially an effective and valuable tool for use in helping doctors make decisions regarding patient care.

  13. Patient acceptance and perceived utility of pre-consultation prevention summaries and reminders in general practice: pilot study

    Directory of Open Access Journals (Sweden)

    Aylward Paul

    2011-05-01

    Full Text Available Abstract Background Patients attending general practices receive only about sixty per cent of the preventive services that are indicated for them. This pilot study explores patient acceptability and perceived utility of automatically generated prevention summary and reminder sheets provided to patients immediately before consultations with their general practitioners. Methods Adult patients attending a general practitioner in a practice in Adelaide and a general practitioner in a practice in Melbourne, Australia for consultations in January and February 2009 received automatically-generated prevention summary and reminder sheets that highlighted indicated preventive activities that were due to be performed, and that encouraged the patient to discuss these with the general practitioner in the consultation. Patients completed a post-consultation questionnaire and were interviewed about their experience of receiving the sheets. Results Sixty patients, median age 53 years (interquartile range 40-74 years, and 58% female, were recruited. Seventy eight per cent of patients found the sheets clear and easy to understand, 75% found them very or quite useful, 72% reported they had addressed with their general practitioner all of the preventive activities that were listed on the sheets as being due to be performed. A further 13% indicated that they had addressed most or some of the activities. 78% of patients said that they would like to keep receiving the sheets. Themes emerging from interviews with patients included: patient knowledge was enhanced; patient conceptions of health and the GP consultation were broadened; the consultation was enhanced; patient pro-activity was encouraged; patients were encouraged to plan their health care; the intervention was suitable for a variety of patients. Conclusions Most patients reported that they found the prevention summary and reminder sheets acceptable and useful. The actual increase in performance of preventive

  14. Prevention of venous thromboembolism in hospitalized acutely ill medical patients: focus on the clinical utility of (low-dose fondaparinux

    Directory of Open Access Journals (Sweden)

    Di Nisio M

    2013-09-01

    Full Text Available Marcello Di Nisio,1,2 Ettore Porreca3 1Department of Medical, Oral and Biotechnological Sciences, University G D'Annunzio of Chieti-Pescara, Chieti, Italy; 2Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; 3Department of Medicine and Aging, Centre for Aging Sciences, Internal Medicine Unit, University G D'Annunzio Foundation, Chieti, Italy Abstract: Venous thromboembolism (VTE is a frequent complication among acutely ill medical patients hospitalized for congestive heart failure, acute respiratory insufficiency, rheumatologic disorders, and acute infectious and/or inflammatory diseases. Based on robust data from randomized controlled studies and meta-analyses showing a reduced incidence of VTE by 40% to about 60% with pharmacologic thromboprophylaxis, prevention of VTE with low molecular weight heparin (LMWH, unfractionated heparin (UFH, or fondaparinux is currently recommended in all at-risk hospitalized acutely ill medical patients. In patients who are bleeding or are at high risk for major bleeding, mechanical prophylaxis with graduated compression stockings or intermittent pneumatic compression may be suggested. Thromboprophylaxis is generally continued for 6 to 14 days or for the duration of hospitalization. Selected cases could benefit from extended thromboprophylaxis beyond this period, although the risk of major bleeding remains a concern, and additional studies are needed to identify patients who may benefit from prolonged prophylaxis. For hospitalized acutely ill medical patients with renal insufficiency, a low dose (1.5 mg once daily of fondaparinux or prophylactic LMWH subcutaneously appears to have a safe profile, although proper evaluation in randomized studies is lacking. The evidence on the use of prophylaxis for VTE in this latter group of patients, as well as in those at higher risk of bleeding complications, such as patients with thrombocytopenia, remains scarce. For critically ill patients

  15. Race and Ethnic Group Differences in Comorbid Major Depressive Disorder, Generalized Anxiety Disorder, and Chronic Medical Conditions.

    Science.gov (United States)

    Watkins, Daphne C; Assari, Shervin; Johnson-Lawrence, Vicki

    2015-09-01

    This study tested whether race and ethnic group differences exist for lifetime major depressive disorder and/or general anxiety disorder with one or more chronic medical conditions. Data from the National Survey of American Life, which included 3570 African American, 1438 Caribbean Black, and 891 non-Hispanic White adults were analyzed. Outcomes included at least one and multiple chronic medical conditions, from a list of 14 medical conditions (e.g., arthritis, cancer, diabetes, kidney disease, stroke, heart disease, etc.). Logistic regressions were fitted to data to determine how the association between major depressive disorder, general anxiety disorder, and one or more chronic medical conditions vary across race and ethnicity. Lifetime major depressive disorder (but not lifetime general anxiety disorder) was associated with at least one chronic medical condition among African Americans and Caribbean Blacks, but not non-Hispanic Whites. Lifetime major depressive disorder was similarly associated with multiple chronic medical conditions among African Americans, Caribbean Blacks, and non-Hispanic Whites. For Caribbean Blacks, stronger associations were found between major depressive disorder and general anxiety disorder with one or more chronic medical conditions compared to African Americans and non-Hispanic Whites. Findings suggest that race and ethnicity may shape the links between comorbid psychiatric disorders and chronic medical conditions. Mental health screening of individuals with chronic medical conditions in primary health-care settings may benefit from tailoring based on race and ethnicity. More research is needed to understand why associations between physical and mental health vary among race and ethnic groups.

  16. Exploring the Role of Neuroticism and Insecure Attachment in Health Anxiety, Safety-Seeking Behavior Engagement, and Medical Services Utilization

    Directory of Open Access Journals (Sweden)

    Fotios Anagnostopoulos

    2016-06-01

    Full Text Available The purpose of this study was to explore an extended interpersonal model of health anxiety, according to which health-anxious individuals are trapped in a vicious circle of health-related reassurance-seeking, alienation from others, and worry about health, while somatic absorption with body sensations, insecure attachment, neuroticism, safety-seeking behaviors, and medical services utilization were also included in the model. Data were collected from 196 Greek university students using standardized instruments. Results indicated that anxious attachment was directly related to absorption (β = .163, p < .05 and alienation (β = .204, p < .05, while avoidant attachment was directly related to absorption (β = −.344, p < .001, reassurance-seeking (β = −.130, p < .05, and alienation (β = .148, p < .05. Neuroticism was positively and significantly associated with all dimensions of health anxiety. Absorption, alienation, and anxious attachment were related to medical services utilization, which, in turn, was related to safety-seeking behaviors (β = .200, p < .01. Neuroticism and anxious attachment were also indirectly and positively associated with worry. Moreover, absorption was positively related to worry and reassurance-seeking, worry was positively related to reassurance-seeking, and alienation was positively related to worry. Study results highlight the key role that interpersonal (e.g., alienation from others and perceptual factors (e.g., the tendency to focus on bodily sensations can play in health anxiety maintenance, and the importance of anxious and avoidant attachment in safety-seeking behavior engagement. Implications of the results and suggestions for future research and practice are outlined.

  17. Utilization of serology for the diagnosis of suspected Lyme borreliosis in Denmark: Survey of patients seen in general practice

    Directory of Open Access Journals (Sweden)

    Skarphedinsson Sigurdur

    2010-11-01

    Full Text Available Abstract Background Serological testing for Lyme borreliosis (LB is frequently requested by general practitioners for patients with a wide variety of symptoms. Methods A survey was performed in order to characterize test utilization and clinical features of patients investigated for serum antibodies to Borrelia burgdorferi sensu lato. During one calendar year a questionnaire was sent to the general practitioners who had ordered LB serology from patients in three Danish counties (population 1.5 million inhabitants. Testing was done with a commercial ELISA assay with purified flagella antigen from a Danish strain of B. afzelii. Results A total of 4,664 patients were tested. The IgM and IgG seropositivity rates were 9.2% and 3.3%, respectively. Questionnaires from 2,643 (57% patients were available for analysis. Erythema migrans (EM was suspected in 38% of patients, Lyme arthritis/disseminated disease in 23% and early neuroborreliosis in 13%. Age 0-15 years and suspected EM were significant predictors of IgM seropositivity, whereas suspected acrodermatitis was a predictor of IgG seropositivity. LB was suspected in 646 patients with arthritis, but only 2.3% were IgG seropositive. This is comparable to the level of seropositivity in the background population indicating that Lyme arthritis is a rare entity in Denmark, and the low pretest probability should alert general practitioners to the possibility of false positive LB serology. Significant predictors for treating the patient were a reported tick bite and suspected EM. Conclusions A detailed description of the utilization of serology for Lyme borreliosis with rates of seropositivity according to clinical symptoms is presented. Low rates of seropositivity in certain patient groups indicate a low pretest probability and there is a notable risk of false positive results. 38% of all patients tested were suspected of EM, although this is not a recommended indication due to a low sensitivity of

  18. Continuing Medical Education Needs Assessment of General Physicians Working at Tabriz Health Centers in 2014

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    Parisa Golanbar

    2014-12-01

    Full Text Available Introduction: The aim of this study was to identify the educational needs of General Physicians working in the health centers of Tabriz in 2014. Methods: The study method was descriptive. The statistical population was 2,024. Of the population of the study, 322 physicians were randomly selected. In order to gather the data, the Delphi method and a researcher-made questionnaire were used in 14 domains of medicine, including: Communicable and Infectious Diseases, Non-communicable Diseases, Health Education, Mental and Social Health, Dental and Oral Health, Medical Procedures, Population and Family, Nutritional Health, Occupational Health, Environmental Health, Complementary Procedures, Health Crisis and Disasters, Laboratory and Drugs, and Alternative Medicine. The validity of the study was confirmed with the viewpoint of the Delphi team and the reliability was confirmed with the Alpha Cronbach (r = 0.84. For data analysis, we used descriptive statistic methods like frequency, percentage and mean, and the Friedman ranking test (calculated using SPSS v. 21. Results: The results showed that the first-ranked educational needs of every domain were the following (in order of domain listed above: respiratory infection, hypertension, healthy lifestyle, stress management, dental growth and care in children, raising hope and pleasure, weight and nutritional control, occupational health and safety, water hygiene, cardiopulmonary resuscitation, therapeutic exercises, natural disasters’ primary cares, rational use of drugs and traditional medicine.Conclusion: The first domain receiving the first rank of educational needs was non-communicable diseases, and the conformity range of implemented plans in continuing medical education with need assessment results was 53.84%.

  19. Osteoarthritis: quality of life, comorbidities, medication and health service utilization assessed in a large sample of primary care patients

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    Szecsenyi Joachim

    2007-06-01

    Full Text Available Abstract Objective To assess the gender related impact of osteoarthritis (OA on quality of life (QoL and health service utilization (HSU of primary care patients in Germany. Methods Cross sectional study with 1250 OA patients attending 75 primary care practices from March to May 2005. QoL was assessed using the GERMAN-AIMS2-SF. Data about comorbidities, prescriptions, health service utilization, and physical activity were obtained by questioning patients or from the patients' medical files. Depression was assessed by means of the Patient Health Questionnaire (PHQ-9. Results 1021 (81.7% questionnaires were returned. 347 (34% patients were male. Impact of OA on QoL was different between gender: women achieved significantly higher scores in the AIMS 2-SF dimensions lower body (p Conclusion The extent to which OA impacts men and women differs in primary care patients. This might have resulted in the revealed differences in the pharmacological treatment and the HSU. Further research is needed to confirm our findings and to assess causality.

  20. [Impact of primary care oriented outpatient benefit package design in new rural cooperative medical system on hypertension outpatient services utilization].

    Science.gov (United States)

    Tang, Shu-nv; Jian, Wei-yan; Yip, Winnie C-M; Guo, Yan

    2014-06-18

    To study the impact of primary care oriented outpatient benefits package design of outpatient services coverage and ladder reimbursement of county, town and village levels in the new rural cooperative medical system (NRCMs) on hypertension outpatient services utilization. The panel data of treatment and control groups in 2009 and 2011 before and after the policy reform were drawn from the household survey data of the innovative payment system project. The difference in difference (DID) method was used for data analysis. The outcome indicators included the utilization of outpatient services of patients with self-reported hypertension and their main treatment locations. The primary care oriented outpatient benefit package design in the NRCMs reduced the probability of no treatment in the latest three months of hypertension by 10.2 percent points. Meanwhile, it increased the probability of choosing village clinic as the preferred location by 15.7 percent points. Primary care oriented outpatient benefits package design lead patients with hypertension to use the nearest outpatient services at low risk of disease.

  1. An initial assessment of the cost and utilization of the Integrated Academic Information System (IAIMS) at Columbia Presbyterian Medical Center.

    Science.gov (United States)

    Clayton, P D; Anderson, R K; Hill, C; McCormack, M

    1991-01-01

    The concept of "one stop information shopping" is becoming a reality at Columbia Presbyterian Medical Center (CPMC). The goal of our effort is to provide access to university and hospital administrative systems as well as clinical and library applications from a single workstation, which also provides utility functions such as word processing and mail. Since June 1987, CPMC has invested the equivalent of $23 million dollars to install a digital communications network that encompasses 18 buildings at seven geographically separate sites and to develop clinical and library applications that are integrated with the existing hospital and university administrative and research computing facilities. During June 1991, 2425 different individuals used the clinical information system, 425 different individuals used the library applications, and 900 different individuals used the hospital administrative applications via network access. If we were to freeze the system in its current state, amortize the development and network installation costs, and add projected maintenance costs for the clinical and library applications, our integrated information system would cost $2.8 million on an annual basis. This cost is 0.3% of the medical center's annual budget. These expenditures could be justified by very small improvements in time savings for personnel and/or decreased length of hospital stay and/or more efficient use of resources. In addition to the direct benefits which we detail, a major benefit is the ease with which additional computer-based applications can be added incrementally at an extremely modest cost.

  2. RUMD: A general purpose molecular dynamics package optimized to utilize GPU hardware down to a few thousand particles

    CERN Document Server

    Bailey, Nicholas P; Hansen, Jesper Schmidt; Veldhorst, Arno A; Bøhling, Lasse; Lemarchand, Claire A; Olsen, Andreas E; Bacher, Andreas K; Larsen, Heine; Dyre, Jeppe C; Schrøder, Thomas B

    2015-01-01

    RUMD is a general purpose, high-performance molecular dynamics (MD) simulation package running on graphical processing units (GPU's). RUMD addresses the challenge of utilizing the many-core nature of modern GPU hardware when simulating small to medium system sizes (roughly from a few thousand up to hundred thousand particles). It has a performance that is comparable to other GPU-MD codes at large system sizes and substantially better at smaller sizes.RUMD is open-source and consists of a library written in C++ and the CUDA extension to C, an easy-to-use Python interface, and a set of tools for set-up and post-simulation data analysis. The paper describes RUMD's main features, optimizations and performance benchmarks.

  3. General surgical interns contributing to the clerkship learning environment of medical students.

    Science.gov (United States)

    Yu, Tzu-Chieh; Lemanu, Daniel P; Henning, Marcus; Maccormick, Andrew D; Hawken, Susan J; Hill, Andrew G

    2013-08-01

    Junior doctors are increasingly promoted as clinical teachers but there is limited understanding of how they contribute to medical student clerkship learning. To describe contributions made by general surgical interns to the student clerkship learning environment. The mixed-methods study involved two focus groups attended by volunteer interns and Year 4 students, and a student questionnaire collecting quantitative data. Focus group transcripts were evaluated using a qualitative analysis system. Six interns and five students attended focus groups in June and August 2011. Qualitative analysis found that intern contributions to student learning can be grouped under four distinct roles: physician, supervisor, teacher and person. Data from 85 questionnaires (response rate 57%) revealed that intern-student encounters occurred daily in the surgical wards and emergency department. Interns demonstrated bedside procedures, clerical/administrative tasks and interpretation of laboratory and radiological investigations. Appreciated for approachability, friendliness and ability to relate to students, interns also played a crucial role in integrating students into the surgical team. This significantly correlated to clerkship enjoyment. Surgical interns improve clerkship learning environments by demonstrating "personal" skills such as friendliness, approachability and relatedness. This has important implications for preparing interns as clinical preceptors.

  4. ANALYTICAL STUDY OFDENTAL STATUS OFPATIENTSWITH CHRONIC GENERALIZED PERIODONTITIS DENTAL CLINIC OF KRASNOYARSK STATE MEDICAL UNIVERSITY

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    Marugina Tatyana Leonidovna

    2013-05-01

    Full Text Available To make distinct approaches in the diagnosis, treatment and prevention of chronic generalized periodontitis the analysis of case rate of the disease during the period of 2010-2012 years was carried out in the dental clinic of Krasnoyarsk State Medical Academy. In order to divide patients into several groups according to severity of the disease the review of case history of 4390 patients aged 20 to 65 was made. 684 patients (15.6 % were diagnosed with mild degree of the disease, 2608 (59.4% with an average degree and 1908 patients (25% with severe degree of the disease. The low percentage of number of patients with mild degree of the disease is the result of late diagnosis of the disease. During the analysis of the structure of providing periodontal care at the stages of examination, periodontal and surgical help the lack of an objective assessment of the condition ofalveolar mucosa isnoted. Therefore, during the initial examination, we suggest to use Schiller-Pisarev method. As a crucial step in the identification of early forms of periodontal disease is a health education outreach.

  5. Utilization of the Generalized Method of Cells to Analyze the Deformation Response of Laminated Ceramic Matrix Composites

    Science.gov (United States)

    Goldberg, Robert K.

    2012-01-01

    In order to practically utilize ceramic matrix composites in aircraft engine components, robust analysis tools are required that can simulate the material response in a computationally efficient manner. The MAC/GMC software developed at NASA Glenn Research Center, based on the Generalized Method of Cells micromechanics method, has the potential to meet this need. Utilizing MAC/GMC, the effective stiffness properties, proportional limit stress and ultimate strength can be predicted based on the properties and response of the individual constituents. In this paper, the effective stiffness and strength properties for a representative laminated ceramic matrix composite with a large diameter fiber are predicted for a variety of fiber orientation angles and laminate orientations. As part of the analytical study, methods to determine the in-situ stiffness and strength properties of the constituents required to appropriately simulate the effective composite response are developed. The stiffness properties of the representative composite have been adequately predicted for all of the fiber orientations and laminate configurations examined in this study. The proportional limit stresses and strains and ultimate stresses and strains were predicted with varying levels of accuracy, depending on the laminate orientation. However, for the cases where the predictions did not have the desired level of accuracy, the specific issues related to the micromechanics theory were identified which could lead to difficulties that were encountered that could be addressed in future work.

  6. [Which medical errors do general practitioners make? Data from the Expert Arbitration and Advisory Board of the Baden-Württemberg State Medical Association].

    Science.gov (United States)

    Moßhammer, D; Eissler, M

    2014-05-01

    In Germany, medical error reporting systems are well established. They collect information reported principally by physicians. Systematic data collection concerning medical errors is also performed by expert arbitration and advisory boards of the German State Medical Associations. Data base MERS (Medical Error Reporting System); cases from the Expert Arbitration and Advisory Board of the State Baden-Württemberg from the years 2004-2011 (8,042 cases) were evaluated as follows: extraction of the cases from general practitioners (n=307, 4%); categorisation of the type of error and degree of severity; classification according to ICD-10 (International Classification of Diseases); overview of confirmed cases including commentaries of the above board; logistic regression analysis of factors potentially associated with confirmed cases. In 26% (n=80) the board confirmed medical errors. 55% of the errors were assigned to the category "diagnosis" (n=44), 21% to "general therapy" (n=17), 8% to "operative therapy" ("minor surgical operations") (n=6) and 10% to "injections" (n=8). 29% of cases (n=23) were associated with permanent damage or death. The majority of cases could be assigned to ICD-10 categories "I" (cardiovascular system, n=20) and "S-T" or "V-Y" (consequences of external causes or external causes of morbidity and mortality, n=34). No significant associations were found by logistic regression analysis. The rate of confirmed cases corresponds with the rate of all medical disciplines. The presented overview is illustrative and may be of help to avoid errors by using it for continuing medical education. © Georg Thieme Verlag KG Stuttgart · New York.

  7. 41 CFR 102-83.15 - Is there a general hierarchy of consideration that agencies must follow in their utilization of...

    Science.gov (United States)

    2010-07-01

    ... hierarchy of consideration that agencies must follow in their utilization of space? 102-83.15 Section 102-83... general hierarchy of consideration that agencies must follow in their utilization of space? Yes, Federal agencies must follow the hierarchy of consideration identified in § 102-79.55 of this chapter. ...

  8. Medical resource utilization and costs associated with autosomal dominant polycystic kidney disease in the USA: a retrospective matched cohort analysis of private insurer data

    Directory of Open Access Journals (Sweden)

    Knight T

    2015-02-01

    relative to the general population. Any treatments that delay progression to later stages of CKD may provide potential health care cost offsets. Keywords: autosomal dominant polycystic kidney disease, medical resource utilization, chronic kidney disease

  9. The Marketability of Integrated Energy/Utility Systems: A Guide to the Dollar Savings Potential in Integrated Energy/Utility Systems; for Campuses, Medical Complexes, and Communities; Architect/Engineers, Industrial and Power Plant Owners; Suppliers; and Constructors.

    Science.gov (United States)

    Coxe, Edwin F.; Hill, David E.

    This publication acquaints the prospective marketplace with the potential and underlying logic of the Integrated Utility System (IUS) concept. This system holds promise for educational and medical institutions seeking to reduce their energy costs. The generic IUS concept is described and how it can be incorporated into existing heating and…

  10. Differences in health services utilization and costs between antihypertensive medication users versus nonusers in adults with diabetes and concomitant hypertension from Medical Expenditure Panel Survey pooled years 2006 to 2009.

    Science.gov (United States)

    Davis-Ajami, Mary Lynn; Wu, Jun; Fink, Jeffrey C

    2014-01-01

    To compare population-level baseline characteristics, individual-level utilization, and costs between antihypertensive medication users versus nonusers in adults with diabetes and concomitant hypertension. This longitudinal retrospective observational research used Medical Expenditure Panel Survey household component pooled years 2006 to 2009 to analyze adults 18 years or older with nongestational diabetes and coexistent essential hypertension. Two groups were created: 1) antihypertensive medication users and 2) no antihypertensive pharmacotherapy. We examined average annualized health care costs and emergency department and hospital utilization. Accounting for Medical Expenditure Panel Survey's complex survey design, all analyses used longitudinal weights. Logistic regressions examined the likelihood of utilization and anytihypertensive medication use, and log-transformed multiple linear regression models assessed costs and antihypertensive medication use. Of the 3261 adults identified with diabetes, 66% (n = 2137) had concomitant hypertension representing 38.7 million individuals during 2006 to 2009. Significantly, the 16% (n = 338) no antihypertensive pharmacotherapy group showed greater mean nights hospitalized (3.6 vs. 1.7, P = 0.0120), greater all-cause hospitalization events per 1000 patient months (41 vs. 24, P = 0.0.007), and lower mean diabetes-related and hypertension-related ambulatory visits. After adjusting for confounders, non-antihypertensive medication users showed 1.64 odds of hospitalization, 29% lower total, and 27% lower average annualized medical expenses compared with antihypertensive medication users. In adults with diabetes and coexistent hypertension, we observed significantly greater hospitalizations and lower costs for the non antihypertensive pharmacotherapy group versus those using antihypertensive medications. The short-term time horizon greater hospitalizations with lower expenses among non-antihypertensive medication users with

  11. Comparison of Medical Service Utilization and HPV Vaccination Rates among Somali and White/non-Hispanic Females

    Science.gov (United States)

    Pruitt, Crystal N.; Breitkopf, Carmen Radecki; Creedon, Douglas J.

    2014-01-01

    Objective To determine if there is a relationship between medical utilization patterns and HPV vaccination rates among a previously studied population of Somali and white/non-Hispanic girls in Rochester, MN. Materials and Methods Utilizing a previously identified group of Somali and white/non-Hispanic girls with known human papillomavirus vaccination (HPV) status, the number, type and age at provider visits were abstracted. Abstraction was blinded to vaccination status and ethnic designation. Chi-squared test and student’s t-test were performed for descriptive analysis of parametric data. For non-parametric data, Wilcoxon Rank Sum Test was performed. Results Somali girls had fewer provider visits (median, 7; Interquartile Range [IQR], 3/12.25) than white/non-Hispanic girls (median, 12; IQR, 6-18) (p<0.001). Among those who completed the HPV vaccine series, Somali girls had more well-child visits (median, 2; IQR 1-2) compared to the white/non-Hispanic group (median 1; IQR 1-2) (p=0.028). There was no difference in the number of ER visits or inpatient hospitalization between groups. Conclusions White/non-Hispanic girls had higher HPV vaccine completion rates and more provider visits. However, this increase in number of encounters is due to an increase in specialty visits. This is unlikely to account for the increase in HPV vaccination completion rates. Community-based research will likely provide greater insight into the cause(s) of reduced vaccine rates among Somali adolescent girls. PMID:24786609

  12. Vancomycin and Five Broad-spectrum Antibiotic Utilization Evaluation in an Educational Medical Center in One Year

    Directory of Open Access Journals (Sweden)

    SiminDokht Shoaei

    2015-10-01

    Full Text Available  Background: Antibiotics can be life saving if they are used correctly, and can have unwanted side effects specially resistance with incorrect use. Unfortunately in fear of no response, physicians use broad spectrum antibiotics meticulously. In this Drug Utilization Evaluation (DUE, improper use of Vancomycin and five broad-spectrum antibiotics are studied to find faults and solution for this problem. Methods:This descriptive cross-sectional study performed during the March of 2012 to March of 2013.DUE of Imipenem, Meropenem, Piperacillin-Tazobactam, Cefepime, Ciprofloxacin and Vancomycin was done in 6 wards of Imam Hossein Hospital in Tehran. Demographic, clinical, laboratory, imaging and treatment data were looked for in medical records of 686 patients. Evaluation was done by three infectious disease specialist based on reference text book of Mandell’s Principles and Practice of Infectious Diseases 2010 and IDSA Guidelines. Results:This study showed 38.5% of prescriptions were correct and the remained 61.5% were incorrect with different faults predominantly incorrect overuse in 51.1%.Ciprofloxacin was the most common incorrect used drug in 74.8% cases and Piperacillin-Tazobactam with 48.7% cases had the least common incorrect use. There was no fault in prescription of antibiotics observing age and sex (pregnancy, breast feeding factors. Conclusions:Our results reveal a significant high level of the inappropriate use of Antibiotics mostly as overuse and empirically without culture results. It is needed to establish continuing medical education (CME courses and a locally conformable guideline of antibiotic use based on antibiogram results.

  13. A comparison of general medical and clinical ethics consultations: what can we learn from each other?

    Science.gov (United States)

    Geppert, Cynthia M A; Shelton, Wayne N

    2012-04-01

    Despite the emergence of clinical ethics consultation as a clinical service in recent years, little is known about how clinical ethics consultation differs from, or is the same as, other medical consultations. A critical assessment of the similarities and differences between these 2 types of consultations is important to help the medical community appreciate ethics consultation as a vital service in today's health care setting. Therefore, this Special Article presents a comparison of medical and clinical ethics consultations in terms of fundamental goals of consultation, roles of consultants, and methodologic approaches to consultation, concluding with reflections on important lessons about the physician-patient relationship and medical education that may benefit practicing internists. Our aim is to examine ethics consultation as a clinical service integral to the medical care of patients. Studies for this analysis were obtained through the PubMed database using the keywords ethics consultation, medical consultation, ethics consults, medical consults, ethics consultants, and medical consultants. All English-language articles published from 1970 through August 2011 that pertained to the structure and process of medical and ethics consultation were reviewed.

  14. Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study.

    Science.gov (United States)

    Dawson, Angela J; Nicolls, Rachel; Bateson, Deborah; Doab, Anna; Estoesta, Jane; Brassil, Ann; Sullivan, Elizabeth A

    2017-03-14

    Australian Government approval in 2012 for the use of mifepristone and misoprostol for medical termination of pregnancy (MTOP) allows general practitioners (GPs) to provide early gestation abortion in primary care settings. However, uptake of the MTOP provision by GPs appears to be low and the reasons for this have been unclear. This study investigated the provision of and referral for MTOP by GPs. We undertook descriptive-interpretive qualitative research and selected participants for diversity using a matrix. Twenty-eight semi-structured interviews and one focus group (N = 4), were conducted with 32 GPs (8 MTOP providers, 24 non MTOP providers) in New South Wales, Australia. Interviews were recorded and transcribed verbatim. A framework to examine access to abortion services was used to develop the interview questions and emergent themes identified thematically. Three main themes emerged: scope of practice; MTOP demand, care and referral; and workforce needs. Many GPs saw abortion as beyond the scope of their practice (i.e. a service others provide in specialist private clinics). Some GPs had religious or moral objections; others regarded MTOP provision as complicated and difficult. While some GPs expressed interest in MTOP provision they were concerned about stigma and the impact it may have on perceptions of their practice and the views of colleagues. Despite a reported variance in demand most MTOP providers were busy but felt isolated. Difficulties in referral to a local public hospital in the case of complications or the provision of surgical abortion were noted. Exploring the factors which affect access to MTOP in general practice settings provides insights to assist the future planning and delivery of reproductive health services. This research identifies the need for support to increase the number of MTOP GP providers and for GPs who are currently providing MTOP. Alongside these actions provision in the public sector is required. In addition

  15. 试论医疗档案的开发利用与现代化管理%A Study on Utilization and Management of Medical Archives

    Institute of Scientific and Technical Information of China (English)

    刘子国

    2012-01-01

      近年来,档案管理作为医院管理工作中的一个有机组成部分愈来愈受到关注和重视。开发利用医疗档案是档案管理人员工作的目的,现代化管理是开发利用的前提条件和首要基础。医疗档案的现代化管理,有力地促进了医疗档案信息的开发利用,进一步提高了医疗档案的开发利用价值,也是医疗档案管理工作未来努力的方向。%  For the last few years, the management of medical archives has become an important component part of the hospital management, drawing a wide attention and concern. To better develop and utilize medical archives is the purpose of the work of the staff for archives;and modern management is its precondition and primary foundation. The modern management of medical archives has greatly promoted the development and utilization of the information of medical archives, and improved the utilization value of medical archives, becoming an orientation of the medical archive management in future.

  16. Knowledge, opinions, and practices about oral cancer among general medical practitioners in Lagos, Nigeria

    Directory of Open Access Journals (Sweden)

    Olalekan Micah Gbotolorun

    2015-01-01

    Full Text Available Objectives: To evaluate the knowledge and practices of general medical practitioners (GMPs in Lagos on screening for oral cancer (OC. Materials and Methods: A 43-item self-administered questionnaires was filled by each GMPs recruited into the study. Analysis was done using the SPSS version 17.5. Descriptive analyses were used and results were presented in percentages, graphs, and tables. Results: One-hundred and twenty GMPs participated in the study, 58.7% were males and 41.3% females; their ages ranged 22-61 years (36.1 ΁ 7.97. While most participants answered correctly that smoked tobacco (96.1%, increasing age >45 years (97%, oral sex (99%, and patient with a previous OC (93.7% were risk factors for OC; there was misinformation on the nonrisk factors as only 5.5%, 7.9%, and 18.9%, respectively, answered correctly that family history of cancer, dental infections, and poor oral hygiene were not identifiable risk factors associated with OC. Furthermore, although majority of subjects (81.1% identified the floor and the tongue as the most common sites of OC and leukoplakia (75.6% as a common precursor of OC; only 29.1% identified correctly that OC had one of the worst morbidity and mortality rates of the most common cancers due to late presentation. Only 0.8% of GMPs had a consistent high score in the indexes. Conclusion: The knowledge and practices of GMPs in the Lagos environment on OC needs a lot of improvement for them to become significant in the screening for the disease entity.

  17. Anxiety Management Training and Relaxation as Self-Control in the Treatment of Generalized Anxiety in Medical Outpatients.

    Science.gov (United States)

    Cragan, Mary K.; Deffenbacher, Jerry L.

    1984-01-01

    Compared Anxiety Management Training (AMT) and Relaxation as Self-Control (RSC) in reducing stress in 55 anxious medical outpatients. At posttreatment and follow-up assessments, both AMT and RSC groups reported significantly less anxiety, stress reactivity, general physiological arousal, depression, and anger than controls. (JAC)

  18. Medical resource utilization and costs among Australian patients with genotype 1 chronic hepatitis C: results of a retrospective observational study.

    Science.gov (United States)

    McElroy, Heather J; Roberts, Stuart K; Thompson, Alex J; Angus, Peter W; McKenna, Sarah Jane; Warren, Emma; Musgrave, Sharon

    2017-01-01

    To evaluate medical resource utilization (MRU) and associated costs among Australian patients with genotype 1 chronic hepatitis C (GT1 CHC), including both untreated patients and those receiving treatment with first-generation protease inhibitor-based regimens (telaprevir, boceprevir with pegylated interferon and ribavirin). Medical records were reviewed for a stratified random sample of GT1 CHC patients first attending two liver clinics between 2011-2013 (principal population; PP), supplemented by all GT1 CHC patients attending one transplant clinic in the same period (transplant population; TP). CHC-related MRU and associated costs are reported for the PP by treatment status (treated/not treated) stratified by baseline fibrosis grade; and for the TP for the pre-transplant, year of transplant and post-transplant periods. A total 1636 patients were screened and 590 patients (36.1%) were included. Comprehensive MRU data were collected for 276 PP patients (F0-1 n = 59, F2 n = 58, F3 n = 53, F4 n = 106; mean follow-up = 17.3 months). Thirty-eight (13.8%) were treatment-experienced prior to enrolment; 55 (19.9%) received triple therapy during the study. Data were collected for 112 TP patients (mean follow-up = 29.9 months), 33 (29.5%) received a transplant during the study, and 51 (45.5%) beforehand. The annual direct medical costs, excluding drug costs, were higher among treated PP vs untreated PP (AU$: $1,954 vs $1,202); and year of transplant TP vs pre-/post-transplant TP (AU$: pre-transplant $32,407, transplant $155,138, post-transplant $7,358). To aid interpretation of results, note that only patients with GT1 CHC who are actively managed are included, and MRU data were collected specifically from liver outpatient clinics. That said, movement of patients between hospitals is rare, and any uncaptured MRU is expected to be minimal. CHC-related MRU increases substantially with disease severity. These real-world MRU data for GT1 CHC will be

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

    Science.gov (United States)

    Zamani-Hank, Yasamean

    2016-08-01

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

  20. General Methodologies for Improving Motor Drive Precision in Order to Utilize It as an Embedded Application Sensor

    Science.gov (United States)

    Secrest, Caleb W.

    The objectives of this research are to reliably, and non-invasively, extract high quality spatial information from a limited-stroke multi-stage gear train driven by an AC machine using only the sensors necessary for normal AC machine control. In this work, the spatial information will be used to estimate the state of wear of each axis in the gear train. To extract this information, cascaded observer structures are utilized to estimate the load disturbances acting on the AC machine, and then to estimate the spatial errors which produce those disturbances. Further signal processing techniques are then utilized to observe the spatial error information in the spatial domain where the information is most relevant and to extract the systematic spatial errors that reoccur over many operating cycles. In prior art, the intrinsic spatial properties of the AC machine and position sensor feedback limited the quality of the spatial error information that could be extracted using motor drive-based estimation. Furthermore, the limited-stroke of the multi-stage gear train limits the separation of spatial content between the axes of the gear train and limits the extraction of the systematic spatial errors that reoccur over many operating cycles. In this work, methods are developed to reduce and separate machine and sensor contributions to the spatial error information being extracted, and general system design methodologies are investigated to improve the quality of spatial error information that can be extracted within the limited-stroke motion constraints of the multi-stage gear train.

  1. "What do you think I should do?": Understanding intercultural medical communication in general practice

    NARCIS (Netherlands)

    Schinkel, S.

    2015-01-01

    Adequate communication between doctors and patients is a crucial aspect of good quality health care. Research has shown that medical communication between doctors and patients from different ethnic and cultural backgrounds is less effective than medical communication between doctors and patients

  2. Self-reported intentional and unintentional non-adherence to medication in a general practice population.

    NARCIS (Netherlands)

    Dijk, L. van; Dulmen, S. van; Sluijs, E.; Heerdink, R.; Ridder, D. de; Bensing, J.

    2006-01-01

    Background: Non-adherence to medication is a major public health problem all over the world. Poor adherence to medication regimes accounts for substantial worsening of disease and an increase in health care costs. Few studies on non-adherence distinguished between intentional and unintentional

  3. Taking decision general theory and its application in the medical assistance field (I.

    Directory of Open Access Journals (Sweden)

    Luis Alberto Corona Martínez

    2004-04-01

    Full Text Available Decision making is a necessary element in the medical work. This article is a part of a series of articles that is aimed at divulging some theoretical aspects about decision making and their concrete application in the medical assistance. This paper analyses the classic (rational and behavioural theories in decision making.

  4. 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...

  5. 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.

  6. The impact of medical insurance policies on the hospitalization services utilization of people with schizophrenia: A case study in Changsha, China.

    Science.gov (United States)

    Feng, Yi; Xiong, Xianjun; Xue, Qiuji; Yao, Lan; Luo, Fei; Xiang, Li

    2013-05-01

    To evaluate the impact of two medical insurers' policies on the hospitalization of people with schizophrenia and the economic burden they faced during a period of rapid health services reform in China. A comparative analysis was made of Urban Employee-Basic Medical Insurance (UE-BMI) and Urban Residents-Basic Medical Insurance (UR-BMI) policies on the medical management of schizophrenics, and was compared with hospitalization expenses, insurer reimbursement data and other information collected from the HMO (health maintenance organization) and social insurance agencies on the care of people with schizophrenia in Changsha in 2010. In-depth interviews were also conducted with relevant managers. Compared with inpatients covered by UR-BMI, the inpatients of UE-BMI were admitted to higher level medical institutions and were prescribed expensive second generation antipsychotics (SGA) medicines. Nevertheless, the hospitalization service utilization and cost of inpatients' hospitalization under UE-BMI were far less than that of inpatients under UR-BMI. The insurance level difference between two medical insurance schemes influences the treatment regimens and benefits received by patients. Furthermore, the integration of schizophrenia management into the outpatient services pooling fund for special diseases(OS-PFSD) can appropriately reduce hospitalization utilization, which, together with the payment way reform and the prescription of reasonable medications, can significantly reduce the overall hospitalization cost for patients.

  7. Medical students' participation in the 2009 Novel H1N1 influenza vaccination administration: policy alternatives for effective student utilization to enhance surge capacity in disasters.

    Science.gov (United States)

    Kaiser, Heather E; Barnett, Daniel J; Hayanga, Awori J; Brown, Meghan E; Filak, Andrew T

    2011-06-01

    As cases of 2009 novel H1N1 influenza became prevalent in Cincinnati, Ohio, Hamilton County Public Health called upon the University of Cincinnati College of Medicine to enhance its surge capacity in vaccination administration. Although the collaboration was well organized, it became evident that a system should exist for medical students' involvement in disaster response and recovery efforts in advance of a disaster. Therefore, 5 policy alternatives for effective utilization of medical students in disaster-response efforts have been examined: maintaining the status quo, enhancing the Medical Reserve Corps, creating medical school-based disaster-response units, using students within another selected disaster-response organization, or devising an entirely new plan for medical students' utilization. The intent of presenting these policy alternatives is to foster a policy dialogue around creating a more formalized approach for integrating medical students into disaster surge capacity-enhancement strategies. Using medical students to supplement the current and future workforce may help substantially in achieving goals related to workforce requirements. Discussions will be necessary to translate policy into practice.

  8. Isolated rural general practice as the focus for teaching core clinical rotations to pre-registration medical students

    Directory of Open Access Journals (Sweden)

    Davies Llewellyn M

    2005-06-01

    Full Text Available Abstract Background Earlier studies have successfully demonstrated that medical students can achieve success in core clinical rotations with long term attachments in small groups to rural general / family practices. Methods In this study, three students from a class of 226 volunteered for this 1-year pilot program, conducted by the University of Queensland in 2004, for medical students in the 3rd year of a 4-year graduate entry medical course. Each student was based with a private solo general practitioner in a different rural town between 170 and 270 km from the nearest teaching hospital. Each was in a relatively isolated rural setting, rated 5 or 6 on the RRMA scale (Rural, Remote, Metropolitan Classification: capital city = 1, other metropolitan = 2, large regional city = 3, most remote community = 7. The rural towns had populations respectively of 500, 2000 and 10,000. One practice also had a General Practice registrar. Only one of the locations had doctors in the same town but outside the teaching practice, while all had other doctors within the same area. All 3 supervisors had hospital admitting rights to a hospital within their town. The core clinical rotations of medicine, surgery, mental health, general practice and rural health were primarily conducted within these rural communities, with the student based in their own consulting room at the general practitioner (GP supervisor's surgery. The primary teacher was the GP supervisor, with additional learning opportunities provided by visiting specialists, teleconferences and university websites. At times, especially during medicine and surgery terms, each student would return to the teaching hospital for additional learning opportunities. Results All students successfully completed the year. There were no statistical differences in marks at summative assessment in each of the five core rotations between the students in this pilot and their peers at the metropolitan or rural hospital based

  9. An eight-year follow-up national study of medical school and general hospital ethics committees in Japan

    Science.gov (United States)

    Akabayashi, Akira; Slingsby, Brian T; Nagao, Noriko; Kai, Ichiro; Sato, Hajime

    2007-01-01

    Background Ethics committees and their system of research protocol peer-review are currently used worldwide. To ensure an international standard for research ethics and safety, however, data is needed on the quality and function of each nation's ethics committees. The purpose of this study was to describe the characteristics and developments of ethics committees established at medical schools and general hospitals in Japan. Methods This study consisted of four national surveys sent twice over a period of eight years to two separate samples. The first target was the ethics committees of all 80 medical schools and the second target was all general hospitals with over 300 beds in Japan (n = 1457 in 1996 and n = 1491 in 2002). Instruments contained four sections: (1) committee structure, (2) frequency of annual meetings, (3) committee function, and (4) existence of a set of guidelines for the refusal of blood transfusion by Jehovah's Witnesses. Results Committee structure was overall interdisciplinary. Frequency of annual meetings increased significantly for both medical school and hospital ethics committees over the eight years. The primary activities for medical school and hospital ethics committees were research protocol reviews and policy making. Results also showed a significant increase in the use of ethical guidelines, particularly those related to the refusal of blood transfusion by Jehovah's Witnesses, among both medical school and hospital ethics committees. Conclusion Overall findings indicated a greater recognized degree of responsibilities and an increase in workload for Japanese ethics committees. PMID:17598923

  10. [Systematic Readability Analysis of Medical Texts on Websites of German University Clinics for General and Abdominal Surgery].

    Science.gov (United States)

    Esfahani, B Janghorban; Faron, A; Roth, K S; Grimminger, P P; Luers, J C

    2016-12-01

    Background: Besides the function as one of the main contact points, websites of hospitals serve as medical information portals. As medical information texts should be understood by any patients independent of the literacy skills and educational level, online texts should have an appropriate structure to ease understandability. Materials and Methods: Patient information texts on websites of clinics for general surgery at German university hospitals (n = 36) were systematically analysed. For 9 different surgical topics representative medical information texts were extracted from each website. Using common readability tools and 5 different readability indices the texts were analysed concerning their readability and structure. The analysis was furthermore stratified in relation to geographical regions in Germany. Results: For the definite analysis the texts of 196 internet websites could be used. On average the texts consisted of 25 sentences and 368 words. The reading analysis tools congruously showed that all texts showed a rather low readability demanding a high literacy level from the readers. Conclusion: Patient information texts on German university hospital websites are difficult to understand for most patients. To fulfill the ambition of informing the general population in an adequate way about medical issues, a revision of most medical texts on websites of German surgical hospitals is recommended.

  11. Soft governance, restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams.

    Science.gov (United States)

    Grant, Suzanne; Ring, Adele; Gabbay, Mark; Guthrie, Bruce; McLean, Gary; Mair, Frances S; Watt, Graham; Heaney, David; O'Donnell, Catherine

    2015-01-01

    In the UK National Health Service, primary care organisation (PCO) managers have traditionally relied on the soft leadership of general practitioners based on professional self-regulation rather than direct managerial control. The 2004 general medical services contract (nGMS) represented a significant break from this arrangement by introducing new performance management mechanisms for PCO managers to measure and improve general practice work. This article examines the impact of nGMS on the governance of UK general practice by PCO managers through a qualitative analysis of data from an empirical study in four UK PCOs and eight general practices, drawing on Hood's four-part governance framework. Two hybrids emerged: (i) PCO managers emphasised a hybrid of oversight, competition (comptrol) and peer-based mutuality by granting increased support, guidance and autonomy to compliant practices; and (ii) practices emphasised a broad acceptance of increased PCO oversight of clinical work that incorporated a restratified elite of general practice clinical peers at both PCO and practice levels. Given the increased international focus on the quality, safety and efficiency in primary care, a key issue for PCOs and practices will be to achieve an effective, contextually appropriate balance between the counterposing governance mechanisms of peer-led mutuality and externally led comptrol.

  12. A pilot study exploring awareness among general public toward issues related to medication safety in the state of Penang, Malaysia

    Directory of Open Access Journals (Sweden)

    Mohamed Azmi Hassali

    2012-01-01

    Full Text Available Context: A better understanding of medication safety ensures better health state among healthcare consumers. Aim: The study aims to assess general public awareness toward issues related to medication safety. Settings and Design: A cross-sectional study was conducted among general public selected conveniently in the state of Penang, Malaysia. Materials and methods: A total of 500 respondents were approached and 476 consumers participated in the survey giving a response rate of 95.2%. Statistical analysis: Data were analyzed by using SPSS version 12.0 and descriptive statistics were reported where appropriate. Results: Majority of the respondents (n=292, 61.3% stated that they were well aware of the possible side effects of their current medications. A total of 196 respondents (41.17% believed that all medicines registered in Malaysia are safe to use as these medicines have no side effects. About 40.33% (n=192 of the respondents claimed that they share their unused medicines with family and friends who are having similar illness. Majority of respondents 57.7% (n=275 were satisfied with the drug information provided by the healthcare professionals. This study also found that more than 80% of the respondents (n=409 did report that they read the labels of their medication before using. Conclusions: In this study, it was revealed that there is a moderate level of public knowledge regarding medication safety. It is evident that public underestimates the risk of their medications. There is a general lack of awareness and understanding among the public especially toward side effects.

  13. Medical resource utilization in dermatomyositis/polymyositis patients treated with repository corticotropin injection, intravenous immunoglobulin, and/or rituximab.

    Science.gov (United States)

    Knight, Tyler; Bond, T Christopher; Popelar, Breanna; Wang, Li; Niewoehner, John W; Anastassopoulos, Kathryn; Philbin, Michael

    2017-01-01

    Dermatomyositis and polymyositis (DM/PM) are rare, incurable inflammatory diseases that cause progressive muscle weakness and can be associated with increased medical resource use (MRU). When corticosteroid treatment is unsuccessful, patients may receive intravenous immunoglobulin (IVIg), rituximab, or repository corticotropin injection (RCI). This study compared real-world, non-medication MRU between patients treated with RCI and those treated with IVIg and/or rituximab for DM/PM. Claims of DM/PM patients were analyzed from the combination of three commercial health insurance databases in the United States from July 2009 to June 2014. Patients treated with RCI were propensity score matched to those treated with IVIg, rituximab, and both (IVIg+rituximab) based on demographics, prior clinical characteristics, and prior MRU. Per-patient per-month (PPPM) MRU and costs were compared using Poisson regression and generalized linear modeling, respectively. One-hundred thirty-two RCI, 1,150 IVIg, and 562 rituximab patients had an average age of 52.6, 46.6, and 51.7 years, respectively, and roughly two-thirds were female. After matching, there were no significant differences in demographics or prior clinical characteristics. RCI patients had fewer PPPM hospitalizations (0.09 vs 0.17; P=0.049), shorter length of stay (LOS; 3.24 days vs 4.55 days; P=0.004), PPPM hospital outpatient department (HOPD) visits (0.60 vs 1.39; PMRU and costs than those treated with IVIg and/or rituximab, particularly in the hospital setting where significant costs are incurred.

  14. Presampling, algorithm factors, and noise: considerations for CT in particular and for medical imaging in general.

    Science.gov (United States)

    Kachelriess, Marc; Kalender, Willi A

    2005-05-01

    to systems with large g. Similarly, detector binning, which corresponds to replacing g by 2g, should be avoided. Note that the figures reported correspond to a one-dimensional interpolation. Two-dimensional detectors typically separate and resulting quality factors can be easily obtained by multiplication. Then, Q2 is expected to improve by a factor of 1.52 without septa and by a factor of 1.32 with septa. This indicates that dose can be reduced by about 56% and about 41%, respectively. Our findings are general and not restricted to CT. They can be readily applied to medical or nonmedical imaging devices and digital detectors and they may also turn out to be useful in other fields.

  15. A syllabus for Jewish medical ethics in the context of general bioethics.

    Science.gov (United States)

    Gesundheit, Benjamin; Shaham, Dorith

    2008-05-01

    Since the beginning of medical history, ethics has interested medical practitioners. The subject has become particularly important in recent years due to the huge advancements in medicine and medical technology and has elicited much public interest. While international ethical principles and guidelines have been established, classical Jewish tradition has always placed great emphasis on bioethics. Prof. Avraham Steinberg's monumental Encyclopedia of Jewish Medical Ethics presents the subject comprehensively and in depth. We propose a bioethics syllabus, to be integrated into the medical curriculum in three stages: i) preclinical - covering basic ethical concepts and principles, relevant history, and ethical codes; ii) clinical - covering bioethical topics relating to the human life cycle; iii) prior to students' final examinations and further specialization - covering bioethical topics relating to their personal interests. Steinberg's Encyclopedia is an ideal basis for the development of a professional course, including Jewish traditional aspects. Such a course would provide future physicians with a varied cultural and intercultural background, help shape their image, and improve the quality of medical care.

  16. A Study to Determine the Impact of Medical Readiness Programs on Fiscal Year 1987 Resource Utilization at Tripler Army Medical Center

    Science.gov (United States)

    1988-10-01

    Requirements..48 McAdam III Ligt of Tables (Continued) Table Number Title Pale Nomber 1 Opportunity Cost of Exercise Support .... 50 19 Total Manpower...Advanced Trauma Life Support Materials Costo Medical Supplies Item Required Unit Price Unit of Measure Unit Cost Quantity Cost Catheter, 16 gauge S 48.22 50...McAdam 56 Chapter III - Summary Medical readiness programs are a vital part of the Army Medical Department mission. They are an integral part of

  17. Rural-to-urban migration and its implication for new cooperative medical scheme coverage and utilization in China

    Directory of Open Access Journals (Sweden)

    Zhang Juying

    2011-06-01

    Full Text Available Abstract Background China has been experiencing the largest rural to urban migration in history. Rural-to-urban migrants are those who leave their hometown for another place in order to work or live without changing their hukou status, which is a household registration system in China, categorizing people as either rural residents or urban residents. Rural-to-urban migrants typically find better job opportunities in destination cities, and these pay higher salaries than available in their home regions. This has served to improve the enrollment rates in the New Cooperative Medical Scheme (NCMS of rural families, protecting households from falling into poverty due to diseases. However, current regulations stipulate that people who are registered in China's rural hukou can only participate in their local NCMS, which in turn poses barriers when migrants seek medical services in the health facilities of their destination cities. To examine this issue in greater depth, this study examined the associations between migration, economic status of rural households, and NCMS enrollment rate, as well as NCMS utilization of rural-to-urban migrants. Methods A multistage cluster sampling procedure was adopted. Our sample included 9,097 households and 36,720 individuals. Chi-square test and T-test were used to examine differences between the two populations of migrants and non-migrants based on age, gender, marriage status, and highest level of education. Ordinal logistic regression was used to examine the association between migration and household economic status. Binary logistic regression was used to examine the associations between household economic status, migration and enrollment in the NCMS. Results Migration was positively associated with improved household economic status. In households with no migrants, only 11.3% of the population was in the richest quintile, whereas the percentage was more than doubled in households with family members who migrated

  18. Rethinking collegiality: restratification in English general medical practice 2004-2008.

    Science.gov (United States)

    McDonald, Ruth; Checkland, Kath; Harrison, Stephen; Coleman, Anna

    2009-04-01

    For Freidson [(1985). The reorganisation of the medical profession. Medical Care Review, 42(1), 11-35], collegiality, or ostensible equal status amongst members of the medical profession, serves a dual purpose. It socialises members into an attitude of loyalty to colleagues and presents an image to those outside the profession that all its members are competent and trustworthy. However, Freidson saw the use of formal standards developed by one (knowledge) elite within medicine and enforced by another (administrative) elite as threatening collegiality and professional unity. Drawing on two studies in English primary medical care this paper reports the emergence of new strata or elites, with groups of doctors involved in surveillance of others and action to improve compliance in deficient individuals and organizations. Early indications are that these developments have not led to the consequences which Freidson predicted. The increasing acceptance of the legitimacy of professional scrutiny and accountability that we identify suggests that new norms are emerging in English primary medical care, the possibility of which Freidson's analysis fails to take account.

  19. Health-Related Quality of Life and Utility Scores in People with Mental Disorders: A Comparison with the Non-Mentally Ill General Population

    Directory of Open Access Journals (Sweden)

    Amélie Prigent

    2014-03-01

    Full Text Available There is a lack of comparable health-related quality of life (HRQoL and utility data across all mental disorders and all inpatient and outpatient settings. Our objective was to investigate the HRQoL and utility scores of people with mental disorders in France, treated in outpatient and inpatient settings, and to identify the HRQoL and utility score losses attributable to mental disorders compared to the non-mentally ill general population. A cross-sectional survey was conducted to assess HRQoL (SF-12 and utility scores of patients with mental disorders and followed in four psychiatric sectors in France. Scores were described by demographic and clinical characteristics and were then adjusted on age and gender and compared with those of the non-mentally ill general population. Median HRQoL and utility scores were significantly lower in patients with mental disorders than in the non-mentally ill general population; median differences amounted to 5.4 for the HRQoL physical score, to 11.8 for the HRQoL mental score and to 0.125 for the utility score. Our findings underscore the negative impact of mental disorders on HRQoL in France and provide a baseline to assess the global impact of current and future organizational changes in the mental health care system.

  20. Medical resource utilization in dermatomyositis/polymyositis patients treated with repository corticotropin injection, intravenous immunoglobulin, and/or rituximab

    Directory of Open Access Journals (Sweden)

    Knight T

    2017-05-01

    Full Text Available Tyler Knight,1 T Christopher Bond,1 Breanna Popelar,2 Li Wang,3 John W Niewoehner,4 Kathryn Anastassopoulos,1 Michael Philbin4 1Covance Market Access Services Inc., Gaithersburg, MD, 2Xcenda, LLC, Palm Harbor, FL, 3STATinMED Research, Ann Arbor, MI, 4Mallinckrodt, LLC, Hazelwood, MO, USA Background: Dermatomyositis and polymyositis (DM/PM are rare, incurable inflammatory diseases that cause progressive muscle weakness and can be associated with increased medical resource use (MRU. When corticosteroid treatment is unsuccessful, patients may receive intravenous immunoglobulin (IVIg, rituximab, or repository corticotropin injection (RCI. This study compared real-world, non-medication MRU between patients treated with RCI and those treated with IVIg and/or rituximab for DM/PM.Methods: Claims of DM/PM patients were analyzed from the combination of three commercial health insurance databases in the United States from July 2009 to June 2014. Patients treated with RCI were propensity score matched to those treated with IVIg, rituximab, and both (IVIg+rituximab based on demographics, prior clinical characteristics, and prior MRU. Per-patient per-month (PPPM MRU and costs were compared using Poisson regression and generalized linear modeling, respectively.Results: One-hundred thirty-two RCI, 1,150 IVIg, and 562 rituximab patients had an average age of 52.6, 46.6, and 51.7 years, respectively, and roughly two-thirds were female. After matching, there were no significant differences in demographics or prior clinical characteristics. RCI patients had fewer PPPM hospitalizations (0.09 vs 0.17; P=0.049, shorter length of stay (LOS; 3.24 days vs 4.55 days; P=0.004, PPPM hospital outpatient department (HOPD visits (0.60 vs 1.39; P<0.001, and PPPM physician office visits (2.01 vs 2.33; P=0.035 than IVIg. RCI had fewer PPPM HOPD visits (0.56 vs 0.92; P<0.001 than rituximab. Patients treated with RCI had shorter LOS (2.18 days vs 5.15; P<0.001 and less PPPM HOPD

  1. Qualitative evaluation of general practitioner training program as viewed by graduates from Shiraz, Fasa and Jahrom Medical Universities

    Directory of Open Access Journals (Sweden)

    FATEMEH SHAHIDI

    2015-07-01

    Full Text Available Introduction: The majority of countries have brought the quality of higher education into focus in the past few years. They have tried to improve the quality of their own higher education. The studies show that Iranian Universities are not at an accepted level in terms of quality. They have encountered several problems which have diminished their quality level. This study aimed at assessing the quality of medical education program as viewed by general practitioners graduated from Shiraz, Fasa and Jahrom Medical Universities. Methods: This is a cross-sectional study. 215 subjects were selected based on a census of all the general practitioners graduated from Shiraz, Fasa and Jahrom Universities during 2011- 2013. The questionnaire used for collecting the data was that of the Association of Graduates from American Medical Colleges. The collected data were then analyzed using SPSS 14 through which such descriptive and bivariate statistics as percentage, means, Standard Deviation and ANOVA were used. The level of significance was set to 0.05. Results: The questionnaire return rate was 97%. As to the graduates’ preclinical experiences, five indices were studied which were assessed as “average” in graduates’ views. However, with respect to their clinical experiences five indices were equally studied, among which such indices as “Communication” were evaluated as “desirable” in view of the graduates from the very three universities. On the contrary, the quality of clinical experiences and technological skills was evaluated as “almost weak”; furthermore, the integration of basic science with required clinical experience was also considered “weak”. Conclusion: It seems essential to set up an annual assessment of general practitioner education program and a review of the medical education program in Iran based on the global medical advancement and international standards.

  2. Prevalence and Correlates of Worry About the Health Harms of Medical Imaging Radiation in the General Population.

    Science.gov (United States)

    Hay, Jennifer L; Gold, Geoffrey S; Baser, Raymond E; Hricak, Hedvig; Dauer, Lawrence T

    2016-10-01

    In recent years, there have been dramatic increases in medical imaging use and increasing media attention to increased exposure to ionizing radiation in the United States. Patient perspectives on medical imaging radiation (MIR) use is understudied, but could guide primary care discussions. This study examines prevalence of worry about the health harms from MIR in the US general population. This cross-sectional study used the 2012-2013 Health Information National Trends Survey conducted by the National Cancer Institute. A nationally representative sample (N = 3532) was drawn from the US general population to observe prevalence of worry about MIR as well as potential covariates, including demographic, medical, and psychological factors, health information-seeking, physician trust in providing cancer information, and cancer fatalism. About 65% of the sample population reported experiencing at least some worry about MIR. Univariable and multivariable logistic regressions indicate higher rates of MIR worry among women, racial/ethnic minorities, those with lower educational attainment, foreign-born Americans, those who self-report poorer health, and those with a personal history of cancer. Lower trust in cancer information from physicians and greater attention to cancer information from popular media were each associated with higher rates of worry about health harms of MIR. An accurate assessment of public worry about MIR will aid primary care providers' efforts to understand patient responses to medical imaging and identify addressable knowledge gaps regarding benefits and risks of medical imaging. These data may improve risk communication regarding medical imaging among referring primary care physicians, radiologists, and patients. © The Author(s) 2016.

  3. Efficacy and utility of phone call follow-up after pediatric general surgery versus traditional clinic follow-up.

    Science.gov (United States)

    Fischer, Kevin; Hogan, Virginia; Jager, Alesha; von Allmen, Daniel

    2015-01-01

    Typical follow-up for surgical procedures consists of an interim history and brief focused physical examination. These appointments occupy clinic resources, require a time investment by the family, and rarely identify problems. Previous studies have demonstrated the safety of a postoperative phone call. Compare a traditional in-person clinic postoperative visit with postoperative phone call follow-up regarding patient satisfaction, rate of successful follow-up, and clinic resource utilization in a large academic practice. A retrospective review of charts of patients who underwent select surgical procedures, along with a review of the clinic schedule for the same time period. Efficacy, patient/family satisfaction, and impact on the clinic. Families were contacted by telephone two weeks after select surgical procedures to assess for complications and questions. Cohorts of patients six months before and six months after implementation were assessed for main outcome measures. Before implementation, 55.5% of patients (427/769) who had one of the select surgical procedures were seen in the clinic postoperatively, and 62.6% (435/695) had a successful postoperative phone call follow-up. There were also 1090 overall scheduled postoperative appointments. Six months after implementation, overall postoperative appointments decreased 35.5% to 703. Overall, postoperative-scheduled visits decreased by 6% compared with new visits and other general follow-up visits, which each increased by 3%. A satisfaction survey revealed that 93% of patients (n = 231) were highly satisfied with the process. A hospital cost analysis suggested an 89% cost savings ($101.75 per patient for clinic visit vs $12.50 per patient for phone call follow-up). Postoperative phone call follow-up is an effective tool that improves patient and physician efficiency and satisfaction.

  4. An Evaluation of Shared Mental Models and Mutual Trust on General Medical Units: Implications for Collaboration, Teamwork, and Patient Safety.

    Science.gov (United States)

    McComb, Sara A; Lemaster, Matthew; Henneman, Elizabeth A; Hinchey, Kevin T

    2015-02-24

    This study examines nurse-physician teamwork and collaboration, a critical component in the delivery of safe patient care, on general medical units. To that end, we assess shared mental models and mutual trust, 2 coordinating mechanisms that help facilitate teamwork, among nurses and physicians working on general medical units. Data were collected from 37 nurses and 42 physicians at an urban teaching medical center in the Northeastern United States. Shared mental model questionnaire items were iteratively developed with experts' input to ensure content validity. Mutual trust items were adapted from an existing scale; items were reliable. Data were analyzed using χ and independent 2-tailed t tests. Physicians and nurses reported significant differences in their perceptions of the professional responsible for a variety of roles (e.g., advocating for the patient [P = 0.0007], identifying a near miss/error [P = 0.003]). Medication reconciliation is only role for which nurses perceive less responsibility than physicians perceive nurses have. Regarding mutual trust, both groups reported significantly more trust within their own professions; both groups reported similar levels of trust in physicians, with physicians reporting significantly less trust in their nursing colleagues than nurses perceive (P collaboration, more work is needed. To that end, we propose increasing knowledge about their respective roles, providing opportunities for nurse and physician collaboration through rounding or committee work and enhancing the preparedness and professionalism of interactions.

  5. Study of relatioship between the Internet addication and general health of students of Lorestan university of medical sciences in 2013

    Directory of Open Access Journals (Sweden)

    Masod Farhadini

    2016-02-01

    Full Text Available Background: The Internet addiction refers to the excessive or unreasonable and pathological use of  the Internet which leads to the social consequences, including public health.The aim of this study was to determine the relation ship between  the Internet addiction  and general health in students of Lorestan university of medical sciences in 2013. Material and Methods: This descriptive analytic study. was carried out on 240 (BSc,MSc and medical students of Lorestan university of medical sciences randomly selected using Yang Internet addiction and the Goldberg general health questionnaire . Data was analyzed by use of independent statistics and SPSS software v.18. Results: The results show that  there was a significant correlation between the Internet addiction    and yeneral health in students of Lorestan university of  medical sciences ( r=- 0.471, p>0.001. Based on our findings, 85% of  the students were normal but 15% were at risk. Conclusion: Considering the destructive effects of the Internet addiction on students' health dimensions, control and supervise the Internet   use among university students and  education about the harmful effects of the Internet it seem  necessary.

  6. The prevalence of mental disorders in adults in different level general medical facilities in Kenya: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Kuria Mary W

    2009-01-01

    Full Text Available Abstract Background The possibility that a significant proportion of the patients attending a general health facility may have a mental disorder means that psychiatric conditions must be recognised and managed appropriately. This study sought to determine the prevalence of common psychiatric disorders in adult (aged 18 years and over inpatients and outpatients seen in public, private and faith-based general hospitals, health centres and specialised clinics and units of general hospitals. Methods This was a descriptive cross-sectional study conducted in 10 health facilities. All the patients in psychiatric wards and clinics were excluded. Stratified and systematic sampling methods were used. Informed consent was obtained from all study participants. Data were collected over a 4-week period in November 2005 using various psychiatric instruments for adults. Descriptive statistics were generated using SPSS V. 11.5. Results A total of 2,770 male and female inpatients and outpatients participated in the study. In all, 42% of the subjects had symptoms of mild and severe depression. Only 114 (4.1% subjects had a file or working diagnosis of a psychiatric condition, which included bipolar mood disorder, schizophrenia, psychosis and depression. Conclusion The 4.1% clinician detection rate for mental disorders means that most psychiatric disorders in general medical facilities remain undiagnosed and thus, unmanaged. This calls for improved diagnostic practices in general medical facilities in Kenya and in other similar countries.

  7. A learning collaborative of CMHCs and CHCs to support integration of behavioral health and general medical care.

    Science.gov (United States)

    Vannoy, Steven D; Mauer, Barbara; Kern, John; Girn, Kamaljeet; Ingoglia, Charles; Campbell, Jeannie; Galbreath, Laura; Unützer, Jürgen

    2011-07-01

    Integration of general medical and mental health services is a growing priority for safety-net providers. The authors describe a project that established a one-year learning collaborative focused on integration of services between community health centers (CHCs) and community mental health centers (CMHCs). Specific targets were treatment for general medical and psychiatric symptoms related to depression, bipolar disorder, alcohol use disorders, and metabolic syndrome. This observational study used mixed methods. Quantitative measures included 15 patient-level health indicators, practice self-assessment of resources and support for chronic disease self-management, and participant satisfaction. Sixteen CHC-CMHC pairs were selected for the learning collaborative series. One pair dropped out because of personnel turnover. All teams increased capacity on one or more patient health indicators. CHCs scored higher than CMHCs on support for chronic disease self-management. Participation in the learning collaborative increased self-assessment scores for CHCs and CMHCs. Participant satisfaction was high. Observations by faculty indicate that quality improvement challenges included tracking patient-level outcomes, workforce issues, and cross-agency communication. Even though numerous systemic barriers were encountered, the findings support existing literature indicating that the learning collaborative is a viable quality improvement approach for enhancing integration of general medical and mental health services between CHCs and CMHCs. Real-world implementation of evidence-based guidelines presents challenges often absent in research. Technical resources and support, a stable workforce with adequate training, and adequate opportunities for collaborator communications are particular challenges for integrating behavioral and general medical services across CHCs and CMHCs.

  8. Paucity of qualitative research in general medical and health services and policy research journals: analysis of publication rates

    Science.gov (United States)

    2011-01-01

    Background Qualitative research has the potential to inform and improve health care decisions but a study based on one year of publications suggests that it is not published in prominent health care journals. A more detailed, longitudinal analysis of its availability is needed. The purpose of this study was to identify, count and compare the number of qualitative and non-qualitative research studies published in high impact health care journals, and explore trends in these data over the last decade. Methods A bibliometric approach was used to identify and quantify qualitative articles published in 20 top general medical and health services and policy research journals from 1999 to 2008. Eligible journals were selected based on performance in four different ranking systems reported in the 2008 ISI Journal Citation Reports. Qualitative and non-qualitative research published in these journals were identified by searching MEDLINE, and validated by hand-searching tables of contents for four journals. Results The total number of qualitative research articles published during 1999 to 2008 in ten general medical journals ranged from 0 to 41, and in ten health services and policy research journals from 0 to 39. Over this period the percentage of empirical research articles that were qualitative ranged from 0% to 0.6% for the general medical journals, and 0% to 6.4% for the health services and policy research journals. Conclusions This analysis suggests that qualitative research it is rarely published in high impact general medical and health services and policy research journals. The factors that contribute to this persistent marginalization need to be better understood. PMID:21992238

  9. Paucity of qualitative research in general medical and health services and policy research journals: analysis of publication rates

    Directory of Open Access Journals (Sweden)

    Dobrow Mark J

    2011-10-01

    Full Text Available Abstract Background Qualitative research has the potential to inform and improve health care decisions but a study based on one year of publications suggests that it is not published in prominent health care journals. A more detailed, longitudinal analysis of its availability is needed. The purpose of this study was to identify, count and compare the number of qualitative and non-qualitative research studies published in high impact health care journals, and explore trends in these data over the last decade. Methods A bibliometric approach was used to identify and quantify qualitative articles published in 20 top general medical and health services and policy research journals from 1999 to 2008. Eligible journals were selected based on performance in four different ranking systems reported in the 2008 ISI Journal Citation Reports. Qualitative and non-qualitative research published in these journals were identified by searching MEDLINE, and validated by hand-searching tables of contents for four journals. Results The total number of qualitative research articles published during 1999 to 2008 in ten general medical journals ranged from 0 to 41, and in ten health services and policy research journals from 0 to 39. Over this period the percentage of empirical research articles that were qualitative ranged from 0% to 0.6% for the general medical journals, and 0% to 6.4% for the health services and policy research journals. Conclusions This analysis suggests that qualitative research it is rarely published in high impact general medical and health services and policy research journals. The factors that contribute to this persistent marginalization need to be better understood.

  10. Template-based data entry for general description in medical records and data transfer to data warehouse for analysis.

    Science.gov (United States)

    Matsumura, Yasushi; Kuwata, Shigeki; Yamamoto, Yuichiro; Izumi, Kazunori; Okada, Yasushi; Hazumi, Michihiro; Yoshimoto, Sachiko; Mineno, Takahiro; Nagahama, Munetoshi; Fujii, Ayumi; Takeda, Hiroshi

    2007-01-01

    General descriptions in medical records are so diverse that they are usually entered as free text into an electronic medical record, and the resulting data analysis is often difficult. We developed and implemented a template-based data entry module and data analyzing system for general descriptions. We developed a template with tree structure, whose content master and entered patient's data are simultaneously expressed by XML. The entered structured data is converted to narrative form for easy reading. This module was implemented in the EMR system, and is used in 35 hospitals as of October, 2006. So far, 3725 templates (3242 concepts) have been produced. The data in XML and narrative text data are stored in the EMR database. The XML data are retrieved, and then patient's data are extracted, to be stored in the data ware-house (DWH). We developed a search assisting system that enables users to find objective data from the DWH without requiring complicated SQL. By using this method, general descriptions in medical records can be structured and made available for clinical research.

  11. A Tangible Bridge-An interview with Mr.Sun Ciyi,Secretary General of Shanghai Pudong Medical Device Trade Association

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    @@ Q:As the Secretary General of Shanghai Pudong Medical Device Trade Association (referred as "the Association").you have worked in the medical industry for many years.Could you tell us your opinion about the current situation of medical device market in China?

  12. Continuing Medical Education for European General Practitioners in Doctor-Patient Relationship Skills and Psychosocial Issues.

    Science.gov (United States)

    Barker, L. Randol

    1998-01-01

    Most of the 23 European providers of continuing medical education (CME) surveyed reported programming on the doctor-patient relationship and psychosocial issues. Visits to programs in France, the Netherlands, and Spain identified the formats used most often in small group instruction, intensive individual learning, and national-level CME. (SK)

  13. Patient anxiety in the medical encounter: a study of verbal and nonverbal communication in general practice.

    NARCIS (Netherlands)

    Bensing, J.M.; Verheul, W.; Dulmen, A.M. van

    2008-01-01

    Purpose: Many patients feel anxious when entering the consultation room, but seldom verbalize their emotions explicitly in the medical encounter. The authors designed a study to analyse the visibility of patient pre-consultation (state) anxiety in their communication during the consultation. In an

  14. A composite screening tool for medication reviews of outpatients: general issues with specific examples.

    NARCIS (Netherlands)

    Smet, P.A.G.M. de; Denneboom, W.; Kramers, C.; Grol, R.P.T.M.

    2007-01-01

    Regular performance of medication reviews is prominent among methods that have been advocated to reduce the extent and seriousness of drug-related problems, such as adverse drug reactions, drug-disease interactions, drug-drug interactions, drug ineffectiveness and cost ineffectiveness. Several scree

  15. Patient anxiety in the medical encounter: a study of verbal and nonverbal communication in general practice.

    NARCIS (Netherlands)

    Bensing, J.M.; Verheul, W.; Dulmen, A.M. van

    2008-01-01

    Purpose: Many patients feel anxious when entering the consultation room, but seldom verbalize their emotions explicitly in the medical encounter. The authors designed a study to analyse the visibility of patient pre-consultation (state) anxiety in their communication during the consultation. In an a

  16. Reflections on the Implementation of General Medical Ed-ucation in Local Medical Colleges%对地方医学院校开展全科医学教育的思考

    Institute of Scientific and Technical Information of China (English)

    李佳凌; 邹礼乐; 巫岳龙

    2015-01-01

    With the rapid development of China's economy and the continuous progress of science and technology, general medi-cal science, as a brand new medical field, has been developed in China. With the formulation of the definition of general medical science, the implementation of general medical education has become an important measure of medical teaching reform in medical colleges in recent years. With the practice and experi-ence of general medical education development in domestic medical colleges as the enlightenment, combined with the imple-mentation of general medical education in local medical colleges, this paper discusses the strategies for the sustainable develop-ment of general medical education in local medical colleges, so as to promote the continuous development of general medical edu-cation.%随着我国经济的飞速发展、科学技术的不断进步,全科医学作为一个全新的医学领域在中国得以发展,随着全科医学概念的提出,全科医学教育的开展成为近年来各大医学院校重要的医学教学改革措施之一。以国内高等医学院校发展全科医学教育的实践和经验为启示,结合地方医学院校全科医学教育的开展情况,思考地方医学院校全科医学教育可持续发展的策略,以促进全科医学教育工作的不断发展。

  17. Shortage in general practice despite the feminisation of the medical workforce: a seeming paradox? A cohort study

    Directory of Open Access Journals (Sweden)

    Boode Beppie

    2008-12-01

    Full Text Available Abstract Background Female medical students often prefer primary care specialties, while male students appear to be attracted to hospital specialties. Notwithstanding the steady feminisation of medicine, in many countries there are still difficulties in recruiting trainees for general practice. This seeming paradox raises the question on what specific role gender plays in a specialty choice. The authors looked at the (a the role of gender in general practice specialty choice of Dutch medical students, (b the decisive factors in career choice and relation of gender to these, and (c differences in how male and female students are influenced by the GP clerkship. Methods A cohort of 206 final year medical students at the Maastricht University, the Netherlands were asked to complete a questionnaire focusing on career preferences before and after a 12-week general practice clerkship and at graduation, a couple of months later. Results Gender was significantly related to willingness to become a GP in bivariate analysis. Adding variables in multivariate analysis made this effect disappear. While females expressed overall higher preference for general practice than males, after the GP clerkship likelihood of choosing general practice increased with 38% among male and 22% among female students. After graduation, interest in general practice had dropped, mainly among females. Attitudes predicting a GP career choice were: extrinsic career motivation before the clerkship, and the content of GP work (patient contacts, treatments and motivation to work with chronic and palliative patients after the clerkship. Conclusion Gender 'as such' appeared not to be a distinctive predictor of specialty choice. It is students' attitudes towards GP work and preferred patient category that determine the career choice in general practice. However, more male students were positively influenced by the GP clerkship than female students. The motivating effect of the clerkship is

  18. An analysis of determinants influencing use of ayurvedic medication in Pune region utilizing a questionnaire survey instrument

    Directory of Open Access Journals (Sweden)

    Vyawahare Neeraj

    2009-01-01

    The survey revealed that consumption of Ayurvedic medication in Pune region is increasing, wherein safety and faith are important parameters, however, like allopathic medication; people usually stick to the prescription issued by the physician. The increasing trend of self medication and lack of knowledge of herb drug interaction especially in non graduates are the major concerns need to be addressed for better outcome of the therapy.

  19. Medication for older people - aspects of rational therapy from the general practitioner's point of view

    DEFF Research Database (Denmark)

    Vass, M; Hendriksen, C

    2005-01-01

    people and to consider different approaches when evaluating evidence of risk and benefit for the individual. Old people are facing a considerable risk of adverse drug reactions and recent initiatives, including the Continuous Medical Educational Efforts Programme, address issues of inappropriate...... state that a number of pharmacological regimens for older people are outperformed by non-pharmacological treatment alternatives involving competent individualised counselling and public provision of easy (transportation) possibilities for joining centres offering staff and equipment for physical......This paper discusses GP perspectives on the principles underlying rational pharmacotherapy for older people. The rising use of prescription medicine forces the GP to balance the benefit of evidence group-based appropriate drug use against the problems arising when medication is given to older...

  20. The primary care prescribing psychologist model: medical provider ratings of the safety, impact and utility of prescribing psychology in a primary care setting.

    Science.gov (United States)

    Shearer, David S; Harmon, S Cory; Seavey, Brian M; Tiu, Alvin Y

    2012-12-01

    Family medicine providers at a large family medicine clinic were surveyed regarding their impression of the impact, utility and safety of the Primary Care Prescribing Psychologist (PCPP) model in which a prescribing psychologist is embedded in a primary care clinic. This article describes the model and provides indications of its strengths and weaknesses as reported by medical providers who have utilized the model for the past 2 years. A brief history of prescribing psychology and the challenges surrounding granting psychologists the authority to prescribe psychotropic medication is summarized. Results indicate family medicine providers agree that having a prescribing psychologist embedded in the family medicine clinic is helpful to their practice, safe for patients, convenient for providers and for patients, and improves patient care. Potential benefits of integrating prescribing psychology into primary care are considered and directions for future research are discussed.

  1. Medical resource utilization and costs associated with autosomal dominant polycystic kidney disease in the USA: a retrospective matched cohort analysis of private insurer data

    Science.gov (United States)

    Knight, Tyler; Schaefer, Caroline; Krasa, Holly; Oberdhan, Dorothee; Chapman, Arlene; Perrone, Ronald D

    2015-01-01

    Background Autosomal dominant polycystic kidney disease (ADPKD) results in kidney cyst development and enlargement, resulting in chronic kidney disease (CKD) leading to renal failure. This study sought to determine if ADPKD patients in the early stages of CKD contribute to a sizable economic burden for the US health care system. Methods This was a retrospective, matched cohort study, reviewing medical resource utilization (MRU) and costs for adults in a US private-payer claims database with a diagnosis code of ADPKD (ICD-9-CM 753.13). ADPKD patients were matched by age grouping (0–17, 18–34, 35–44, 45–54, 55–64, and 65+ years) and sex to controls to understand the burden of ADPKD. Descriptive statistics on 6-month MRU and costs were assessed by CKD stages, dialysis use, or previous renal transplant. Results The analysis included ADPKD patients in CKD stages 1–5 (n=316 to n=860), dialysis (n=586), and post-transplant (n=615). Mean ages did not differ across CKD stages (range 43–56 years). Men were the majority in the later stages but the minority in the early stages. The proportion of patients with at least one hospitalization increased with CKD stage, (12% to >40% CKD stage 2 to stage 5, dialysis or post-transplant). The majority had at least one hospital outpatient visit and at least one pharmacy claim. Total 6-month per-patient costs were greater among ADPKD patients than in age-matched and sex-matched healthy non-ADPKD controls (P<0.001 for all comparisons). Conclusion ADPKD patients with normal kidney function are associated with a significant economic burden to the health care system relative to the general population. Any treatments that delay progression to later stages of CKD may provide potential health care cost offsets. PMID:25759590

  2. Nonadherence and factors affecting adherence of diabetic patients to anti-diabetic medication in Assela General Hospital, Oromia Region, Ethiopia

    Directory of Open Access Journals (Sweden)

    Ashebir Kassahun

    2016-01-01

    Full Text Available Background: Diabetes mellitus is a major global health problem covering approximately 347 million persons worldwide. Glycemic control has a main role in its management which mainly depends upon patient adherence to the treatment plan. Accurate assessment of medication adherence is necessary for effective management of diabetes. Objective: To assess nonadherence and factors affecting adherence of diabetic patients to anti-diabetic medication in Assela General Hospital (AGH, Oromia Region, Ethiopia. Materials and Methods: A descriptive cross-sectional study was conducted on patients seeking anti-diabetic drug treatment and follow-up at AGH using structured questionnaire and reviewing the patient record card using check list from January 24, 2014 to February 7, 2014. Descriptive analysis was used to describe the percentages and number of distributions of the variables in the study; and association was identified for categorical data. P ≤ 0.05 was considered as statistically significant. Result: Of all respondents, 149 (52.3% and 136 (47.7% were female and male, respectively. The majority of the study participants 189 (66.3% were in the age group of 30–60 years. Two-hundred nineteen (76.8% of respondents were married currently. The majority, 237 (83.2% of respondents did not have blood glucose self-monitoring equipment (glucometer. A total of 196 (68.8% respondents were adhered to anti-diabetic medication. There was a significant association between adherence to the medication and side effect, level of education, monthly income and presence of glucometer at home (P < 0.05. Conclusion: The participants in the area of study were moderately adherent to their anti-diabetic medications with nonadherence rate of 31.2%. Different factors of medication nonadherence were identified such as side effect and complexity of regimen, failure to remember, and sociodemographic factors such as educational level and monthly income.

  3. Hypokalaemia: Improving the investigation, management and therapeutic monitoring of hypokalaemic medical inpatients at a district general hospital.

    Science.gov (United States)

    Jordan, Mark; Caesar, Jenny

    2015-01-01

    Hypokalaemia is prevalent in 20% of hospitalised patients. Furthermore, inadequate management of hypokalemia was identified in 24% of these patients. Associated with significant patient morbidity and mortality, the identification, investigation, and treatment of hypokalaemia was identified as an area for improvement in the management of medical inpatients. The project aims to measure the assessment, management, and therapeutic monitoring of medical inpatients with hypokalaemia in a district general hospital. All medical inpatients over a one week period who met the criteria for hypokalaemia (serum potassium <3.5 mmol/L on standard biochemical sample) were included in the audit. Patient's notes were located and evaluated to identify if they had mild, moderate, or severe hypokalaemia. Further data on ECG requests, repeat U&Es, serum magnesium analysis, treatment prescribed, and medication review dates was collated. A re-audit was completed after the introduction of a set of interventions which included a hypokalaemia treatment algorithm. Pre-intervention analysis of all medical inpatients, who met our inclusion criteria for hypokalaemia, identified 32 patients. 25 of these patients met the criteria for mild hypokalaemia (3.1-3.4 mmol/L) and 7 met the criteria for moderate hypokalaemia (2.5-3.0 mmol/L). Only 7/32 (22 %) patients were receiving adequate treatment based on trust guidelines. Post intervention results showed marked improvement in the management of patients with hypokalaemia. A total of 30 patients were identified in this post-intervention group. There were 16/30 patients who qualified as mild hypokalaemia (3.1-3.4 mmol/L) and 14/30 with moderate hypokalaemia (2.5-3.0 mmol/L). 19/30 (63%) patients in the post-intervention group were correctly prescribed appropriate medication doses consistent with the treatment algorithm. Following the initial success of the project, analysis at 3 months showed a positive trend for sustained improvement when compared to

  4. Long-term medical utilization following ventilator-associated pneumonia in acute stroke and traumatic brain injury patients: a case-control study

    OpenAIRE

    Yang, Chih-Chieh; Shih, Nai-Ching; Chang, Wen-Chiung; Huang, San-Kuei; Chien, Ching-Wen

    2011-01-01

    Background The economic burden of ventilator-associated pneumonia (VAP) during the index hospitalization has been confirmed in previous studies. However, the long-term economic impact is still unclear. The aim of this study is to examine the effect of VAP on medical utilization in the long term. Methods This is a retrospective case-control study. Study subjects were patients experiencing their first traumatic brain injury, acute hemorrhagic stroke, or acute ischemic stroke during 2004. All su...

  5. Long-term medical utilization following ventilator-associated pneumonia in acute stroke and traumatic brain injury patients: a case-control study

    OpenAIRE

    Huang San-Kuei; Chang Wen-Chiung; Shih Nai-Ching; Yang Chih-Chieh; Chien Ching-Wen

    2011-01-01

    Abstract Background The economic burden of ventilator-associated pneumonia (VAP) during the index hospitalization has been confirmed in previous studies. However, the long-term economic impact is still unclear. The aim of this study is to examine the effect of VAP on medical utilization in the long term. Methods This is a retrospective case-control study. Study subjects were patients experiencing their first traumatic brain injury, acute hemorrhagic stroke, or acute ischemic stroke during 200...

  6. Accounting for graduate medical education production of primary care physicians and general surgeons: timing of measurement matters.

    Science.gov (United States)

    Petterson, Stephen; Burke, Matthew; Phillips, Robert; Teevan, Bridget

    2011-05-01

    Legislation proposed in 2009 to expand GME set institutional primary care and general surgery production eligibility thresholds at 25% at entry into training. The authors measured institutions' production of primary care physicians and general surgeons on completion of first residency versus two to four years after graduation to inform debate and explore residency expansion and physician workforce implications. Production of primary care physicians and general surgeons was assessed by retrospective analysis of the 2009 American Medical Association Masterfile, which includes physicians' training institution, residency specialty, and year of completion for up to six training experiences. The authors measured production rates for each institution based on physicians completing their first residency during 2005-2007 in family or internal medicine, pediatrics, or general surgery. They then reassessed rates to account for those who completed additional training. They compared these rates with proposed expansion eligibility thresholds and current workforce needs. Of 116,004 physicians completing their first residency, 54,245 (46.8%) were in primary care and general surgery. Of 683 training institutions, 586 met the 25% threshold for expansion eligibility. At two to four years out, only 29,963 physicians (25.8%) remained in primary care or general surgery, and 135 institutions lost eligibility. A 35% threshold eliminated 314 institutions collectively training 93,774 residents (80.8%). Residency expansion thresholds that do not account for production at least two to four years after completion of first residency overestimate eligibility. The overall primary care production rate from GME will not sustain the current physician workforce composition. Copyright © by the Association of American medical Colleges.

  7. VIEWPOINTS OF SUPERVISORS ABOUT THE PROCESS OF DISSERTATIONS FOR GENERAL MEDICINE PROGRAM SHAHID SADOUGHI UNIVERSITY OF MEDICAL SCIENCES

    Directory of Open Access Journals (Sweden)

    J Ayatollahi

    2007-07-01

    Full Text Available Introduction: It is important to know the viewpoints of supervisors about different issues and problems in preparing dissertations (as a mandatory course in general medicine (MD program such as the objectives of the course, improving learning methods, problems of the practical phase, and their ideas about the course efficacy. This study explores supervisors’ views concerning the thesis process and its related problems in Shaheed Sadoughi University of Medical Sciences. Methods: In total 119 academic members as supervisors from medical school participated in this cross sectional descriptive study. A self administered questionnaire, which proved to be valid and reliable, was used for data collection. The questionnaires were completed individually in the participants’ office or school. SPSS software was used for data analysis. Results were analyzed according to the frequency distribution of variables and compared by t-test and ANOVA. Results: Of those 42.3% of supervisors believed that thesis is necessary for Medical students but according to the supervisors, the most important problems were access to statistical guide masters allocating appropriate budget, and suitable time's allocation for student's guidance. Conclusion: Our results showed that dissertations in general medicine program are facing some problems, and revising the course plane may improve the quality of dissertations.

  8. Determining the Relation between General Health and Educational Progress among Paramedical Faculty’s Students of Tehran Medical University

    Directory of Open Access Journals (Sweden)

    Hossein Dargahi

    2016-12-01

    Full Text Available Considering the fact that students studying various fields of Study will have the responsibility to create, maintain and improve society’s level of health, they should be cared for with precision so they can perform and play their role as an educated and expert work force. this is due to the fact that getting accepted in university is a very sensitive period in lives of efficient workforce and active youth in each country, therefore, present study determines the relation between general health and educational progress among paramedical faculty’s Students of Tehran Medical University. Method: present research has a descriptive-analytic nature and was executed in a time period during winter of 2016. the target society included all students of paramedical faculty and required data was gathered by an adults’ health function literacy questionnaire and general health was also gathered by means of general health questionnaire. in order to present descriptive results of percentage and median and to study and analyses quantitative data, parametric statistical tests was used for normal data and in case there were not normal, unparametric tests were applied. Findings: Results of present study showed that there is a positive significant relation between general health and educational progress (r=01 / 0 p <،28 / 0. Still, no significant relation was observed between general health and health literacy (r= 0.038, p=0.569. Conclusion: In studying general health aspects with health literacy and educational health motivation, all aspects of general health (physical aspect, anxiety aspect, social function aspect, depression aspect showed a direct and significant relation with educational progress but presented no significant relation with health literacy. Still, we could observe a positive effect on educational progress and health literacy by trying to improve any of general health factors. In other words, we could use organizational capitals to improve

  9. ON THE SCOPE AND TYPOLOGY OF 'RESEARCH MISCONDUCT': THE GAZE OF THE GENERAL MEDICAL COUNCIL, 1990-2015.

    Science.gov (United States)

    Jacob, Marie-Andrée

    2016-10-05

    Violations of research integrity are understood to have wide-ranging negative consequences for the trustworthiness of science and the health of the public. My goal in this article is not to cause further outrage about research misconduct. Instead, this article queries research conducts expressly as seen through the eyes of a specific regulator and over a specific period (1990-2015). The result is an assessment of the strengths and limitations of the application of the General Medical Council's (GMC's) fitness to practice model in this area. It provides with an opportunity to shift the analytical attention back onto the existing typology of research misconduct-the classic Fabrication, Falsification, and Plagiarism or FFP-point to its deficiencies, and imagine how it could be refined in light of what the fitness to practice casework tells us about concrete, context-specific instances of research misconduct committed by medical practitioners. In the literature, there has been neither a systematic examination of research behaviours as they get apprehended-when they do-through the lens of the British medical professional regulator, nor a case-based reflection on whether the existing frameworks and typologies used in the scientific community describe adequately the practices of medical research misconduct. The article aims to fill these two gaps.

  10. TractRender: a new generalized 3D medical image visualization and output platform

    Science.gov (United States)

    Hwang, Darryl H.; Tsao, Sinchai; Gajawelli, Niharika; Law, Meng; Lepore, Natasha

    2015-01-01

    Diffusion MRI allows us not only voxelized diffusion characteristics but also the potential to delineate neuronal fiber path through tractography. There is a dearth of flexible open source tractography software programs for visualizing these complicated 3D structures. Moreover, rendering these structures using various shading, lighting, and representations will result in vastly different graphical feel. In addition, the ability to output these objects in various formats increases the utility of this platform. We have created TractRender that leverages openGL features through Matlab, allowing for maximum ease of use but still maintain the flexibility of custom scene rendering.

  11. Blurred lines: the General Medical Council guidance on doctors and social media .

    Science.gov (United States)

    Cork, Nick; Grant, Paul

    2016-06-01

    Digital technology in the early 21st century has introduced significant changes to everyday life and the ways in which we practise medicine. It is important that the ease and practicality of accessing and disseminating information does not intrude on the high standards expected of doctors, and that the boundaries between professional and public life do not become blurred through the increasing adoption of social media. This said, as with any such profound disruption, the social media age could be responsible for driving a new understanding of what it means to be a medical professional.

  12. Satisfaction with civilian family medicine residency training: Perspectives from serving general duty medical officers in the Canadian Armed Forces.

    Science.gov (United States)

    Wolfrom, Brent; Hodgetts, Geoff; Kotecha, Jyoti; Pollock, Emily; Martin, Mary; Han, Han; Morissette, Pierre

    2016-09-01

    To evaluate satisfaction with civilian residency training programs among serving general duty medical officers within the Canadian Armed Forces. A 23-item, cross-sectional survey face-validated by the office of the Surgeon General of the Canadian Armed Forces. Canada. General duty medical officers serving in the Canadian Armed Forces as of February 2014 identified through the Directorate of Health Services Personnel of the Canadian Forces Health Services Group Headquarters. Satisfaction with and time spent in 7 domains of training: trauma, critical care, emergency medicine, psychiatry, occupational health, sports medicine, and base clinic training. Overall preparedness for leading a health care team, caring for a military population, working in isolated and challenging environments, and being deployed were evaluated on a 5-point Likert scale. Among the survey respondents (n = 135, response rate 54%), 77% agreed or strongly agreed that their family medicine residency training was relevant to their role as a general duty medical officer. Most respondents were either satisfied or very satisfied with their emergency medicine training (77%) and psychiatry training (63%), while fewer were satisfied or very satisfied with their sports medicine (47%), base clinic (41%), and critical care (43%) training. Even fewer respondents were satisfied or very satisfied with their trauma (26%) and occupational health (12%) training. Regarding overall preparedness, 57% believed that they were adequately prepared to care for a military patient population, and 52% of respondents believed they were prepared for their first posting. Fewer respondents (38%) believed they were prepared to work in isolated, austere, or challenging environments, and even fewer (32%) believed that residency training prepared them to lead a health care team. General duty medical officers were satisfied with many aspects of their family medicine residency training; however, military-specific areas for improvement

  13. Using medical imaging for the detection of adverse events ("incidents") during the utilization of left ventricular assist devices in adult patients with advanced heart failure.

    Science.gov (United States)

    Kaufmann, Friedrich; Krabatsch, Thomas

    2016-05-01

    Ventricular assist devices (VAD) are used for mechanical support of the terminally failing heart. Failure of these life supporting systems can be fatal. Early and reliable detection of any upcoming problems is mandatory and is crucial for the outcome. Medical imaging methods are described within this review, which are not only essential for diagnosis of typically VAD-related complications but also for the detection or verification of technical issues. Within this review the utilization of medical imaging equipment for the diagnosis of technical malfunctions or damages of implanted system components is discussed. A newly developed specialized acoustic imaging method for pump thrombosis detection will also be described along with the most common VAD-related medical complications and their respective imaging methods and the limitations induced by the use of the VAD-system.

  14. Effect of a Comprehensive Health Care Program by Korean Medicine Doctors on Medical Care Utilization for Common Infectious Diseases in Child-Care Centers

    Directory of Open Access Journals (Sweden)

    Minjung Park

    2014-01-01

    Full Text Available As the role of traditional medicine in community health improvement increases, a comprehensive health care program for infectious diseases management in child-care centers by Korean medicine doctors was developed. The purpose of this study is to evaluate the effects of the program intervention on infection-related medical care utilization among children. The study used a quasi-experimental design with nonequivalent control group, comparing pre- and post-intervention data of the same children. The program implemented interventions in terms of management, education, and medical examination for the teachers, parents, and children in 12-week period. The frequency of utilization, cost, and prescription days of drugs and antibiotics due to infectious diseases prior to the intervention were compared with those during the 3-month intervention, using health insurance claim data. A panel analysis was also conducted to support the findings. A significant reduction (12% in infection-related visit days of hospitals was observed with the intervention (incident rate ratio = 0.88, P=0.01. And medical cost, drug prescription days, and antibiotics prescription days were decreased, although not statistically significant. A further cost-effectiveness analysis in terms of social perspectives, considering the opportunity costs for guardians to take children to medical institutions, would be needed.

  15. Availability of CYP2D6 genotyping results in general practitioner and community pharmacy medical records

    NARCIS (Netherlands)

    Simoons, Mirjam; Mulder, Hans; Schoevers, Robert A; Ruhé, Henricus G; van Roon, Eric N

    AIM: To investigate the availability of CYP450-2D6 (CYP2D6) genotyping results in general practitioner (GP) and/or community pharmacy records, and the influence thereof on psychotropic CYP2D6 substrate dosing. MATERIALS & METHODS: Primary outcome was the percentage of patients genotyped for CYP2D6

  16. Motives and preferences of general practitioners for new collaboration models with medical specialists : a qualitative study

    NARCIS (Netherlands)

    Berendsen, Annette J.; Benneker, Wim H. G. M.; Jong, Betty Meyboom-de; Klazinga, Niek S.; Schuling, Jan

    2007-01-01

    Background: Collaboration between general practitioners (GPs) and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates GPs to initiate and continue participating w

  17. 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.

  18. Barriers to utilization of pre-hospital emergency medical services among residents in Libreville, Gabon: A qualitative study

    Directory of Open Access Journals (Sweden)

    Nichole Bosson

    2013-12-01

    Conclusion: We identified remediable barriers to EMS (SAMU access in Libreville, Gabon: lack of awareness, misperceptions, established alternatives, and cost. Interventions and future investigations designed to increase EMS utilization in Gabon should target these four areas.

  19. Simulation Suggests that medical group mergers won't undermine the potential utility of health information exchanges.

    NARCIS (Netherlands)

    Rudin, R.S.; Schneider, E.C.; Volk, L.A.; Szolovits, P.; Salzberg, C.A.; Simon, S.R.; Bates, D.W.

    2012-01-01

    Federal and state agencies are investing substantial resources in the creation of community health information exchanges, which are consortia that enable independent health care organizations to exchange clinical data. However, under pressure to form accountable care organizations, medical groups ma

  20. Cost - utility analysis of parenteral antibiotics prescribed in medical wards in a tertiary care health facility in southern province of Sri Lanka

    Directory of Open Access Journals (Sweden)

    Lukshmy Menik Hettihewa

    2012-10-01

    Full Text Available Introduction: Parenteral antibiotic (PA prescription pattern in a hospital will directly influence the annual budget allocation, development of bacterial resistance and occurrence of unnecessary adverse drug reactions if it is done with poor adherence to the standard guidelines of prescription. As specialist in the field we understand the need of conducting economic studies in relation to the cost and utility of PA prescription pattern. It will be helpful to predict the drug procurement plan for the next year and also to prevent unnecessary complications mentioned above. Objective: Our main objective was to analyze the cost/utility relationship of PA drugs which were used in medical wards in this hospital according to the top ten of the cost (TTTC and the top ten of the consumption (TTCS. Materials and method : Aggregate data from the pharmacy record books were collected for year 2010 from indoor pharmacy. Unit prize was obtained from medical supplies division. Total quantity consumed by each medical ward was considered for analysis of the cost /utility relationship. Two top ten lists were prepared according to the cost and the consumption respectively for medical wards and the correlation was analyzed using non parametric testing with spearman test. Results: Regarding PA drugs used in this hospital, 7/10 PA drugs in TTTC are not included in the TTCS. Out of the total cost for TTTC, 82.6% of the cost had been spent for the PA drugs which are not in the TTCS and 17.5% of the cost of TTTC was used to purchase only three drugs from the TTCS. But these three drugs had contributed only 28% of top ten consumption. 72% of the PA drugs in TTCS were not costly drugs and highly consumed in medical wards. Correlation was significantly positive between cost and utility of PA drugs. ( r=-0.91,p<0.001 Conclusion: Majority of the consumed PA drugs are non-costly and it indicates the prescriptions had been done according to the rational guidelines including

  1. The "general practice class"--an eligible compulsory course in undergraduate medical education: didactical structure, teaching targets and implementation.

    Science.gov (United States)

    Langosch, Claudia; Onnasch, Jörg-Friedrich; Steger, Thomas; Klement, Andreas; Grundke, Susanne

    2012-01-01

    Undergraduate medical education in the field of general practice currently faces two considerable challenges: enhancing the attractiveness of general practice for all students and contributing to the necessary future rural physician workforce in primary care. Thus, we introduce a curriculum-based concept called the "General Practice Class" (Klasse Allgemeinmedizin) as an elective compulsory course to be taken during preclinical study. The aim of this concept is to strengthen the program focus on primary care in rural areas for interested students at an early stage.Since October 2011, the "General Practice Class" in Halle-Wittenberg offers learning experiences in regard to GP professional culture and a practice-oriented learning environment for 10% (n=20) of the freshman students. Each participating student is assigned to an individual GP mentor, who acts as a "professional example" and accompanies the student during the entire course of study. The concept of the "General Practice Class" is considered to be an innovative project due to the close connection between practical experience, problem-oriented skills training, early patient contact, and the accompanying face-to-face mentorship, starting from the beginning of preclinical study.

  2. Job Stress of Medical Staffs in General Hospital%综合医院一线医务人员工作应激调查

    Institute of Scientific and Technical Information of China (English)

    王玉林; 刘碧英; 王锐

    2003-01-01

    Objective: To explore the job stress status of medical staffs in general hospital. Methods: A total of 201 medical staffs were sampled from a general hospital in Changsha City, Hunan Province, and their job stress levels were evaluated by the Medical Job Stress Invemory. Results:The subjects from internal medicine department showed silgnificantIy higher job stress level than those from surgical departmem;and the doctors group showed higher stress level in the interpersonal subscale than the nurses group. Condusion:It is important to pay attention to medical staff''s job stress and job burnout in order to improve their mental health levels.

  3. Applications of the Generalized X-ray Diffraction Enhanced Imaging in the Medical Imaging

    Science.gov (United States)

    Maksimenko, Anton; Hashimoto, Eiko; Ando, Masami; Sugiyama, Hiroshi

    2007-01-01

    The X-ray Diffraction Enhanced Imaging (DEI) is the analyzer-based X-ray imaging technique which allows extraction of the "pure refraction" and "apparent absorption" contrasts from two images taken on the opposite sides of the rocking curve of the analyzing crystal. The refraction contrast obtained by this method shows many advantages over conventional absorption contrast. It was successfully applied in medicine, technique and other fields of science. However, information provided by the method is rather qualitative than quantitative. This happens because either side of the rocking curve of the analyzer is approximated as a straight line what limits the ranges of applicability and introduces additional error. One can easily overcome this problem considering the rocking curve as is instead of it's Taylor's expansion. This report is dedicated to the application of this idea in medical imaging and especially computed tomography based on the refraction contrast. The results obtained via both methods are presented and compared.

  4. Artificial intelligence (AI)-based relational matching and multimodal medical image fusion: generalized 3D approaches

    Science.gov (United States)

    Vajdic, Stevan M.; Katz, Henry E.; Downing, Andrew R.; Brooks, Michael J.

    1994-09-01

    A 3D relational image matching/fusion algorithm is introduced. It is implemented in the domain of medical imaging and is based on Artificial Intelligence paradigms--in particular, knowledge base representation and tree search. The 2D reference and target images are selected from 3D sets and segmented into non-touching and non-overlapping regions, using iterative thresholding and/or knowledge about the anatomical shapes of human organs. Selected image region attributes are calculated. Region matches are obtained using a tree search, and the error is minimized by evaluating a `goodness' of matching function based on similarities of region attributes. Once the matched regions are found and the spline geometric transform is applied to regional centers of gravity, images are ready for fusion and visualization into a single 3D image of higher clarity.

  5. The value of vaccination: results of an Italian survey among Medical Doctors, Policy Makers and General Population

    Directory of Open Access Journals (Sweden)

    Chiara Cadeddu

    2012-03-01

    Full Text Available

    Abstract:

    Background: In the Italian context, evolving toward the abandonment of compulsory vaccination, the
    maintenance of adequate levels of coverage appears as essential. The promotion of a good vaccination
    knowledge, supported by strong scientific evidence, and the collaboration of all the involved stakeholders,
    appears hence fundamental. The aim of this survey was to understand why vaccination is not appreciated
    for its real value by different stakeholders.
    Methods: In collaboration with other Italian Universities and Health Districts, in Summer 2011 we submitted
    a survey of 17 questions to a convenience sample of Italian Medical Doctors, Policy Makers and General
    Population. The main questions analyzed the importance of vaccination for health, actions to attain vaccination
    value and consequences of a free choice policy.
    Results: Of the 173 stakeholders interviewed, 78% of Medical Doctors, 82% Policy Makers and 46%
    General Population believe that vaccination is important for health. The most important actions suggested
    for strengthening vaccination were information about its efficacy and safety and studies on its impact on
    Public Health, according to most of General Population and of Medical Doctors and Policy Makers, respectively.
    According to 60.4% Medical Doctors, 72.8% Policy Makers and 56.3% General Population the abolition
    of compulsory vaccination would lead to a reduction of vaccinees in all the Italian regions.
    Conclusions: Our study confirms the need for a thorough “education in vaccination”. Among stakeholders
    there are still doubts that hinder the decision process about vaccination policies and programmes. On
    the other hand, a call for an “Alliance” for promoting and implementing vaccination to its full potential
    would be favoured, as

  6. The general practitioner and mental health problems: challenges and strategies for medical education

    Directory of Open Access Journals (Sweden)

    Dinarte Alexandre Ballester

    Full Text Available CONTEXT AND OBJECTIVE: Within the context of primary health care and mental disorders, our aim was to study the opinions of general practitioners regarding attendance of people with mental health problems. DESIGN AND SETTING: Qualitative focal group study among primary care services in the cities of Porto Alegre and Parobé, State of Rio Grande do Sul. METHODS: A deliberately selected sample of 41 general practitioners who were working in basic health services met in focal groups. Two videos were presented, which simulated consultations for patients with depression and psychoses. The discussions about the identification and handling of mental health problems were recorded and assessed via content analysis. RESULTS: The opinions related to the difficulties of diagnosing and treating mental problems, the involvement of relatives in caring for patients, the difficulty of compliance with the treatment, the uncertainty experienced by physicians and the difficulty of referring patients to specialized services. CONCLUSIONS: The general practitioners indicated that they perceived the mental health problems among their clientele, but the diagnosis and treatment of these problems are still seen as a task for specialists. The challenge of continuing education on mental health requires methods of interactive and critical teaching, such as the problem-based approach.

  7. Eating Disorders in the General Practice : A Case-Control Study on the Utilization of Primary Care

    NARCIS (Netherlands)

    Van Son, Gabrielle E.; Hoek, Hans W.; Van Hoeken, Daphne; Schellevis, Francois G.; Van Furth, Eric F.

    Objective To investigate primary care utilization between patients with an eating disorder (ED) and other patient groups, and between the ED subgroups anorexia nervosa (AN) and bulimia nervosa (BN). Method The present study was an observational casecontrol study. In total, 167 patients with ED were

  8. Eating Disorders in the General Practice : A Case-Control Study on the Utilization of Primary Care

    NARCIS (Netherlands)

    Van Son, Gabrielle E.; Hoek, Hans W.; Van Hoeken, Daphne; Schellevis, Francois G.; Van Furth, Eric F.

    2012-01-01

    Objective To investigate primary care utilization between patients with an eating disorder (ED) and other patient groups, and between the ED subgroups anorexia nervosa (AN) and bulimia nervosa (BN). Method The present study was an observational casecontrol study. In total, 167 patients with ED were

  9. An Analysis of the Effectiveness of the Retail Pharmacy Utilization Intervention at General Leonard Wood Army Community Hospital

    Science.gov (United States)

    2009-04-23

    limited to those beneficiaries who filled prescriptions for esomeprazole, clopidogrel, zolpidem, omeprazole , atorvastatin, monteluckast, fexofenadine...formulary. Nexium (esomeprazole) Plavix (clopidogrel) Ambien (zolpidem) Prilosec ( omeprazole ) Lipitor (atorvastatin) Singulair (montelukast...Prilosec ( omeprazole ) • Topimax (topiramate) • Detrol (tolterodine) Lipitor (atorvastatin) We would like to remind you that these medications and many

  10. Impact of Out-of-Pocket Expenditure on Physical Therapy Utilization for Nonspecific Low Back Pain: Secondary Analysis of the Medical Expenditure Panel Survey Data.

    Science.gov (United States)

    Dolot, Janet; Viola, Deborah; Shi, Qiuhu; Hyland, Matthew

    2016-02-01

    Physical therapy decreases low back pain, improves function, and may lead to decreased use of medical services. However, factors predicting physical therapy utilization for patients with low back pain are not well understood. The purpose of this study was to identify the impact of out-of-pocket expenditure on physical therapy utilization for US adults with nonspecific low back pain. This study was a secondary analysis of retrospective Medical Expenditure Panel Survey data. The participants were US adults with nonspecific low back pain. The outcome variable was the number of visits per episode of care. The research variable was out-of-pocket expenditure. Covariate variables were Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) component scores. Descriptive statistics and multiple linear regression analyses were performed. Three hundred fourteen adults met the inclusion criteria and submitted SF-12 scores, representing nearly 4 million adults. Out-of-pocket expenditure, physical component score, and the age-insurance category "18-64 years with public coverage only for all of the year or uninsured all of the year" negatively predicted visits per episode of care in the final regression model. Limitations of the study included use of a nonexperimental design, lack of information about symptom severity and content of physical therapy, and SF-12 scores were not taken coincidental with the episode of care. Out-of-pocket expenditure negatively predicts physical therapy utilization. More research is needed to identify all factors influencing physical therapy utilization so that effective health policies may be developed. © 2016 American Physical Therapy Association.

  11. Long-term medical utilization following ventilator-associated pneumonia in acute stroke and traumatic brain injury patients: a case-control study

    Directory of Open Access Journals (Sweden)

    Huang San-Kuei

    2011-10-01

    Full Text Available Abstract Background The economic burden of ventilator-associated pneumonia (VAP during the index hospitalization has been confirmed in previous studies. However, the long-term economic impact is still unclear. The aim of this study is to examine the effect of VAP on medical utilization in the long term. Methods This is a retrospective case-control study. Study subjects were patients experiencing their first traumatic brain injury, acute hemorrhagic stroke, or acute ischemic stroke during 2004. All subjects underwent endotracheal intubation in the emergency room (ER on the day of admission or the day before admission, were transferred to the intensive care unit (ICU and were mechanically ventilated for 48 hours or more. A total of 943 patients who developed VAP were included as the case group, and each was matched with two control patients without VAP by age ( ± 2 years, gender, diagnosis, date of admission ( ± 1 month and hospital size, resulting in a total of 2,802 patients in the study. Using robust regression and Poisson regression models we examined the effect of VAP on medical utilization including hospitalization expenses, outpatient expenses, total medical expenses, number of ER visits, number of readmissions, number of hospitalization days and number of ICU days, during the index hospitalization and during the following 2-year period. Results Patients in the VAP group had higher hospitalization expenses, longer length of stay in hospital and in ICU, and a greater number of readmissions than the control group patients. Conclusions VAP has a significant impact on medical expenses and utilization, both during the index hospitalization during which VAP developed and in the longer term.

  12. Long-term medical utilization following ventilator-associated pneumonia in acute stroke and traumatic brain injury patients: a case-control study.

    Science.gov (United States)

    Yang, Chih-Chieh; Shih, Nai-Ching; Chang, Wen-Chiung; Huang, San-Kuei; Chien, Ching-Wen

    2011-10-31

    The economic burden of ventilator-associated pneumonia (VAP) during the index hospitalization has been confirmed in previous studies. However, the long-term economic impact is still unclear. The aim of this study is to examine the effect of VAP on medical utilization in the long term. This is a retrospective case-control study. Study subjects were patients experiencing their first traumatic brain injury, acute hemorrhagic stroke, or acute ischemic stroke during 2004. All subjects underwent endotracheal intubation in the emergency room (ER) on the day of admission or the day before admission, were transferred to the intensive care unit (ICU) and were mechanically ventilated for 48 hours or more. A total of 943 patients who developed VAP were included as the case group, and each was matched with two control patients without VAP by age ( ± 2 years), gender, diagnosis, date of admission ( ± 1 month) and hospital size, resulting in a total of 2,802 patients in the study. Using robust regression and Poisson regression models we examined the effect of VAP on medical utilization including hospitalization expenses, outpatient expenses, total medical expenses, number of ER visits, number of readmissions, number of hospitalization days and number of ICU days, during the index hospitalization and during the following 2-year period. Patients in the VAP group had higher hospitalization expenses, longer length of stay in hospital and in ICU, and a greater number of readmissions than the control group patients. VAP has a significant impact on medical expenses and utilization, both during the index hospitalization during which VAP developed and in the longer term. © 2011 Yang et al; licensee BioMed Central Ltd.

  13. Utilization of serology for the diagnosis of suspected Lyme borreliosis in Denmark: survey of patients seen in general practice

    DEFF Research Database (Denmark)

    Dessau, Ram B; Bangsborg, Jette Marie; Ejlertsen, Tove

    2010-01-01

    Serological testing for Lyme borreliosis (LB) is frequently requested by general practitioners for patients with a wide variety of symptoms.......Serological testing for Lyme borreliosis (LB) is frequently requested by general practitioners for patients with a wide variety of symptoms....

  14. Building generalized tree mass/volume component models for improved estimation of forest stocks and utilization potential

    Science.gov (United States)

    David W. MacFarlane

    2015-01-01

    Accurately assessing forest biomass potential is contingent upon having accurate tree biomass models to translate data from forest inventories. Building generality into these models is especially important when they are to be applied over large spatial domains, such as regional, national and international scales. Here, new, generalized whole-tree mass / volume...

  15. The Utility of General and School-Specific Personality Traits and an Examination of Their Relationship over Time

    Science.gov (United States)

    Eschleman, Kevin J.; Burns, Gary

    2012-01-01

    A university student sample was used to compare school-specific (i.e., personality at school) and general personality (i.e., personality across all life domains) over eight weeks. School-specific and general personality incrementally predicted change in school-specific criteria (i.e., school satisfaction and school citizenship behaviors). Less…

  16. Utility of a dermatology interest group blog: the impact of medical student interest groups and Web 2.0 tools as educational resources

    Directory of Open Access Journals (Sweden)

    Jalalat SZ

    2014-09-01

    Full Text Available Sheila Z Jalalat, Richard F Wagner Jr Department of Dermatology, University of Texas Medical Branch, Galveston, TX, USA Abstract: The open access University of Texas Dermatology Interest Group blog was established in 2004 for the purposes of increasing communication and collaboration between medical students and dermatology faculty, residents, and alumni, as well as to promote educational opportunities and the missions for which the interest group was created. This blog is unique because of its longevity and continuous postings directed toward the educational and professional needs of medical students and residents. A blog user survey was performed to assess viewers' thoughts, purpose of viewing, demographic profile, subscriber status, usage of the blog and other Web 2.0 tools (forums, Facebook, blogs, Twitter, podcasts, and perceived usefulness. Sixty-one anonymous online surveys were completed during a 1-month period. Statistical analyses of the responses demonstrated that the utilization of web-based tools and the blog were valuable resources for students, especially for blog subscribers, those more involved in an interest group, and those reading the blog for a longer period of time. The usefulness and impact of this method of communication and dissemination of information in medical education may encourage other student groups, faculty advisors, and educators to implement similar educational tools at their institutions. Keywords: education, medical student, dermatology, blog

  17. A System Approach to Navy Medical Education and Training. Appendix 11. Advanced General Duty Corpsman.

    Science.gov (United States)

    1974-08-31

    IIRRIGATE WOUND 27 IREMOVE/SHORTEM DRAIN 28 IESTIMATE/RECORD BLOOD LOSS FOLLOWING HEMORRHAGE 29 ICHECK COLOR OF SKINw E.G. CYANOSIS, BLANCHING JAUNDICE...REPORT OR DESCRIBE VISUAL DISTURPANCES, E.G. IBLURRED, DOUBLE, MIRRORT TUNNEL 8 100 VISUAL ACUITY TEST USING SNELLEN CHART 9 100 COLOR VISION TEST 10...RFPORT SYMPTOMS OF !DFLIRIuM T~eEESI! 4 OBSERVE PATIENT’S GENERAL EMOTIONAL CONDITION, E.G. FACIAL AND lEYE EXPRESSIONS, QUALITY CF VOICE 5 OBSERVE

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

    Science.gov (United States)

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

    2014-01-01

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

  19. Stigma, medication adherence and coping mechanism among people living with HIV attending General Hospital, Lagos Island, Nigeria

    Directory of Open Access Journals (Sweden)

    Adekemi O. Sekoni

    2012-02-01

    Full Text Available Background: People living with HIV and AIDS (PLWHA experience some form of stigma which could lead to poor medication adherence.Objectives: This study assessed the various domains of stigma experienced by PLWHAs attending an HIV clinic at General Hospital, Lagos Island, their medication adherence patterns and their coping mechanisms for ensuring adherence to antiretroviral therapy.Method: A cross-sectional study design with a sample size of 200 was used. Respondents were selected using systematic random sampling. Interviewers administered structured questionnaires were used to collect information on the domains of stigma. Data was analysed using EPI info©. This was followed by a focus group discussion (FGD with seven participants at the clinic using an interview guide with open-ended questions.Results: Overall, stigma was experienced by 35% of the respondents. Within this group, 6.6%, 37.1%, 43.1% and 98.0% of the respondents reported experiencing negative self image stigma, personalised stigma, disclosure stigma and public attitude stigma respectively. Almost 90% of the respondents were adherent. The FGD revealed that disclosure was usually confined to family members and the coping mechanism for achieving adherence was to put antiretroviral (ARVs in unlabelled pill boxes.Conclusion: This study found that stigma was low and that the most common domain of stigma experienced was public attitude stigma. Medication adherence of respondents was good as a result of the coping mechanism, which involves putting ARVs in unlabelled pill boxes.

  20. Physical Culture as an integral part of general culture of medical students

    Directory of Open Access Journals (Sweden)

    N. V. Sivas

    2015-01-01

    Full Text Available The problem of education of the individuality through the culture with the help of development of value potential in physical culture is discussed in the article. Improving the efficiency of education of medical students is becoming the leading aim of high school, which is connected with the development of culture of thinking, imagination, feelings and human creativity. Development of human motor capabilities is inseparable from the development of his personal qualities in physical education. One of the most important tasks of the educational process at high school is providing the motivation of a healthy lifestyle, motivation for physical culture and sports. Promotion of a healthy lifestyle should go through the activation of incentive mechanisms and a number of other phenomena of the individual's inner world. Efficiency of this approach is that it provides activity of a person in questions connected with preservation of individual and public health. The article tells us about the need to develop programs that can promote future professionals to form healthy and productive lifestyle, sustained motivation to permanent physical self-improvement. The problem can be successfully solved in the process of learning such course as «Physical education».

  1. [Geriatric emergencies versus adult emergencies: retrospective analysis of medical emergencies at a general hospital].

    Science.gov (United States)

    Rodríguez Artalejo, F; González Montalvo, J I; Sanz Segovia, F; Jaramillo Gómez, E; Banegas Banegas, J R; Rodríguez Mañas, L; Carbonell Collar, A

    1989-10-14

    The aim of the study was to evaluate the process of the attention to emergencies in patients older than 65 years and to compare it with the same process in adult patients. To this end, 965 clinical records of medical emergencies from the Hospital Central de la Cruz Roja in Madrid were retrospectively evaluated, and data were obtained regarding age, the cause for consultation, the investigations performed and their yield, the administration of drug therapy, the major diagnosis at the time of discharge from the service and the clinical course. It was found that all evaluated diagnostic investigations were carried out with equal or higher frequency in patients older than 65 years and that their mean clinical effectiveness was also higher. In addition, it was found that the patients older than 65 years were more commonly admitted to the hospital through the emergency service than the rest of the population. It was concluded, therefore, that the process of attention to emergencies has differential characteristics in the elderly population, and that if the number and proportion of old people increase as it will presumably happen during the two next decades, the cost of attention to emergencies and the number of emergency hospital admissions will also increase.

  2. [Moderate asthma in adults: diagnosis and management in general medical practice].

    Science.gov (United States)

    Vernejoux, J M; Tunon De Lara, J M; Guizard, A V; Villanueva, P; Taytard, A

    1996-10-01

    Moderate asthma is a frequent disorder in general medicine. In 1990, the British Thoracic Society published their first guidelines on the management of asthma. Three years later, we have studied, using a questionnaire, the diagnosis and therapeutic criteria of moderate asthma used by general physicians, and comparing these to the guideline recommendations. Out of 46 physicians questioned in Bordeaux, 40 (87 per cent) agreed to participate in the study. Thirty two physicians (80 per cent) described as moderate an asthma which was mild according to the guidelines; eight physicians (20 per cent) described a moderate asthma according to the guidelines; twenty five (63 per cent) considered as severe a moderate asthma according to the recommendations, although eleven (28 per cent) considered it as moderate and four (10 per cent) did not give an opinion. In total, four (10 per cent) judged asthma severity according to the guidelines (Group R), twenty one (52 per cent) over-estimated the severity of moderate asthma (Group S), and fifteen (37 per cent) gave an inconsistent assessment (Group 1). Twenty six (65 per cent) prescribed an association of beta-2-agonists and inhaled corticosteroids for moderate asthma. Although most of the questioned physicians gave an appropriate treatment for moderate asthma treatment adapted to the severity of the situation, their therapeutic approach did not seem to be based upon the same criteria than that recommended in the guidelines.

  3. Interpreting international governance standards for health IT use within general medical practice.

    Science.gov (United States)

    Mahncke, Rachel J; Williams, Patricia A H

    2014-01-01

    General practices in Australia recognise the importance of comprehensive protective security measures. Some elements of information security governance are incorporated into recommended standards, however the governance component of information security is still insufficiently addressed in practice. The International Organistion for Standardisation (ISO) released a new global standard in May 2013 entitled, ISO/IEC 27014:2013 Information technology - Security techniques - Governance of information security. This standard, applicable to organisations of all sizes, offers a framework against which to assess and implement the governance components of information security. The standard demonstrates the relationship between governance and the management of information security, provides strategic principles and processes, and forms the basis for establishing a positive information security culture. An analysis interpretation of this standard for use in Australian general practice was performed. This work is unique as such interpretation for the Australian healthcare environment has not been undertaken before. It demonstrates an application of the standard at a strategic level to inform existing development of an information security governance framework.

  4. University of Saskatchewan Radiology Courseware (USRC): an assessment of its utility for teaching diagnostic imaging in the medical school curriculum.

    Science.gov (United States)

    Burbridge, Brent; Kalra, Neil; Malin, Greg; Trinder, Krista; Pinelle, David

    2015-01-01

    We have found it very challenging to integrate images from our radiology digital imaging repository into the curriculum of our local medical school. Thus, it has been difficult to convey important knowledge related to viewing and interpreting diagnostic radiology images. We sought to determine if we could create a solution for this problem and evaluate whether students exposed to this solution were able to learn imaging concepts pertinent to medical practice. We developed University of Saskatchewan Radiology Courseware (USRC), a novel interactive web application that enables preclinical medical students to acquire image interpretation skills fundamental to clinical practice. This web application reformats content stored in Medical Imaging Resource Center teaching cases for BlackBoard Learn™, a popular learning management system. We have deployed this solution for 2 successive years in a 1st-year basic sciences medical school course at the College of Medicine, University of Saskatchewan. The "courseware" content covers both normal anatomy and common clinical pathologies in five distinct modules. We created two cohorts of learners consisting of an intervention cohort of students who had used USRC for their 1st academic year, whereas the nonintervention cohort was students who had not been exposed to this learning opportunity. To assess the learning experience of the users we designed an online questionnaire and image review quiz delivered to both of the student groups. Comparisons between the groups revealed statistically significant differences in both confidence with image interpretation and the ability to answer knowledge-based questions. Students were satisfied with the overall usability, functions, and capabilities of USRC. USRC is an innovative technology that provides integration between Medical Imaging Resource Center, a teaching solution used in radiology, and a Learning Management System.

  5. Review of the utilization of HEEPF – competitive projects for educational enhancement in the Egyptian medical sector

    Directory of Open Access Journals (Sweden)

    Taher Salah

    2008-04-01

    Full Text Available Abstract In Egypt, the medical sector has been facing the same problems that challenged the system of higher education in the past decades, mainly an increasing student enrollment, limited resources, and old governance and bylaws. These constraints and the escalating paucity of resources have had a major negative influence on quality of education. Consequently, thoughts of educational reform came forward in the form of competitive projects, which have attracted several institutes from the health sector to improve their educational performance. The aim of this paper is to review the share of the medical sector in the higher education enhancement project fund (HEEPF, its outcomes, sustainability, and to provide recommendations for keeping the momentum of reform pursuit in the future. The methodology included obtaining statistics pertaining to the medical sector in Egypt as regards colleges, students, and staff. We also reviewed the self-studies of the medical sector colleges, HEEPF projects reports, performance appraisal reports, and World Bank reports on HEEPF achievements in order to retrieve the required data. Results showed that medical sector had a large share of the HEEPF (28.5% of projects as compared to its size (8% of student population. The projects covered 10 areas; the frequency distribution of which ranged between 4.4% (creation of new programs to 97.8% (human resource development. In conclusion, educational enhancement in the medical sector in Egypt could be apparently achieved through the HEEPF competitive projects. A study of the long-term impact of these projects on the quality of education is recommended

  6. Review of the utilization of HEEPF--competitive projects for educational enhancement in the Egyptian medical sector.

    Science.gov (United States)

    Abdel-Hamid Abdellah, Galal; El-Din Mohamed Fahmy Taher, Salah; Hosny, Somaya

    2008-04-18

    In Egypt, the medical sector has been facing the same problems that challenged the system of higher education in the past decades, mainly an increasing student enrollment, limited resources, and old governance and bylaws. These constraints and the escalating paucity of resources have had a major negative influence on quality of education. Consequently, thoughts of educational reform came forward in the form of competitive projects, which have attracted several institutes from the health sector to improve their educational performance. The aim of this paper is to review the share of the medical sector in the higher education enhancement project fund (HEEPF), its outcomes, sustainability, and to provide recommendations for keeping the momentum of reform pursuit in the future. The methodology included obtaining statistics pertaining to the medical sector in Egypt as regards colleges, students, and staff. We also reviewed the self-studies of the medical sector colleges, HEEPF projects reports, performance appraisal reports, and World Bank reports on HEEPF achievements in order to retrieve the required data. Results showed that medical sector had a large share of the HEEPF (28.5% of projects) as compared to its size (8% of student population). The projects covered 10 areas; the frequency distribution of which ranged between 4.4% (creation of new programs) to 97.8% (human resource development). In conclusion, educational enhancement in the medical sector in Egypt could be apparently achieved through the HEEPF competitive projects. A study of the long-term impact of these projects on the quality of education is recommended.

  7. Use of Addenbrooke’s cognitive examination-revised to evaluate the patients’ state in general medical practice

    Directory of Open Access Journals (Sweden)

    Nikolai Nikolayevich Ivanets

    2012-01-01

    Full Text Available The differential diagnosis of cognitive impairments is of great importance in mental disorders detectable in general medical practice. Objective: to study whether Addenbrooke's Cognitive Examination — Revised (ACE-R may be used in these patients. Patients and methods. The study was conducted in two steps at somatic hospitals and city polyclinics. It enrolled 130patients (36 men and 94 women with anxiety-depression spectrum disorders (ADSD, mild cognitive disorders (MCD and a concurrence of these conditions. The authors used the following psychometric scales: the hospital anxiety and depression scale; the mini-mental state examination; the frontal assessment battery; ACE-R; ten words learning test. The psychometric characteristics of ACE-R and the possibilities of its use were estimated to detect MCD. The differences in the spectrum of cognitive impairments were analyzed in patients with different types of ADSD. Results. ACE-R is shown to be an effective neuropsychological tool for the primary diagnosis, detection, and evaluation of MCD in the general medical network. The results of ACE-R use indicate that the spectrum of cognitive impairments has substantial differences in patients with different types of non-psychotic disorders.

  8. Comparisons of citations in Web of Science, Scopus, and Google Scholar for articles published in general medical journals.

    Science.gov (United States)

    Kulkarni, Abhaya V; Aziz, Brittany; Shams, Iffat; Busse, Jason W

    2009-09-09

    Until recently, Web of Science was the only database available to track citation counts for published articles. Other databases are now available, but their relative performance has not been established. To compare the citation count profiles of articles published in general medical journals among the citation databases of Web of Science, Scopus, and Google Scholar. Cohort study of 328 articles published in JAMA, Lancet, or the New England Journal of Medicine between October 1, 1999, and March 31, 2000. Total citation counts for each article up to June 2008 were retrieved from Web of Science, Scopus, and Google Scholar. Article characteristics were analyzed in linear regression models to determine interaction with the databases. Number of citations received by an article since publication and article characteristics associated with citation in databases. Google Scholar and Scopus retrieved more citations per article with a median of 160 (interquartile range [IQR], 83 to 324) and 149 (IQR, 78 to 289), respectively, than Web of Science (median, 122; IQR, 66 to 241) (P Scopus retrieved more citations from non-English-language sources (median, 10.2% vs 4.1%) and reviews (30.8% vs 18.2%), and fewer citations from articles (57.2% vs 70.5%), editorials (2.1% vs 5.9%), and letters (0.8% vs 2.6%) (all P Scopus, and Google Scholar produced quantitatively and qualitatively different citation counts for articles published in 3 general medical journals.

  9. Oral cancer--current knowledge, practices and implications for training among an Irish general medical practitioner cohort.

    LENUS (Irish Health Repository)

    Ni Riordain, Richeal

    2009-11-01

    This study investigated the current knowledge and practices of general medical practitioners (GMPs) in Ireland regarding the examination of the oral cavity and the detection of oral malignancy and the training they had received at both undergraduate and postgraduate level and since commencing in practice. A questionnaire survey of GMPs in Ireland was conducted. One hundred and fifty four (65.3%) of the practitioners reported regularly examining the oral mucosa of their patients. Almost half of these (n=68) further qualified this response by stating that they only examined the oral mucosa if the patient reported pain in this area or if the patient specifically requested an oral examination for some reason. Eighty one (34.3%) practitioners surveyed felt confident in their ability to detect oral malignancies with the remaining two thirds unsure of whether they would be able to detect oral cancer. There was a significant association between the undergraduate and postgraduate teaching on examination of the oral cavity and whether practitioners felt confident in their ability to detect oral cancer [chi(2)(1)=4.811, p<0.05]. A statistically significant association was also found between the undergraduate and postgraduate teaching on the diagnosis of oral malignant disease and whether practitioners felt confident in their ability to detect oral cancer [chi(2)(1)=6.194, p<0.05]. In conclusion the level of knowledge of Irish general medical practitioners needs to be addressed with appropriate initiatives both at undergraduate level and via CME.

  10. [Intentional roundings in general medical practice: the experience of the Azienda Ospedali Riuniti Marche Nord (Italy).

    Science.gov (United States)

    Frassini, Serena; Giovannini, Donatella; Gargiulo, Mariarosaria; Warid, Amina; Tonucci, Sonia; Capalbo, Maria

    2017-04-01

    The "intentional roundings" are planned rounds, conducted at regular intervals by nursing staff to anticipate care, comfort, hospitality and psychological needs of hospitalized users. These purposes are achieved with a structured way to make observations and carry out activities for well-being and patient safety, documenting what was done with a structured ad hoc form. In the United Kingdom, as well as in the USA, intentional rounding is an established model of care that improve the safety of provided care, to reduce the occurrence of preventable events, address proactively basic caring needs, and that increase users and staff satisfaction. Implementing in a medical pilot unit the care model named "intentional rounding". The care team carried intentional rounds every two hours, in a systematic and documented manner. All patients received admission informations about the organizational method and were invited to participate by completing a satisfaction questionnaire at discharge. At the end of the experimental period organizational impact have been investigated, specifically users and hospital staff satisfaction. About privacy, courtesy, nurse support and quality of care provided, level of satisfaction of patients and caregivers reached high percentage of approval (90-99%). Nurses and other healthcare personnel have perceived they delivered either a safer and most satisfying healthcare (90-94%) as well as inter- and intra-professional dynamics communications (95%). Value of roundings have been less appreciated concerning the optimization about the worktime management (79%). Calls to the bell have had a notable change of their reasons unlikely about the quantity. Intentional roundings affects very positively to users satisfaction level and to the perception of the quality of care provided; the care team, though express the need to make some changes for a real implementation, recognize the proactivity of intentional roundings as an added value.

  11. A Useful Tool As a Medical Checkup in a General Population—Bioelectrical Impedance Analysis

    Science.gov (United States)

    Enomoto, Mika; Adachi, Hisashi; Fukami, Ako; Kumagai, Eita; Nakamura, Sachiko; Nohara, Yume; Kono, Shoko; Nakao, Erika; Morikawa, Nagisa; Tsuru, Tomoko; Sakaue, Akiko; Fukumoto, Yoshihiro

    2017-01-01

    Accumulation of visceral fat leads to metabolic syndrome and increases risks of cerebro-cardiovascular diseases, which should be recognized and improved at the early stage in general population. Accurate measurement of visceral fat area (VFA) is commonly performed by the abdominal cross-sectional image measured by computed tomography scan, which is, however, limited due to the radiation exposure. The bioelectrical impedance analysis (OMRON, HDS-2000 DUALSCANR) has been recently developed to measure VFA, which is more easily accessible modality. In the present study, we investigated the clinical usefulness of DUALSCANR in 226 subjects who received health examination, including blood chemistries, electrocardiography, cardio, and carotid ultrasonography. VFA was measured within only just 5 min. Average of VFA was 83.5 ± 36.3 cm2 in men, and 64.8 ± 28.0 cm2 in women, which was correlated to weight (r = 0.7404, p < 0.0001), body mass index (BMI) (r = 0.7320, p < 0.0001), and waist circumstance (r = 0.7393, p < 0.0001). In multivariate analyses, VFA was significantly associated with weight (p < 0.0001), BMI (p < 0.0001), and waist circumstance (p < 0.0001). Compared to the group of smaller waist and normal BMI, VFA was significantly increased (p < 0.0001) in the group of larger waist and obese subjects. In conclusion, these results indicated that DUALSCANR is useful to measure VFA easily in general population, even in a large number of subjects. PMID:28210619

  12. Knowledge Translation for Research Utilization: Design of a Knowledge Translation Model at Tehran University of Medical Sciences

    Science.gov (United States)

    Majdzadeh, Reza; Sadighi, Jila; Nejat, Saharnaz; Mahani, Ali Shahidzade; Gholami, Jaleh

    2008-01-01

    Introduction: The present study aimed to generate a model that would provide a conceptual framework for linking disparate components of knowledge translation. A theoretical model of such would enable the organization and evaluation of attempts to analyze current conditions and to design interventions on the transfer and utilization of research…

  13. Self-reported Health Care Utilization of Patients with Inflammatory Bowel Disease Correlates Perfectly with Medical Records

    NARCIS (Netherlands)

    Severs, Mirjam; Petersen, Roosmarijn E.; Siersema, Peter D.; Mangen, Marie Josee J; Oldenburg, Bas

    2015-01-01

    Studies on the costs of health care in patients with inflammatory bowel disease (IBD) are increasingly conducted through the collection of self-reported data. We aimed to assess the concordance between estimated annual costs based on self-reported health care utilization and administrative data in I

  14. Longitudinal Prescribing Patterns for Psychoactive Medications in Community-Based Individuals with Developmental Disabilities: Utilization of Pharmacy Records

    Science.gov (United States)

    Lott, I. T.; McGregor, M.; Engelman, L.; Touchette, P.; Tournay, A.; Sandman, C.; Fernandez, G.; Plon, L.; Walsh, D.

    2004-01-01

    Little is known about longitudinal prescribing practices for psychoactive medications for individuals with intellectual disabilities and developmental disabilities (IDDD) who are living in community settings. Computerized pharmacy records were accessed for 2344 community-based individuals with IDDD for whom a total of 3421 prescriptions were…

  15. Assessment of nutritional status and obesity in elderly patients as seen in general medical practice.

    Science.gov (United States)

    DeVore, P A

    1993-09-01

    Overweight and obesity are generally considered to have a negative impact on longevity because of their association with many diseases, including hypertension, diabetes, coronary artery disease, osteoarthritis, and certain types of cancer. Nevertheless, some authors, notably Ancel Keys, have concluded that being overweight improves one's chances for longevity. I studied 122 consecutive patients who had comprehensive geriatric assessment with regard to their body mass index, responses to Wolinsky's Nutritional Risk Index, and serum albumin levels. There was a high prevalence of overweight (60% of men and 45.6% of women). This fact, coupled with the observed low prevalence of underweight subjects, tends to support Keys' statement concerning the benefit of being overweight. However, the relative absence of significant obesity supports the impression that significantly obesity reduces prospects for longevity. Although serum albumin measurements were obtained for only 38 subjects, the fact that the value was low in only one instance--in the case of a person who was seriously ill--suggests that obtaining routine serum albumin measurements in ambulatory, community-dwelling elderly people is not cost-effective.

  16. Investigation on Depression of Inpatients in Medical Ward in General Hospital%综合医院内科住院病人抑郁状况调查

    Institute of Scientific and Technical Information of China (English)

    陈庆红; 舒德海; 刘宇宁; 曹伟; 张可

    2003-01-01

    Objective:To investigate the depression of inpatients in general hospital. Methods:252 inpatients in medical ward were investigated by SDS. Results:there were 100(39.7 % ) cases with depression symptoms according to SDS(SDS total scores 1>50) .There were significant correlations between the incidence of depression and kind of disease or education level. Conclusion:There are 39.7% patients with depression sympoms in medical ward of general hosoital.

  17. Shift Work and Related Health Problems among Medical and Diagnostic Staff of the General Teaching Hospitals Affiliated to Shiraz University of Medical Sciences, 2012

    Directory of Open Access Journals (Sweden)

    Zahra Sajjadnia

    2015-07-01

    Full Text Available Introduction:Today, shift work is considered as a necessity in many jobs and for some 24-hour services the use of shift-work is growing. However, shift work can lead to physiological and psycho-social problems for shift workers. This study aimed to determine the effects of shift work on the associated health problems, together with the demographic and job characteristics underlying the problems, among the medical and diagnostic staff of the general teaching hospitals affiliated to Shiraz University of Medical Sciences in 2012. Method:This study was an applied, cross-sectional and descriptive-analytical one. The study employed a sample of 205 employees from the medical and diagnostic staff using stratified sampling proportional to the size and simple random sampling methods. Data were collected using the Survey of Shift workers (SOS questionnaire, validity and reliability of which have already been confirmed. Finally, the collected data were analyzed using SPSS 16.0 software through ANOVA, Chi-square, Independent-Samples T-Test, as well as Pearson Correlation Coefficient. A P<0.05 was considered statistically significant. Results: The results showed that among the demographic and job characteristics studied, the individual, family and social problems had significant associations with work schedules, shift work and job satisfaction. In addition, there were significant associations between musculoskeletal disorders and the satisfaction of shift work; cardiovascular disorders and marital status and occupation; digestive disorders and the work schedules; sleep disorders and the satisfaction of shift work; musculoskeletal disorders, cardiovascular disorders and sleep disorders and age, job experience and shift work experience. And finally, there were significant associations among sleep disorders and age, job experience and the shift work experience. Conclusion: Based on the findings of this study, demographic characteristics such as age, marital

  18. The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: A multi-center study.

    Science.gov (United States)

    Stanford, Fatima Cody; Alfaris, Nasreen; Gomez, Gricelda; Ricks, Elizabeth T; Shukla, Alpana P; Corey, Kathleen E; Pratt, Janey S; Pomp, Alfons; Rubino, Francesco; Aronne, Louis J

    2017-03-01

    Patients who undergo bariatric surgery often have inadequate weight loss or weight regain. We sought to discern the utility of weight loss pharmacotherapy as an adjunct to bariatric surgery in patients with inadequate weight loss or weight regain. Two academic medical centers. We completed a retrospective study to identify patients who had undergone bariatric surgery in the form of a Roux-en-Y gastric bypass (RYGB) or a sleeve gastrectomy from 2000-2014. From this cohort, we identified patients who were placed on weight loss pharmacotherapy postoperatively for inadequate weight loss or weight regain. We extracted key demographic data, medical history, and examined weight loss in response to surgery and after the initiation of weight loss pharmacotherapy. A total of 319 patients (RYGB = 258; sleeve gastrectomy = 61) met inclusion criteria for analysis. More than half (54%; n = 172) of all study patients lost≥5% (7.2 to 195.2 lbs) of their total weight with medications after surgery. There were several high responders with 30.3% of patients (n = 96) and 15% (n = 49) losing≥10% (16.7 to 195.2 lbs) and≥15% (25 to 195.2 lbs) of their total weight, respectively, Topiramate was the only medication that demonstrated a statistically significant response for weight loss with patients being twice as likely to lose at least 10% of their weight when placed on this medication (odds ratio = 1.9; P = .018). Regardless of the postoperative body mass index, patients who underwent RYGB were significantly more likely to lose≥5% of their total weight with the aid of weight loss medications. Weight loss pharmacotherapy serves as a useful adjunct to bariatric surgery in patients with inadequate weight loss or weight regain. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  19. 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.

  20. Medical documentation, bioanalytical evidence of an accidental human exposure to sulfur mustard and general therapy recommendations.

    Science.gov (United States)

    Steinritz, Dirk; Striepling, Enno; Rudolf, Klaus-Dieter; Schröder-Kraft, Claudia; Püschel, Klaus; Hullard-Pulstinger, Andreas; Koller, Marianne; Thiermann, Horst; Gandor, Felix; Gawlik, Michael; John, Harald

    2016-02-26

    Sulfur mustard (SM) is a chemical warfare agent (CWA) that was first used in World War I and in several military conflicts afterwards. The threat by SM is still present even today due to remaining stockpiles, old and abandoned remainders all over the world as well as to its ease of synthesis. CWA are banned by the Chemical Weapons Convention (CWC) interdicting their development, production, transport, stockpiling and use and are subjected to controlled destruction. The present case report describes an accidental exposure of three workers that occurred during the destruction of SM. All exposed workers presented a characteristic SM-related clinical picture that started about 4h after exposure with erythema and feeling of tension of the skin at the upper part of the body. Later on, superficial blister and a burning phenomenon of the affected skin areas developed. Similar symptoms occurred in all three patients differing severity. One patient presented sustained skin affections at the gluteal region while another patient came up with affections of the axilla and genital region. Fortunately, full recovery was observed on day 56 after exposure except some little pigmentation changes that were evident even on day 154 in two of the patients. SM-exposure was verified for all three patients using bioanalytical GC MS and LC MS/MS based methods applied to urine and plasma. Urinary biotransformation products of the β-lyase pathway were detected until 5 days after poisoning whereas albumin-SM adducts could be found until day 29 underlining the beneficial role of adduct detection for post-exposure verification. In addition, we provide general recommendations for management and therapy in case of SM poisoning.

  1. Standardized sign-out reduces intern perception of medical errors on the general internal medicine ward.

    Science.gov (United States)

    Salerno, Stephen M; Arnett, Michael V; Domanski, Jeremy P

    2009-01-01

    Prior research on reducing variation in housestaff handoff procedures have depended on proprietary checkout software. Use of low-technology standardization techniques has not been widely studied. We wished to determine if standardizing the process of intern sign-out using low-technology sign-out tools could reduce perception of errors and missing handoff data. We conducted a pre-post prospective study of a cohort of 34 interns on a general internal medicine ward. Night interns coming off duty and day interns reassuming care were surveyed on their perception of erroneous sign-out data, mistakes made by the night intern overnight, and occurrences unanticipated by sign-out. Trainee satisfaction with the sign-out process was assessed with a 5-point Likert survey. There were 399 intern surveys performed 8 weeks before and 6 weeks after the introduction of a standardized sign-out form. The response rate was 95% for the night interns and 70% for the interns reassuming care in the morning. After the standardized form was introduced, night interns were significantly (p intern. However, the day teams thought there were significantly less perceived errors on the part of the night intern (p = .001) after introduction of the standardized sign-out sheet. There was no difference in mean Likert scores of resident satisfaction with sign-out before and after the intervention. Standardized written sign-out sheets significantly improve the completeness and effectiveness of handoffs between night and day interns. Further research is needed to determine if these process improvements are related to better patient outcomes.

  2. Utilizing food effects to overcome challenges in delivery of lipophilic bioactives: structural design of medical and functional foods.

    Science.gov (United States)

    McClements, David Julian

    2013-12-01

    The oral bioavailability of many lipophilic bioactives, such as pharmaceuticals and nutraceuticals, is relatively low due to their poor solubility, permeability and/or chemical stability within the human gastrointestinal tract (GIT). The oral bioavailability of lipophilic bioactives can be improved by designing food matrices that control their release, solubilization, transport and absorption within the GIT. This article discusses the challenges associated with delivering lipophilic bioactive components, the impact of food composition and structure on oral bioavailability and the design of functional and medical foods for improving the oral bioavailability of lipophilic bioactives. Food-based delivery systems can be used to improve the oral bioavailability of lipophilic bioactives. There are a number of potential advantages to delivering lipophilic bioactives using functional or medical foods: greater compliance than conventional delivery forms; increased bioavailability and efficacy; and reduced variability in biological effects. However, food matrices are structurally complex multicomponent materials and research is still needed to identify optimum structures and compositions for particular bioactives.

  3. Utilization of a mobile medical van for delivering pediatric care in the bateys of the Dominican Republic

    OpenAIRE

    2010-01-01

    Background Bateys are impoverished areas of housing for migrant Haitian sugar cane workers in the Dominican Republic (DR). In these regions, preventative health care is almost non-existent, public service accessibility is limited, and geographic isolation prevents utilization of care even by those families with resources. Consequently, the development of a viable mobile system is vital to the delivery of acute and preventative health care in this region. Aims This study evaluated an existing ...

  4. A comparative study on lecture based versus case based education on teaching general surgery to medical students

    Directory of Open Access Journals (Sweden)

    M. Moazeni Bistegani

    2013-06-01

    Full Text Available Introduction : various methods of teaching have different learning outcomes. Using a combination of teaching and training methods of training may boost education. This study compared lecture based and case based teaching as a combined approach in learning general surgery by medical students. Methods: This study was a quasi-experimental performed on two consecutive groups of 33 and 36 students who were studying general surgery course. The two styles of teaching were lecture-based and real case teaching methods. The final exam included twenty multiple choice questions. The mean scores of each group of students were collected and analyzed accordingly with descriptive tests, Fisher’s test and T-test. Results: The mean final mark of students' who received real case based education was 16.8/20 ± 1.8 and for the lecture group was 12.7± 1.7. There was a significant difference between the two groups (P <0.0001. In both groups, there were significant differences in the mean scores of questions with taxonomy two and three, but not in the questions with taxonomy one. Students' evaluation score of the teacher of the real case group increased by 1.7/20 (8.7% in the case based group compared to the lecture group. Conclusions: Case based teaching of general surgery led to a better outcome and students were more satisfied. It is recommended that case based education of surgery be encouraged.

  5. COMPARISON OF THE KNOWLEDGE, ATTITUDE AND PRACTICES OF ESSENTIAL MEDICINES AMONG MEDICAL PRACTITIONERS OF A MEDICAL COLLEGE VERSUS PRIVATE MEDICAL GENERAL PRACTITIONERS OF AN URBAN PLACE OF SOUTH INDIA

    Directory of Open Access Journals (Sweden)

    Vidyarthi SurendraK, Nayak RoopaP, Gupta Sandeep K, Dandekar Rahul H

    2015-04-01

    Full Text Available Background: India is the third largest producer and exporter of medicinestomost of the countries. The World Medicine Situation Report 2011 states that 65% persons in India do not have access to essential medicines. While, huge unethical prescribing ofdrugs for monetary gains has been a second major cause of rural indebtedness. Aims and Objectives:The primary objective of the study was to compare the Knowledge, Attitude and Practices of Essential Medicines among Medical Practitioners of a Medical College and Private Medical General Practitioners of an urban place, e.g. Perambalur District of South India.Materials and Methods: After ethical approval, thestudy was started, in Dhanalakshmi Srinivasan Medical College and Hospital (DSMCH, Siruvachur-621113, Perambalur, Tamil Nadu. It was a questionnaire based study. The faculties of the DSMCH and Medical Private Practitioner of Perambalur district included as participants in the study. We distributed knowledge, attitude and practice (KAP based 15multiple choice questionson National Essential Medicine List, 2011 (NEML to each healthcare professionals (HCPs to attempt within 15 minutes.Results:Overall, Knowledge, attitude and practices regarding NEML 2011 were 57.06%, 38.36%; 51.16%, 51.82%; 21.73%, 28.7% to HCP from DSMCH and HCP from Perambalur district, respectively. Whereas, 42.2 % HCPs from DSMCH and 44.7 % HCPs from Perambalur district wereprescribed branded and generic drugs both. Conclusion:The result’s data shows that regular awareness programmes should be conducted to update knowledge, change attitude and practices regarding essential medicines to serve the society as best as possible.

  6. Contrast of Relief Effect of Tramadol and Dexmedetomidine on Shivering after General Anesthesia%Medical Recapitulate

    Institute of Scientific and Technical Information of China (English)

    王怡

    2016-01-01

    目的:比较曲马多与右美托咪定缓解全身麻醉术后寒战的临床效果。方法选取于2013年1月至2014年1月来辽宁省肿瘤医院行择期腹部手术后发生寒战的患者100例,依据随机数字表法分为右美托咪啶组(35例)、曲马多组(35例)、生理盐水组(30例)。右美托咪啶组给予右美托咪啶0.5μg/kg,曲马多组给予曲马多1 mg/kg,生理盐水组给予0.9%NaCl注射液0.05 mg/kg。观察对比三组患者的临床效果及术后寒战情况。结果右美托咪定组、曲马多组全身麻醉腹部手术患者给药后5、10 min寒战评分均较给药前呈下降趋势,右美托咪定组下降速度更快;生理盐水组给药后5、10 min寒战评分均较给药前无变化[右美托咪定组:(0.60±0.11)分、(0.22±0.03)分比(3.82±0.11)分;曲马多组:(2.01±0.41)分、(2.23±0.21)分比(3.91±0.12)分;生理盐水组:(3.71±0.13)分、(3.72±0.22)分比(3.74±0.13)分],三组寒战评分组间、时点间、组间・时点间交互效应比较差异有统计学意义( P<0.05)。右美托咪啶组给药后10 min 的镇静评分均高于曲马多、生理盐水两组[(2.89±0.23)分比(1.97±0.35)分、(1.74±0.28)分,P<0.05],差异有统计学意义;右美托咪啶组用药后恶心呕吐、心动过缓不良反应发生率为5.71%(2/35),低于曲马多组的22.86%(8/35),差异有统计学意义(P<0.05)。结论与曲马多相比,全身麻醉中静脉注射右美托咪定可有效减少术后寒战、恶心、呕吐等并发症发生,临床效果好,具有良好的临床价值。%Objective To compare the clinical effect of tramadol and dexmedetomidine for the relief of shivering after general anesthesia.Methods From Jan.2013 to Jan.2004 100 patients with postoperative shivering after elective

  7. A general formula for Rayleigh-Schroedinger perturbation energy utilizing a power series expansion of the quantum mechanical Hamiltonian

    Energy Technology Data Exchange (ETDEWEB)

    Herbert, J.M.

    1997-02-01

    Perturbation theory has long been utilized by quantum chemists as a method for approximating solutions to the Schroedinger equation. Perturbation treatments represent a system`s energy as a power series in which each additional term further corrects the total energy; it is therefore convenient to have an explicit formula for the nth-order energy correction term. If all perturbations are collected into a single Hamiltonian operator, such a closed-form expression for the nth-order energy correction is well known; however, use of a single perturbed Hamiltonian often leads to divergent energy series, while superior convergence behavior is obtained by expanding the perturbed Hamiltonian in a power series. This report presents a closed-form expression for the nth-order energy correction obtained using Rayleigh-Schroedinger perturbation theory and a power series expansion of the Hamiltonian.

  8. Visit to general practitioners as a proxy for accessing chronic benefits by members of medical schemes, South Africa

    Directory of Open Access Journals (Sweden)

    Mncedisi M. Willie

    2012-02-01

    Full Text Available Background: Prescribed Minimum Benefits is a list of conditions that all medical schemes need to cover in full, and includes a select of chronic conditions. Chronic conditions affect people’s lifestyles and require ongoing management over a period of years for long-term survival. Objectives: This study examined the association between prevalence of selected chronic diseases and health service use, in particular visits to general practitioners (GPs by medical scheme members.Method: This was a retrospective study on medical schemes data. The median imputation method was employed to deal with missing and unreported chronic diseases prevalence. Multivariate logistic regression analysis was employed to assess effects of chronic disease prevalence, age stratum and scheme size on GP visits per annum.Results: The study showed that prevalence of asthma was significantly associated with more than three GP visits (OR = 1.081; 95% CI = 1.008–1.159, as was prevalence of type 2 diabetes (OR = 1.087; 95% CI = 1.027–1.152, whilst prevalence of hyperlipidaemia (OR = 0.92; 95% CI = 0.875–0.97 was more likely to be associated with less than three GP visits. Prevalence of hypertension was associated with more than three GP visits per year (OR = 1.132; 95% CI = 1.017–1.26.Conclusion: This study shows that scheme size, prevalence of chronic diseases such as asthma, type 2 diabetes, hyperlipidaemia and hypertension are related to GP visits. GPs and managed care programmes employed by schemes should give special attention to certain disease states with high prevalence rates in an effort to better manage them.

  9. Visit to general practitioners as a proxy for accessing chronic benefits by members of medical schemes, South Africa

    Directory of Open Access Journals (Sweden)

    Mncedisi M. Willie

    2012-10-01

    Full Text Available Background: Prescribed Minimum Benefits is a list of conditions that all medical schemes need to cover in full, and includes a select of chronic conditions. Chronic conditions affect people’s lifestyles and require ongoing management over a period of years for long-term survival.Objectives: This study examined the association between prevalence of selected chronic diseases and health service use, in particular visits to general practitioners (GPs by medical scheme members.Method: This was a retrospective study on medical schemes data. The median imputation method was employed to deal with missing and unreported chronic diseases prevalence. Multivariate logistic regression analysis was employed to assess effects of chronic diseaseprevalence, age stratum and scheme size on GP visits per annum.Results: The study showed that prevalence of asthma was significantly associated with more than three GP visits (OR = 1.081; 95% CI = 1.008–1.159, as was prevalence of type 2 diabetes (OR = 1.087; 95% CI = 1.027–1.152, whilst prevalence of hyperlipidaemia (OR = 0.92; 95%CI = 0.875–0.97 was more likely to be associated with less than three GP visits. Prevalence of hypertension was associated with more than three GP visits per year (OR = 1.132; 95% CI = 1.017–1.26.Conclusion: This study shows that scheme size, prevalence of chronic diseases such as asthma, type 2 diabetes, hyperlipidaemia and hypertension are related to GP visits. GPs and managed care programmes employed by schemes should give special attention to certain disease states with high prevalence rates in an effort to better manage them.

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

    Directory of Open Access Journals (Sweden)

    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

  11. Loyalty conflicts in medical practice. A comparative study of general practitioners', paediatricians' and gynaecologists' assessments of three cases.

    Science.gov (United States)

    Lynöe, N; Mattsson, B

    1998-09-01

    To shed light on attitudes towards loyalty conflicts among general practitioners (GPs) compared with related specialists such as gynaecologists and paediatricians. A postal questionnaire containing three case histories with arguments for and against different ways of acting in loyalty conflicts. The medical problems of the clinical cases varied, but the ethical ones were in principle similar. A random sample of all Swedish GPs, gynaecologists, and paediatricians. GPs (n = 313), paediatricians (n = 197), and gynaecologists (n = 236). On average 71% of the doctors replied. The gynaecologists differed from the other groups by being markedly loyal to the individual patient especially in one case. The paediatricians tended to reply most consistently and they seemed to favour the family perspective, compared with the other doctors. The GPs' response pattern fell in between the other two groups. The study indicates that ethical reasoning depends on the doctors' different medical background with regard to specialty. This study should be followed by others in order to give further explanation of the findings.

  12. General physicians graduated from a PBL undergraduate medical curriculum: how well do they perform as PBL tutors?

    Science.gov (United States)

    Kim, Kyong-Jee; Lee, Joo Heung; Kee, Changwon

    2009-06-01

    A study was conducted on the effectiveness of general physicians recently graduated from a medical school with Problem-Based Learning (PBL) curriculum as PBL tutors to expand the school's tutor pool. This study aims to investigate these non-staff tutors' effectiveness in terms of student satisfaction and learning outcomes. An experimental study was conducted of 12 PBL groups of second-year medical students (n = 40). Four PBL groups were led by non-staff tutors; the other eight groups were led by staff tutors during the two PBL units. Tutor evaluation and student satisfaction questionnaires were administered and student performance scores were analysed to compare between groups led by staff tutors and non-staff tutors. The students' overall satisfaction with the non-staff tutors on a five-point Likert-scale was high (M = 4.5 +/-.638). Additionally, the student scores on written tests were comparable between groups. Yet, in one unit, the groups led by staff tutors received significantly higher scores on the group evaluation than those led by non-staff tutors. The results of this study show that the non-staff tutors performed as effectively as the staff tutors did with regard to student achievement in written exams. Still, the findings of this study suggest that different tutor backgrounds and experiences might affect student performance beyond the written exam scores.

  13. The Lorazepam and Diazepam Protocol for Catatonia Due to General Medical Condition and Substance in Liaison Psychiatry

    Science.gov (United States)

    Lin, Chin-Chuen; Hung, Yi-Yung; Tsai, Meng-Chang; Huang, Tiao-Lai

    2017-01-01

    Objective The lorazepam-diazepam protocol had been proved to rapidly and effectively relieve catatonia in patients with schizophrenia or mood disorder. This study aims to investigate the efficacy of lorazepam-diazepam protocol in catatonia due to general medical conditions (GMC) and substance. Method Patients with catatonia that required psychiatric intervention in various settings of a medical center were included. The lorazepam-diazepam protocol had been used to treat the catatonia due to GMC or substance according to DSM-IV criteria. The treatment response had been assessed by two psychiatrists. Results Eighteen (85.7%) of 21 catatonic patients due to GMC or substance became free of catatonia after the lorazepam-diazepam protocol. Five (23.8%) of the 21 patients had passed away with various causes of death and wide range of time periods after catatonia. Conclusion Our results showed that the lorazepam-diazepam protocol could rapidly and effectively relieve catatonia due to GMC and substance. PMID:28114315

  14. [Individual medical services with no entitlement to reimbursement: general conditions relating to german social legislation and liability law].

    Science.gov (United States)

    Wartensleben, Herbert

    2006-01-01

    Physicians owe their patients the necessary duty of care in both examination and treatment. A physician who disregards this basic level of care acts negligently and may be held liable for damages. The same level of duty applies to contracting physicians (Sect. 76 para. 4 SGBV). The efficiency principle of Title Five of the German Social Code (SGB V), and in particular the jurisdiction of the Federal Social Court has already taken into account the strained financial situation of the Statutory Health Insurance Systems through increasing rationing elements: Panel patients' entitlement to benefits is limited by the procurement rights of the contracting physician so that actually the two-class medicine strictly denied by politicians has become reality long since. For the physician, a new legal obligation to inform his patient arises from the divergence between the civil and criminal part of the medical statutes on the one hand and the restrictive regulations for physicians practising under SGB V, creating considerable potential for conflict the extent of which will generally remain hidden from the medically ignorant patient. In its decision of December 6, 2005, the Federal Constitutional Court (BVerfG) has set limits to the increasingly restrictive jurisdiction of the Federal Social Court referring to the welfare state principle. The dictate of humanity of Section 70 SGB V must not be degraded to the rank of a mere political statement.

  15. Medication use patterns, health care resource utilization, and economic burden for patients with major depressive disorder in Beijing, People’s Republic of China

    Directory of Open Access Journals (Sweden)

    Zhang L

    2016-04-01

    Full Text Available Ling Zhang,1–4 Yun Chen,5 Li Yue,5 Qingjing Liu,6 William Montgomery,7 Lihua Zhi,5 Wanqi Wang51Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, 2China Clinical Research Center for Mental Disorders, 3China Center of Depression, Beijing Institute for Brain Disorders, 4Department of Psychiatry, Capital Medical University, Beijing, 5Medical Department, Lilly Suzhou Pharmaceutical Company, Ltd, Shanghai, 6Pharmacoeconomics and Outcomes Research, Beijing Brainpower Pharma Consulting Co, Ltd, Beijing, People’s Republic of China; 7Medical Department, Eli Lilly Australia Pty, Ltd, Sydney, NSW, AustraliaObjective: The objective of the study was to investigate medication usage patterns, health care resource utilization, and direct medical costs of patients with major depressive disorder (MDD in Beijing, People’s Republic of China.Methods: Data were extracted from a random sample of the Beijing Urban Employee Basic Medical Insurance database. Patients aged ≥18 years, with ≥1 primary diagnosis of MDD and 12-month continuous enrollment after their first observed MDD diagnosis between 2012 and 2013 were identified. Those with a diagnosis of schizophrenia, bipolar disorder, or cancer during the analysis period were excluded.Results: In total 8,484 patients, with mean age of 57.2 years, were included and 63% were female. The top three commonly observed comorbidities were hypertension (70.9%, anxiety disorder (68.6%, and coronary heart disease (65.1%. Furthermore, 71.4% of patients were treated with antidepressant medications, including 60.5% of patients treated with selective serotonin reuptake inhibitors, followed by noradrenergic and specific serotonergic antidepressants (9.0% and serotonin–norepinephrine reuptake inhibitors (8.3%. The proportions of patients who discontinued their initial antidepressant within the first and second months after the index date were 45.4% and 77.0%, respectively. Concomitant

  16. Exploring Rural Disparities in Medical Diagnoses Among Veterans With Transgender-related Diagnoses Utilizing Veterans Health Administration Care.

    Science.gov (United States)

    Bukowski, Leigh A; Blosnich, John; Shipherd, Jillian C; Kauth, Michael R; Brown, George R; Gordon, Adam J

    2017-09-01

    Research shows transgender individuals experience pronounced health disparities compared with their nontransgender peers. Yet, there remains insufficient research about health differences within transgender populations. This study seeks to fill this gap by exploring how current urban/rural status is associated with lifetime diagnosis of mood disorder, alcohol dependence disorder, illicit drug abuse disorder, tobacco use, posttraumatic stress disorder, human immunodeficiency virus, and suicidal ideation or attempt among veterans with transgender-related diagnoses. This study used a retrospective review of The Department of Veterans Affairs (VA) administrative data for transgender patients who received VA care from 1997 through 2014. Transgender patients were defined as individuals that had a lifetime diagnosis of any of 4 International Classification of Diseases-9 diagnosis codes associated with transgender status. Independent multivariable logistic regression models were used to explore associations of rural status with medical conditions. Veterans with transgender-related diagnoses residing in small/isolated rural towns had increased odds of tobacco use disorder (adjusted odds ratio=1.39; 95% confidence intervals, 1.09-1.78) and posttraumatic stress disorder (adjusted odds ratio=1.33; 95% confidence intervals, 1.03-1.71) compared with their urban transgender peers. Urban/rural status was not significantly associated with other medical conditions of interest. This study contributes the first empirical investigations of how place of residence is associated with medical diagnoses among veterans with transgender-related diagnoses. The importance of place as a determinant of health is increasingly clear, but for veterans with transgender-related diagnoses this line of research is currently limited. The addition of self-reported sex identity data within VA electronic health records is one way to advance this line of research.

  17. Primary non-adherence to prescribed medication in general practice: lack of influence of moderate increases in patient copayment.

    Science.gov (United States)

    Linnet, Kristján; Halldórsson, Matthías; Thengilsdóttir, Gudrún; Einarsson, Ólafur B; Jónsson, Kristinn; Almarsdóttir, Anna B

    2013-02-01

    Primary non-adherence refers to the patient not redeeming a prescribed medication at some point during drug therapy. Research has mainly focused on secondary non-adherence. Prior to this study, the overall rate of primary non-adherence in general practice in Iceland was not known. To determine the prevalence of primary non-adherence, test whether it is influenced by a moderate increase in patient copayment implemented in 2010 and examine the difference between copayment groups (general versus concession patients). A population-based data linkage study, wherein prescriptions issued electronically by 140 physicians at 16 primary health care centres in the Reykjavik capital area during two periods before and after increases in copayment were matched with those dispensed in pharmacies, the difference constituting primary non-adherence (population: 200 000; patients: 21 571; prescriptions: 22 991). Eight drug classes were selected to reflect symptom relief and degree of copayment. Two-tailed chi-square test and odds ratios for non-adherence by patient copayment groups were calculated. The rate of primary non-adherence was 6.2%. It was lower after the increased copayment, reaching statistical significance for hypertensive agents, non-steroidal anti-inflammatory drugs (NSAIDs) and antipsychotics. Generally, primary non-adherence, except for antibacterials and NSAIDs, was highest in old-age pensioners. Primary non-adherence in Icelandic general practice was within the range of prior studies undertaken in other countries and was not adversely affected by the moderate increase in patient copayment. Older patients showed a different pattern of primary non-adherence. This may possibly be explained by higher prevalence of medicine use.

  18. "Interventions for Promoting Research Knowledge Translation: Why and how should we promote utilization of research-based knowledge through medical journals?"

    Directory of Open Access Journals (Sweden)

    Bahareh Yazdizadeh

    2009-05-01

    Full Text Available "nWhat is medical journals purpose of publishing research? These objectives have significantly changed since the first medical journals have been published; accordingly article formats have also transformed. Initially publication of articles was done with the purpose of informing the other researchers, but gradually, as the volumes of information and research target audiences increased, certain changes such as formatting abstracts and full texts were implemented in article presentations to inform target audiences in the shortest time. The question now is, how have medical journals moved on following the occurrence and development of evidence-based medicine and subsequently knowledge translation which highlight the importance of changing target audiences' behavior on the grounds of new evidence?"nIn order to identify the changes introduced in journals to promote knowledge translation, a search was conducted in electronic journals that were accessible. Eventually, it was observed that two important events had taken place in medical journals: changing article formats and creating new journals. In some journals there is a separate section that clearly highlights the essence of the study. For example inserting questions like "what does your study add to the current knowledge available?" or "how can the results of this study change target audiences' behavior?". On the other hand, journals were created that only publish systematic review studies."nUnfortunately, the aforementioned changes have not been addressed by many international and domestic medical journals. Therefore, in order to strengthen knowledge translation through journals in the country, we suggest inserting a section titled "Overview Box" in addition to formatting abstracts. To assess the impact of this intervention in improving the status of knowledge translation, we suggest an interventional study aimed at examining the impact of this box and properly transferring the article

  19. The Role of Engineering Principles in the Medical Utilization of Electromagnetic Energies from kHz to Visible Light - Examples

    Science.gov (United States)

    Rosen, Arye; Rosen, Harel D.

    2009-12-01

    The use of RF/microwaves in medicine has increased dramatically over the last ten years. RF and microwave therapies for the treatment of cancer in humans are well documented, and are presently used in many cancer centers. RF treatment for supra ventricular arrhythmias, and more recently for the treatment of ventricular tachycardia, are currently employed by major hospitals. RF/microwave are also used in human subjects for the treatment of benign prostatic hyperplasia (BPH). In the last few years, several otolaryngological centers have been utilizing RF to treat upper airway obstruction and to alleviate sleep apnea. Many centers also utilize RF for the treatment of gastro-esophageal disease (GERD), for pain management, and for endometrial ablation. Balloon microwave catheters for ablating solid tumors, then forming cavities in those tumors for the local delivery of therapeutic agents, are currently being investigated. New modalities are being studied, such as RF/microwave for the enhancement of drug absorption and microwave septic wound treatment, microwave imaging for the detection of breast cancer, epidemiological studies on the effects of rats’ exposure to microwave, as well as tissue regeneration using electromagnetic fields. In addition, technology is presently being developed that allows for permanent implantation of microwave wireless sensors in humans. A permanently implantable intra-cranial pressure monitor is one such application of the latter technology. Many more areas of research are currently being investigated, a partial list of which is summarized here.

  20. Reducing Over-Utilization of Cardiac Telemetry with Pop-Ups in an Electronic Medical Record System.

    Science.gov (United States)

    Rizvi, Wajeeha; Munguti, Cyrus M; Mehta, Jeet; Kallail, K James; Youngman, Darrell; Antonios, Samer

    2017-05-29

    Non-invasive cardiac monitoring has well-established indications and protocols. Telemetry is often overused leading to a shortage of tele-beds and an increment of hospital expenses. In some cases, patients are kept on telemetry longer than the indicated length because providers are unaware of its ongoing use. We investigated the effect of reminder pop-ups, incorporated into an electronic medical record (EMR), on minimizing the use of telemetry. Three regional hospitals implemented an electronic pop-up reminder for discontinuing the use of telemetry when no longer indicated. A retrospective analysis of data for patients on telemetry, outside of the intensive care unit (ICU), was conducted and comparisons were drawn from pre- and post-implementation periods. A composite analysis of the number of days on telemetry was calculated using the Kruskal-Wallis test. With the implementation of the pop-up reminder, the median number of days on telemetry was significantly lower in 2016 than in 2015 (2.25 vs 3.61 days, p pop-up reminder built into the electronic medical record system reduced the overuse of telemetry by 37% between the two time periods studied.