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Sample records for general medicine service

  1. Audit of the consultation process on general internal medicine services.

    Science.gov (United States)

    Conley, J; Jordan, M; Ghali, W A

    2009-02-01

    To determine the proportion of consultations requested by general internal medicine services that communicate key components of the consultation process to medical subspecialists. Retrospective chart review by two researchers, using a standardised chart abstraction instrument (93.1% agreement, kappa 0.85). Calgary, Alberta, Canada. A random sample of medical consultations was selected from those generated on two medical teaching units (MTUs) from 2003 to 2004. The primary measure of interest was whether a "clear clinical question" was posed to the subspecialist, a binary variable. Two hundred consultations were sampled from the 2885 subspecialty consultations. Of the selected consultations, 94.0% (188/200) were available for review. A clear clinical question was posed in 69.7% (131/188) of consultations (CI 0.63 to 0.74). In a secondary analysis involving a larger sample permitting comparison across subspecialties, 95.1% (368/387) of the consultations, representative of the subspecialties, were available for review. An MTU member contacted the subspecialist for 74.2% of consultations. If a consultation was urgent, a member of the MTU contacted the subspecialist in 81.0% of consultations. Of these urgent consultations, 63.3% had a clear clinical question. More than one in four consultations does not contain a clear clinical question, illustrating suboptimal communication between physicians. Innovative strategies that provide a sustainable solution for overcoming barriers to communication could have a significant impact on quality of care.

  2. General Nuclear Medicine

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z General Nuclear Medicine Nuclear medicine imaging uses small amounts of ... limitations of General Nuclear Medicine? What is General Nuclear Medicine? Nuclear medicine is a branch of medical ...

  3. 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.

  4. The future of general medicine.

    Science.gov (United States)

    Firth, John

    2014-08-01

    It is a truth universally acknowledged that there is a problem with general medicine. Physicians have become increasingly specialised over the past 30 years or so, and specialist care has produced increasingly better outcomes for some patients. The patients left behind are looked after by general medicine, where demand is increasing, operational priority within hospitals is low, there is little professional kudos and recruitment is suffering. Three recent reports - Hospitals on the Edge?, the Future Hospital Commission report, and the Shape of Training report - have described the problems, but not articulated compelling solutions. Here, I discuss what is good about general medicine, what is bad and make suggestions for improvement. These involve getting specialities to take responsibility for care of appropriate admissions automatically and without delay, giving general physicians control over the service that they provide, and using well-chosen financial drivers to support movement in the right direction.

  5. A Randomized Controlled Trial of a CPR Decision Support Video for Patients Admitted to the General Medicine Service.

    Science.gov (United States)

    Merino, Aimee M; Greiner, Ryan; Hartwig, Kristopher

    2017-09-01

    Patient preferences regarding cardiopulmonary resuscitation (CPR) are important, especially during hospitalization when a patient's health is changing. Yet many patients are not adequately informed or involved in the decision-making process. We examined the effect of an informational video about CPR on hospitalized patients' code status choices. This was a prospective, randomized trial conducted at the Minneapolis Veterans Affairs Health Care System in Minnesota. We enrolled 119 patients, hospitalized on the general medicine service, and at least 65 years old. The majority were men (97%) with a mean age of 75. A video described code status choices: full code (CPR and intubation if required), do not resuscitate (DNR), and do not resuscitate/do not intubate (DNR/DNI). Participants were randomized to watch the video (n = 59) or usual care (n = 60). The primary outcome was participants' code status preferences. Secondary outcomes included a questionnaire designed to evaluate participants' trust in their healthcare team and knowledge and perceptions about CPR. Participants who viewed the video were less likely to choose full code (37%) compared to participants in the usual care group (71%) and more likely to choose DNR/DNI (56% in the video group vs. 17% in the control group) ( < 0.00001). We did not see a difference in trust in their healthcare team or knowledge and perceptions about CPR as assessed by our questionnaire. Hospitalized patients who watched a video about CPR and code status choices were less likely to choose full code and more likely to choose DNR/DNI.

  6. Generalism in modern subspecializing medicine.

    Science.gov (United States)

    Levi, Marcel

    2017-04-01

    Medicine is currently developing at a breath holding pace. Diseases and medical conditions for which no remedy was available only a few years ago, can now be treated or even completely cured. However, this advancement of medicine comes with increasing complexity in many situations. This article discusses how we have to adapt our health care organization and our work as physicians to better cope with the new challenges of the enormous advancement of medicine, with a specific focus on internal medicine. If we want our patients to obtain maximal benefit of the progress in biomedical knowledge and the ensuing improved clinical outcomes in many areas we need to further focus and concentrate complex medical care in a team-based approach. In addition, we need to match increasing subspecialization with an attitude of generalism, both in our clinical work and in our teaching and training programs. Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  7. Medical Services: Preventive Medicine

    Science.gov (United States)

    2007-11-02

    personnel, and higher headquarters for definitive analysis and review of the Occupational Health Program. This tool s h o u l d a i d i n e v a l u a t i...anemia. (e) Diabetes mellitus. (f) Silicosis. (g) Chronic hemodialysis . (h) History of gastrectomy. (i) Chronic undernutrition or weight loss. (11...See the definition of occupa- tional medicine staff in the glossary.) (4) Appoint an individual to act as the industrial hygiene program manager

  8. How to fulfill residents' training needs and public service missions in outpatient general internal medicine? An observational pilot study.

    Science.gov (United States)

    Junod Perron, Noelle; Humair, Jean-Paul; Gaspoz, Jean-Michel

    2012-07-12

    QUESTION UNDER STUDY/PRINCIPLES: Ambulatory care is a mandatory component of post-graduate training in general internal medicine. Academic outpatient clinics face challenges in training residents in terms of exposure to sufficient patient case-mix, diversity of clinical activities and continuity of care while fulfilling their mission to provide care to vulnerable populations. We report the development and evaluation of a new postgraduate curriculum in ambulatory care in Geneva, Switzerland, designed to overcome such challenges. The content of learning activities was adapted to core competencies and learning objectives. In the new 2-year curriculum, residents had their working week divided into 2½ days of continuity clinic over two years, and 2½ days of 6 to 12 months rotations (e.g., walk-in clinics). Team work was consolidated through the creation of subunits including an attending physician, 1-2 senior residents during one year and 6- to 8 residents, who met in bi-monthly meetings with other health professionals. In both local and national surveys, residents and senior residents expressed an overall global satisfaction with the new curriculum. Nursing and administrative staff were less satisfied, because of reduced residents' time in each unit. Interprofessional meetings were highly appreciated for both patient care and team building. Management of residents' absences became more complex. The new curriculum met its goals in gaining residents' satisfaction and in reinforcing interprofessional collaboration although management of human resources became more complex. It also gave insights into challenges to be addressed when disseminating a new curriculum, such as strong leadership, educational expertise and management skills and tools.

  9. Clinical Service of Chinese Medicine

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ The clinical practice of traditional Chinese medicine (TCM) faces three major challenges:(1)How to enhance its contribution on overall medical service quality? (2) How to best address the unmet medical needs in the contemporary society? (3)How to guarantee that the traditional perspective for disease diagnosis and treatment not be neglected in clinical practice?

  10. Customer service in equine veterinary medicine.

    Science.gov (United States)

    Blach, Edward L

    2009-12-01

    This article explores customer service in equine veterinary medicine. It begins with a discussion about the differences between customers and clients in veterinary medicine. An overview of the nature of the veterinary-client-patient relationship and its effects on the veterinarian's services sheds light on how to evaluate your customer service. The author reviews a study performed in 2007 that evaluated 24 attributes of customer service and their importance to clients of equine veterinarians in their decision to select a specific veterinarian or hospital. The article concludes with an overview of how to evaluate your customer service in an effort to optimize your service to achieve customer loyalty.

  11. Research data services in veterinary medicine libraries.

    Science.gov (United States)

    Kerby, Erin E

    2016-10-01

    The study investigated veterinary medicine librarians' experience with and perceptions of research data services. Many academic libraries have begun to offer research data services in response to researchers' increased need for data management support. To date, such services have typically been generic, rather than discipline-specific, to appeal to a wide variety of researchers. An online survey was deployed to identify trends regarding research data services in veterinary medicine libraries. Participants were identified from a list of contacts from the MLA Veterinary Medical Libraries Section. Although many respondents indicated that they have a professional interest in research data services, the majority of veterinary medicine librarians only rarely or occasionally provide data management support as part of their regular job responsibilities. There was little consensus as to whether research data services should be core to a library's mission despite their perceived importance to the advancement of veterinary research. Furthermore, most respondents stated that research data services are just as or somewhat less important than the other services that they provide and feel only slightly or somewhat prepared to offer such services. Lacking a standard definition of "research data" and a common understanding of precisely what research data services encompass, it is difficult for veterinary medicine librarians and libraries to define and understand their roles in research data services. Nonetheless, they appear to have an interest in learning more about and providing research data services.

  12. [Everyday bioethics in general internal medicine].

    Science.gov (United States)

    Lamy, O; Aujesky, D; Vollenweider, P; Waeber, G; Foppa, C

    2006-11-08

    The knowledge of the national legislation and the key concepts of bioethics are necessary for medical practice. The four principles of bioethics are autonomy, beneficence, non-maleficence, and justice. General internal medicine is the speciality of comprehensive care for often elderly patients with multiple chronic illnesses. This care is related to many ethically difficult decisions. In our article, we discuss common ethical problems in general internal medicine, including ethical aspects of the patient-physician relationship and medical decision making, the ethical significance of time management, research in bioethics and medical education.

  13. CAS information services for medicinal chemists.

    Science.gov (United States)

    Heyman, J J; Karasinskia, E H; Giles, P M

    1982-01-01

    In summary, the medicinal chemist has four new ways to access the information contained in the CAS database: CAS ONLINE, the only structure search system based on the entire CAS Registry database, and three printed services, CA SELECTS, BIOSIS/CAS SELECTS, and CAS Customer-Defined Information Services, which provide abstracts on specialized topics of interest.

  14. ¿Medicina general integral o medicina familiar? ¿Integral general medicine or family medicine?

    Directory of Open Access Journals (Sweden)

    Leonardo A. Cuesta Mejías

    2007-09-01

    Full Text Available En el presente trabajo, además de ofrecer la opinión basada en la experiencia personal del autor, se aplica encuesta confeccionada al efecto en la que se indaga fundamentalmente cuál es la preferencia de los profesionales vinculados a la práctica de la Medicina General Integral o de la Medicina Familiar a la hora de denominar la especialidad que desempeñan. Es decir, responder la pregunta que da título al trabajo es la intención u objetivo general del mismo.At present paper, beside to offer author's personal experience-based opinion, it is applied survey to know which is the preference of professionals related to practice of Integral General Medicine o Family Medicine, at moment of to denominates its real specialty. That is, to answer the question that is the title of this paper, is its general aim.

  15. Heart Rate Variability Analysis in General Medicine

    Directory of Open Access Journals (Sweden)

    Yi Gang

    2003-01-01

    Full Text Available Autonomic nervous system plays an integral role in homeostasis. Autonomic modulation can frequently be altered in patients with cardiac disorders as well as in patients with other critical illnesses or injuries. Assessment of heart rate variability is based on analysis of consecutive normal R-R intervals and may provide quantitative information on the modulation of cardiac vagal and sympathetic nerve input. The hypothesis that depressed heart rate variability may occur over a broad range of illness and injury, and may inversely correlated with disease severity and outcome has been tested in various clinical settings over the last decade. This article reviews recent literature concerning the potential clinical implications and limitations of heart rate variability assessment in general medicine.

  16. [Relevant publications in ambulatory general internal medicine in 2007].

    Science.gov (United States)

    Amstutz, R; Humair, J P; Junod Perron, N; Malacarne, S; Nyffenegger, L; Rieder, J P; Steiner, A S; Motamed, S

    2008-01-30

    Screening procedures for genital Chlamydia infection, cancer risks linked to oral contraceptives, indications and efficacy of HPV vaccination, and diagnostic tools for celiac disease in adults; these are just a few of the general practice themes that were reviewed and analysed in 2007 by residents and chief residents at the Community medicine and primary care Service of the Geneva University Hospitals. These commented summaries, intended for all our colleagues, constitute Geneva's contribution to the literature data base initiated in 2005 by chief residents in Lausanne.

  17. Sleep medicine services in Saudi Arabia: The 2013 national survey

    Directory of Open Access Journals (Sweden)

    Ahmed S Bahammam

    2014-01-01

    Conclusion: The sleep medicine services provided in the KSA have improved since the 2005 survey; however, these services are still below the level of service provided in developed countries. Organized efforts are needed to overcome the identified obstacles and challenges to the progress of sleep medicine in the KSA.

  18. services in nigeria: perception of general practitioners

    African Journals Online (AJOL)

    Departments of *Radiology and **General Medical Practice. ... Aim: To determine General Practitioners' perceptions of factors influencing patient's access to ... Health insurance and subsidized services as well as training of personnel are ...

  19. [Constitutions and generalities in traditional Tibetan medicine].

    Science.gov (United States)

    Rovere, P M

    1986-04-28

    The present work is the result of a preliminary study promoted by C.I.S.ME.T. (the International Tibetan Medicine Study Centre) and aims to unify the diagnostic and therapeutic language of various medical cultures. In line with the spirit of the W.H.O. aimed at safeguarding the cultural heritage represented by popular and traditional medicine, encouraged by the Tibetan Medical Centre and under the auspices of His Holiness the Dalai Lama a terminological and conceptual integration of the basic elements of traditional Tibetan medicine is proposed. The Rlung, Bad Kan, Mkris Pa constitution is correlated with embryological anatomy. The 5 exhalations, 5 biles and 5 phlegbs are analysed from a tissue viewpoint with a search for parallels with embryological tissues.

  20. [Precision medicine : a required approach for the general internist].

    Science.gov (United States)

    Waeber, Gérard; Cornuz, Jacques; Gaspoz, Jean-Michel; Guessous, Idris; Mooser, Vincent; Perrier, Arnaud; Simonet, Martine Louis

    2017-01-18

    The general internist cannot be a passive bystander of the anticipated medical revolution induced by precision medicine. This latter aims to improve the predictive and/or clinical course of an individual by integrating all biological, genetic, environmental, phenotypic and psychosocial knowledge of a person. In this article, national and international initiatives in the field of precision medicine are discussed as well as the potential financial, ethical and limitations of personalized medicine. The question is not to know if precision medicine will be part of everyday life but rather to integrate early the general internist in multidisciplinary teams to ensure optimal information and shared-decision process with patients and individuals.

  1. 78 FR 32461 - Verizon Services Corporation, Customer Service Clerk, General Clerk, Clarksburg, West Virginia...

    Science.gov (United States)

    2013-05-30

    ... Employment and Training Administration Verizon Services Corporation, Customer Service Clerk, General Clerk... workers and former workers of Verizon Services Corporation, Customer Service Clerk, General Clerk.... Workers of Verizon Services Corporation's Customer Service Clerk, General Clerk business unit at...

  2. Health services under the General Agreement on Trade in Services.

    OpenAIRE

    Adlung, R.; Carzaniga, A.

    2001-01-01

    The potential for trade in health services has expanded rapidly in recent decades. More efficient communication systems have helped to reduce distance-related barriers to trade; rising incomes and enhanced information have increased the mobility of patients; and internal cost pressures have led various governments to consider possibilities for increased private participation. As yet, however, health services have played only a modest role in the General Agreement on Trade in Services (GATS). ...

  3. The role of general nuclear medicine in breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Greene, Lacey R, E-mail: lgreene@csu.edu.au [Faculty of Science, Charles Sturt University, Wagga Wagga, New South Wales (Australia); Wilkinson, Deborah [Faculty of Health, Wheeling Jesuit University, Wheeling, West Virginia (United States); Faculty of Science, Charles Sturt University, Wagga Wagga, New South Wales (Australia)

    2015-03-15

    The rising incidence of breast cancer worldwide has prompted many improvements to current care. Routine nuclear medicine is a major contributor to a full gamut of clinical studies such as early lesion detection and stratification; guiding, monitoring, and predicting response to therapy; and monitoring progression, recurrence or metastases. Developments in instrumentation such as the high-resolution dedicated breast device coupled with the diagnostic versatility of conventional cameras have reinserted nuclear medicine as a valuable tool in the broader clinical setting. This review outlines the role of general nuclear medicine, concluding that targeted radiopharmaceuticals and versatile instrumentation position nuclear medicine as a powerful modality for patients with breast cancer.

  4. [Smoking cessation: experience in general medicine].

    Science.gov (United States)

    Cnockaert, P

    2003-09-01

    The author reviews the main psychological resistances that may be the origin of discomfort and diminishing efficiency for the general practitioner when the meets tobacco addict patients in his practice. He examines the different stages of the tobacco addicts patients according to the Prochaska and Di Clemente model and discusses stage after stage the patient's motivations and the interventions of the general practitioner. He insists on the necessary adequacy between these aspects and proposes a possible content for follow-up consultations.

  5. REGENERATIVE MEDICINE AS APPLIED TO GENERAL SURGERY

    Science.gov (United States)

    Orlando, Giuseppe; Wood, Kathryn J; De Coppi, Paolo; Baptista, Pedro M; Binder, Kyle W; Bitar, Khalil N; Breuer, Christopher; Burnett, Luke; Christ, George; Farney, Alan; Figliuzzi, Marina; Holmes, James H; Koch, Kenneth; Macchiarini, Paolo; Sani, Sayed-Hadi Mirmalek; Opara, Emmanuel; Remuzzi, Andrea; Rogers, Jeffrey; Saul, Justin M; Seliktar, Dror; Shapira-Schweitzer, Keren; Smith, Tom; Solomon, Daniel; Van Dyke, Mark; Yoo, James J; Zhang, Yuanyuan; Atala, Anthony; Stratta, Robert J; Soker, Shay

    2012-01-01

    The present review illustrates the state of the art of regenerative medicine (RM) as applied to surgical diseases and demonstrates that this field has the potential to address some of the unmet needs in surgery. RM is a multidisciplinary field whose purpose is to regenerate in vivo or ex vivo human cells, tissues or organs in order to restore or establish normal function through exploitation of the potential to regenerate, which is intrinsic to human cells, tissues and organs. RM uses cells and/or specially designed biomaterials to reach its goals and RM-based therapies are already in use in several clinical trials in most fields of surgery. The main challenges for investigators are threefold: Creation of an appropriate microenvironment ex vivo that is able to sustain cell physiology and function in order to generate the desired cells or body parts; identification and appropriate manipulation of cells that have the potential to generate parenchymal, stromal and vascular components on demand, both in vivo and ex vivo; and production of smart materials that are able to drive cell fate. PMID:22330032

  6. [Exploring a new mode of integrative medicine information service].

    Science.gov (United States)

    Su, Da-Ming; Fan, Wei-Yu; Cui, Meng

    2012-06-01

    With the significant and continuous growth of the research and application of complementary and alternative medicine (CAM) all over the world, the demand for medical information services has been increasing correspondingly. However, the barriers of accessing and utilizing non-English literature, and the barrier of language have blocked English speaking clinicians and researchers of CAM from obtaining high quality and authoritative medical evidence from the non-English medical resources. This article, with introducing the UCLA Information Center for East-West Integrative Medicine, will demonstrate a new collaborative mode of integrative medicine information service between China and the US, and discuss the perceived challenges.

  7. Consumer preferences for general practitioner services.

    Science.gov (United States)

    Morrison, Mark; Murphy, Tom; Nalder, Craig

    2003-01-01

    This study focuses on segmenting the market for General Practitioner services in a regional setting. Using factor analysis, five main service attributes are identified. These are clear communication, ongoing doctor-patient relationship, same gender as the patient, provides advice to the patient, and empowers the patient to make his/her own decisions. These service attributes are used as a basis for market segmentation, using both socio-demographic variables and cluster analysis. Four distinct market segments are identified, with varying degrees of viability in terms of target marketing.

  8. Demand for general practitioner and internist services.

    Science.gov (United States)

    Guzick, D S

    1978-01-01

    Demand equations for general-practitioner and internist visits were estimated from 1970 CHAS-NORC survey data on health-service utilization and expenditure. Because a large proportion of respondents reported zero visits, observations were grouped according to cross-classified independent variables and regression analyses were performed using group means as data. The results showed significant differences between demand equations for general-practitioner visits and those for internist visits. Of potential importance was an apparent substitution of internists for general practitioners as ability to pay (income or insurance coverage) increased. Own-price elasticities were low for both general practitioners and internists but were even lower for the latter (0.1 to 0.02) than the former (0.2 to 0.3). The demand for services of the two specialties also differed with respect to disability days, age, sex, residence, and race. PMID:738894

  9. Global health education in general preventive medicine residencies.

    Science.gov (United States)

    Bussell, Scottie A; Kihlberg, Courtney J; Foderingham, Nia M; Dunlap, Julie A; Aliyu, Muktar H

    2015-05-01

    Opportunities for global health training during residency are steadily increasing. For example, surveys show that more than half of residency programs now offer international electives. Residency programs are increasingly recognizing that global health training improves communication skills, fosters awareness of health disparities, and inspires careers in primary care and public health. Although research has focused on global health education in other specialties, there is a paucity of research on global health training in public health and general preventive medicine (GPM). We sought to describe the extent of global health training across GPM residencies, capture the perspectives of program directors regarding competencies residents need for careers in global health, and identify program directors' perceived barriers to providing global health training. The survey was sent electronically to 42 U.S. GPM residency program directors from September to October 2013. Twenty-three completed surveys were returned. Information from residencies that did not complete the study survey was collected through a predefined search protocol. Data analysis was performed from February through July 2014. Among program directors completing the survey, the most common types of reported global health education were courses (n=17), followed by international rotations (n=10). Ten program directors indicated that resident(s) were involved in global health training, research, or service initiatives. Commonly perceived barriers included funding (87%), scheduling (56.5%), and partnership and sustainability (34.8%). Through global health coursework, research, and practicum rotations, GPM residents could acquire skills, knowledge, and attitudes contributing to careers in global health.

  10. Academic general internal medicine: a mission for the future.

    Science.gov (United States)

    Armstrong, Katrina; Keating, Nancy L; Landry, Michael; Crotty, Bradley H; Phillips, Russell S; Selker, Harry P

    2013-06-01

    After five decades of growth that has included advances in medical education and health care delivery, value cohesion, and integration of diversity, we propose an overarching mission for academic general internal medicine to lead excellence, change, and innovation in clinical care, education, and research. General internal medicine aims to achieve health care delivery that is comprehensive, technologically advanced and individualized; instills trust within a culture of respect; is efficient in the use of time, people, and resources; is organized and financed to achieve optimal health outcomes; maximizes equity; and continually learns and adapts. This mission of health care transformation has implications for the clinical, educational, and research activities of divisions of general internal medicine over the next several decades.

  11. Medication discrepancies at discharge from an internal medicine service.

    Science.gov (United States)

    Herrero-Herrero, José-Ignacio; García-Aparicio, Judit

    2011-02-01

    Medication errors most commonly occur at the time of medication prescribing and particularly at the moment of the transitions of care. The objectives of this study were to identify and characterize the discrepancies between the physicians' discharge medication orders and the medication lists at admission obtained by an internal medicine specialist physician in a general internal medicine service. This descriptive, retrospective, study was carried out at a tertiary care university teaching hospital in Spain. It was based on the review of non selected, consecutive, hospital discharge reports. Discrepancies were identified, categorized and characterized through the analysis of the information (medication lists, laboratory tests results, diagnosis, and clinical evolution) contained in them. We analyzed 954 discharge reports. In the medication reconciliation process, we find discrepancies in 832 (87.2%) of them. Justified discrepancies were found in 828 (86.8%) reports and unjustified discrepancies in 52 (5.4%). Omission of a medication was the most frequent medication error detected in 86.4% of cases, followed by incomplete prescription (9.6%). The number of diagnosis, the length of hospital stay and the number of permanent medications at admission were the characteristics of cases associated with medication discrepancies in multivariate linear regression (Premarkable the low number of medication errors detected in our study. Appropriate routines to ensure an accurate medication history collection and a methodical elaboration of the medication list at discharge, when performed by trained internists, are important for an adequate medication reconciliation process. Copyright © 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  12. Health services under the General Agreement on Trade in Services.

    Science.gov (United States)

    Adlung, R; Carzaniga, A

    2001-01-01

    The potential for trade in health services has expanded rapidly in recent decades. More efficient communication systems have helped to reduce distance-related barriers to trade; rising incomes and enhanced information have increased the mobility of patients; and internal cost pressures have led various governments to consider possibilities for increased private participation. As yet, however, health services have played only a modest role in the General Agreement on Trade in Services (GATS). It is possible that Members of the World Trade Organization have been discouraged from undertaking access commitments by the novelty of the Agreement, coordination problems between relevant agencies, widespread inexperience in concepts of services trade, a traditionally strong degree of government involvement in the health sector, and concerns about basic quality and social objectives. However, more than five years have passed since GATS entered into force, allowing hesitant administrations to familiarize themselves with its main elements and its operation in practice. The present paper is intended to contribute to this process. It provides an overview of the basic structure of GATS and of the patterns of current commitments in health services and of limitations frequently used in this context. The concluding section discusses possibilities of pursuing basic policy objectives in a more open environment and indicates issues that may have to be dealt with in current negotiations on services.

  13. Determining the Frequency of Defensive Medicine Among General Practitioners in Southeast Iran

    Directory of Open Access Journals (Sweden)

    Mahmood Moosazadeh

    2014-04-01

    Full Text Available Background Defensive medicine prompts physicians not to admit high-risk patients who need intensive care. This phenomenon not only decreases the quality of healthcare services, but also wastes scarce health resources. Defensive medicine occurs in negative and positive forms. Hence, the present study aimed to determine frequency of positive and negative defensive medicine behaviors and their underlying factors among general practitioners in Southeast Iran. Methods The present cross-sectional study was performed among general practitioners in Southeast Iran. 423 subjects participated in the study on a census basis and a questionnaire was used for data collection. Data analysis was carried out using descriptive and analytical statistics through SPSS 20. Results The majority of participants were male (58.2%. The mean age of physicians was 40 ± 8.5. The frequency of positive and negative defensive medicine among general practitioners in Southeast Iran was 99.8% and 79.2% respectively. A significant relationship was observed between working experience, being informed of law suits against their colleagues, and committing defensive medicine behavior (P< 0.001. Conclusion The present study indicated high frequency of defensive medicine behavior in the Southeast Iran. So, it calls policy-makers special attention to improve the status quo.

  14. 77 FR 4203 - Energy Conservation Program: Test Procedures for General Service Fluorescent Lamps, General...

    Science.gov (United States)

    2012-01-27

    ... Fluorescent Lamps, General Service Incandescent Lamps, and Incandescent Reflector Lamps AGENCY: Office of... the test procedures for general service fluorescent lamps (GSFLs), general service incandescent lamps (GSILs), and incandescent reflector lamps (IRLs). That proposed rulemaking serves as the basis for...

  15. Specific filters applied in nuclear medicine services

    Energy Technology Data Exchange (ETDEWEB)

    Ramos, Vitor S.; Crispim, Verginia R., E-mail: verginia@con.ufrj.b [Coordenacao dos Programas de Pos-Graduacao de Engenharia (PEN/COPPE/UFRJ), RJ (Brazil). Programa de Engenharia Nuclear; Brandao, Luis E.B. [Instituto de Engenharia Nuclear (IEN/CNEN-RJ) Rio de Janeiro, RJ (Brazil)

    2011-07-01

    In Nuclear Medicine, radioiodine, in various chemical forms, is a key tracer used in diagnostic practices and/or therapy. Due to its high volatility, medical professionals may incorporate radioactive iodine during the preparation of the dose to be administered to the patient. In radioactive iodine therapy doses ranging from 3.7 to 7.4 GBq per patient are employed. Thus, aiming at reducing the risk of occupational contamination, we developed a low cost filter to be installed at the exit of the exhaust system where doses of radioactive iodine are fractionated, using domestic technology. The effectiveness of radioactive iodine retention by silver impregnated silica [10%] crystals and natural activated carbon was verified using radiotracer techniques. The results showed that natural activated carbon is effective for I{sub 2} capture for a large or small amount of substrate but its use is restricted due to its low flash point (150 deg C). Besides, when poisoned by organic solvents, this flash point may become lower, causing explosions if absorbing large amounts of nitrates. To hold the CH{sub 3}I gas, it was necessary to increase the volume of natural activated carbon since it was not absorbed by SiO{sub 2} + Ag crystals. We concluded that, for an exhaust flow range of (306 {+-} 4) m{sup 3}/h, a double stage filter using SiO{sub 2} + Ag in the first stage and natural activated carbon in the second is sufficient to meet radiological safety requirements. (author)

  16. Author self-citation in the general medicine literature.

    Directory of Open Access Journals (Sweden)

    Abhaya V Kulkarni

    Full Text Available BACKGROUND: Author self-citation contributes to the overall citation count of an article and the impact factor of the journal in which it appears. Little is known, however, about the extent of self-citation in the general clinical medicine literature. The objective of this study was to determine the extent and temporal pattern of author self-citation and the article characteristics associated with author self-citation. METHODOLOGY/PRINCIPAL FINDINGS: We performed a retrospective cohort study of articles published in three high impact general medical journals (JAMA, Lancet, and New England Journal of Medicine between October 1, 1999 and March 31, 2000. We retrieved the number and percentage of author self-citations received by the article since publication, as of June 2008, from the Scopus citation database. Several article characteristics were extracted by two blinded, independent reviewers for each article in the cohort and analyzed in multivariable linear regression analyses. Since publication, author self-citations accounted for 6.5% (95% confidence interval 6.3-6.7% of all citations received by the 328 articles in our sample. Self-citation peaked in 2002, declining annually thereafter. Studies with more authors, in cardiovascular medicine or infectious disease, and with smaller sample size were associated with more author self-citations and higher percentage of author self-citation (all p≤0.01. CONCLUSIONS/SIGNIFICANCE: Approximately 1 in 15 citations of articles in high-profile general medicine journals are author self-citations. Self-citation peaks within about 2 years of publication and disproportionately affects impact factor. Studies most vulnerable to this effect are those with more authors, small sample size, and in cardiovascular medicine or infectious disease.

  17. 42 CFR 482.53 - Condition of participation: Nuclear medicine services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Nuclear medicine... HOSPITALS Optional Hospital Services § 482.53 Condition of participation: Nuclear medicine services. If the hospital provides nuclear medicine services, those services must meet the needs of the patients...

  18. Comparison of pharmacist and public views and experiences of community pharmacy medicines-related services in England

    Science.gov (United States)

    Rodgers, Ruth M; Gammie, Shivaun M; Loo, Ruey Leng; Corlett, Sarah A; Krska, Janet

    2016-01-01

    Background Services provided by community pharmacists designed to support people using medicines are increasing. In England, two national services exist: Medicine Use Reviews (MUR) and New Medicines Service (NMS). Very few studies have been conducted seeking views of the public, rather than service users, on willingness to use these services or expectations of these services, or determined whether views align with pharmacist perceptions. Objective To compare the perceptions of pharmacists and the general public on medicines-related services, particularly MUR and NMS services. Methods Two parallel surveys were conducted in one area of England: one involved the general public and was administered using a street survey, and the other was a postal survey of community pharmacists. Similar questionnaires were used, seeking views of services, awareness, reasons for using services, and perceived benefits. Results Response rates were 47.2% (1,000/2,012 approached) for the public and 40.8% (341/836) for pharmacists. Few people had experienced a discussion in a private consultation room or were aware of the two formal services, although their willingness to use them was high. Pharmacists estimated time spent on service provision as 10 minutes for MUR and 12 minutes for NMS, which aligned with acceptability to both pharmacists and the public. Pharmacists underestimated the willingness of the public to wait for an informal discussion or to make appointments for formal services. Both pharmacists and the public had high expectations that services would be beneficial in terms of increasing knowledge and understanding, but public expectations and experiences of services helping to sort out problems fell well below pharmacists’ perceptions. People who had experienced a pharmacy service had different perceptions of pharmacists. Conclusion Views differed regarding why people use services and key aspects of service delivery. For services to improve, the pharmacy profession needs a

  19. Comparison of pharmacist and public views and experiences of community pharmacy medicines-related services in England.

    Science.gov (United States)

    Rodgers, Ruth M; Gammie, Shivaun M; Loo, Ruey Leng; Corlett, Sarah A; Krska, Janet

    2016-01-01

    Services provided by community pharmacists designed to support people using medicines are increasing. In England, two national services exist: Medicine Use Reviews (MUR) and New Medicines Service (NMS). Very few studies have been conducted seeking views of the public, rather than service users, on willingness to use these services or expectations of these services, or determined whether views align with pharmacist perceptions. To compare the perceptions of pharmacists and the general public on medicines-related services, particularly MUR and NMS services. Two parallel surveys were conducted in one area of England: one involved the general public and was administered using a street survey, and the other was a postal survey of community pharmacists. Similar questionnaires were used, seeking views of services, awareness, reasons for using services, and perceived benefits. Response rates were 47.2% (1,000/2,012 approached) for the public and 40.8% (341/836) for pharmacists. Few people had experienced a discussion in a private consultation room or were aware of the two formal services, although their willingness to use them was high. Pharmacists estimated time spent on service provision as 10 minutes for MUR and 12 minutes for NMS, which aligned with acceptability to both pharmacists and the public. Pharmacists underestimated the willingness of the public to wait for an informal discussion or to make appointments for formal services. Both pharmacists and the public had high expectations that services would be beneficial in terms of increasing knowledge and understanding, but public expectations and experiences of services helping to sort out problems fell well below pharmacists' perceptions. People who had experienced a pharmacy service had different perceptions of pharmacists. Views differed regarding why people use services and key aspects of service delivery. For services to improve, the pharmacy profession needs a better awareness of what the public, especially

  20. General Practitioners Using Complementary and Alternative Medicine Differ From General Practitioners Using Conventional Medicine in Their View of the Risks of Electromagnetic Fields

    DEFF Research Database (Denmark)

    Kowall, Bernd; Breckenkamp, Jürgen; Berg-Beckhoff, Gabriele

    2015-01-01

    OBJECTIVE: General practitioners (GPs) play a key role in consulting patients worried about health effects of electromagnetic fields (EMF). We compared GPs using conventional medicine (COM) with GPs using complementary and alternative medicine (CAM) concerning their perception of EMF risks...

  1. Corporate travel medicine: benefit analysis of on-site services.

    Science.gov (United States)

    Prince, T S; Spengler, S E; Collins, T R

    2001-01-01

    Corporations with employees who travel internationally address their travel-related medical needs in a variety of ways. Options utilized include corporate medical departments, local health departments, and local clinics, both contracted and independent. A travel clinic at a university medical center routinely provided preventive travel medicine services for many of the local companies. Two of these companies had on-site medical clinics which routinely saw patients for occupational and personal health reasons. At these companies , the university travel clinic assisted in moving employee travel medicine services to the on-site clinic. Direct and indirect costs for new, predeparture employee travel care at each company were compared before, and after, the move on-site. When measured per patient, total cost savings associated with the on-site travel clinic were greater than 15% at both companies (17%, 25%), primarily due to the value of the employees' time saved with decreased travel. Utilization increased at one company by 24% over the first 8 months and lead to higher overall cost, but this cost increase was only 4%. Informal assessments of the value of the on-site service at both companies was uniformly positive. For certain corporate settings, on-site clinics may be effective ways of providing travel medicine services.

  2. US Forest Service Surface Ownership Parcels (Generalized)

    Data.gov (United States)

    US Forest Service, Department of Agriculture — A map service on the www depicting areas as surface ownership parcels dissolved on the same ownership classification. This map service was prepared to describe...

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

    Directory of Open Access Journals (Sweden)

    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

  4. 75 FR 31702 - General Information on Postal Service

    Science.gov (United States)

    2010-06-04

    ... From the Federal Register Online via the Government Publishing Office POSTAL SERVICE 39 CFR PART 111 General Information on Postal Service AGENCY: Postal Service. ACTION: Final rule. SUMMARY: The... above, the Postal Service hereby amends 39 CFR Part 111 as follows: PART 111--GENERAL INFORMATION...

  5. Prevalence of myofascial pain in general internal medicine practice.

    OpenAIRE

    Skootsky, S A; Jaeger, B; Oye, R K

    1989-01-01

    Myofascial pain is a regional pain syndrome characterized in part by a trigger point in a taut band of skeletal muscle and its associated referred pain. We examined a series of 172 patients presenting to a university primary care general internal medicine practice. Of 54 patients whose reason for a visit included pain, 16 (30%) satisfied criteria for a clinical diagnosis of myofascial pain. These patients were similar in age and sex to other patients with pain, and the frequency of pain as a ...

  6. Medicines use among general public in Taif, KSA

    Directory of Open Access Journals (Sweden)

    Qasem M. A. Abdallah

    2014-01-01

    Full Text Available Objectives: Patient practice toward medication including the extent of self-medication has an important impact on therapeutic outcome. Therefore, this study aimed to assess general public practice toward the usage of medicines in Taif city. Materials and Methods: A cross-sectional research design using nonprobability convenience sampling technique was used in this study. Data were collected face-to-face from literate adults in public areas such as malls, shopping centers, and health centers. Data were analyzed using SPSS version 16 and significant values of difference were determined using the Chi-square and Fisher Exact tests. Results: Nine hundred questionnaires were successfully collected from literate adults in Taif city over 8 weeks. Eighty percent of respondents tend to stop taking their medications once they feel good. In addition, only 62% of respondents refer to pharmacists or doctors once they feel unwell. On the other hand, one-fifth of respondents store their medications as directed by the pharmacist or as written in the drug leaflet. Furthermore, as little as 12% of respondents consult a doctor or a pharmacist once they miss their medication dose. Conclusion: This study demonstrates that public in Taif city has, to a certain extent, improper practice toward medicine. Thus, it is of urge for healthcare and policymakers to develop healthcare programs aiming to enhance practice of public toward medicines.

  7. Innovations in service learning: a novel program for community service at NYU School of Medicine.

    Science.gov (United States)

    Herlihy, Nola Seta; Brown, Christina

    2015-01-01

    As NYU medical students, the authors determined that there was no structured form of service learning in their curriculum. They sought to establish a service program that recognizes students for their dedication to community service in both the NYU and NYC communities. In 2012, with the support of the Office of Student Affairs (OSA), the authors created the NYU School of Medicine Community Service Program (CSP). The program tracks and verifies students' participation in service projects. It sets a goal for students to complete 100 service hours through at least five unique service initiatives. Two reflective essays at the completion of pre-clinical and core clerkship curricula challenge students to express how their service experiences will inform their future careers in medicine. The authors developed an innovative online portal for students to track their service involvement and allow the committee to easily approve hours. They created the Community Service Committee, made up of two representatives from each class year, to be in charge of regulating the program together with the OSA. The class of 2015 is the first class to participate; thus far, 13 students have met program requirements. In the classes of 2016 and 2017, 20 and 41 students, respectively, are expected to receive the award. Total participation has significantly increased in successive class years. The authors seek to gather data on CSP participants' changing perspectives and hope the program can serve as a model for other schools to build service learning into their curricula.

  8. Innovations in service learning: a novel program for community service at NYU School of Medicine

    Directory of Open Access Journals (Sweden)

    Nola Seta Herlihy

    2015-09-01

    Full Text Available Problem: As NYU medical students, the authors determined that there was no structured form of service learning in their curriculum. They sought to establish a service program that recognizes students for their dedication to community service in both the NYU and NYC communities. Approach: In 2012, with the support of the Office of Student Affairs (OSA, the authors created the NYU School of Medicine Community Service Program (CSP. The program tracks and verifies students’ participation in service projects. It sets a goal for students to complete 100 service hours through at least five unique service initiatives. Two reflective essays at the completion of pre-clinical and core clerkship curricula challenge students to express how their service experiences will inform their future careers in medicine. The authors developed an innovative online portal for students to track their service involvement and allow the committee to easily approve hours. They created the Community Service Committee, made up of two representatives from each class year, to be in charge of regulating the program together with the OSA. Outcomes: The class of 2015 is the first class to participate; thus far, 13 students have met program requirements. In the classes of 2016 and 2017, 20 and 41 students, respectively, are expected to receive the award. Total participation has significantly increased in successive class years. Next steps: The authors seek to gather data on CSP participants’ changing perspectives and hope the program can serve as a model for other schools to build service learning into their curricula.

  9. Citation distribution profile in Brazilian journals of general medicine.

    Science.gov (United States)

    Lustosa, Luiggi Araujo; Chalco, Mario Edmundo Pastrana; Borba, Cecília de Melo; Higa, André Eizo; Almeida, Renan Moritz Varnier Rodrigues

    2012-01-01

    Impact factors are currently the bibliometric index most used for evaluating scientific journals. However, the way in which they are used, for instance concerning the study or journal types analyzed, can markedly interfere with estimate reliability. This study aimed to analyze the citation distribution pattern in three Brazilian journals of general medicine. This was a descriptive study based on numbers of citations of scientific studies published by three Brazilian journals of general medicine. The journals analyzed were São Paulo Medical Journal, Clinics and Revista da Associação Médica Brasileira. This survey used data available from the Institute for Scientific Information (ISI) platform, from which the total number of papers published in each journal in 2007-2008 and the number of citations of these papers in 2009 were obtained. From these data, the citation distribution was derived and journal impact factors (average number of citations) were estimated. These factors were then compared with those directly available from the ISI Journal of Citation Reports (JCR). Respectively, 134, 203 and 192 papers were published by these journals during the period analyzed. The observed citation distributions were highly skewed, such that many papers had few citations and a small percentage had many citations. It was not possible to identify any specific pattern for the most cited papers or to exactly reproduce the JCR impact factors. Use of measures like "impact factors", which characterize citations through averages, does not adequately represent the citation distribution in the journals analyzed.

  10. [Should modern medicine become a service industry? An ethical appraisal of a market-oriented medicine].

    Science.gov (United States)

    Maio, Giovanni

    2009-08-01

    Currently, modern medicine is undergoing fundamental transformation. Care for the patient has transformed into a client service delivery where patients are perceived as customers. It's not just simple semantics. Rather, such changes reflect a fundamental shift in human and social values and, in particular, in human self-awareness. Health has become the absolute and natural human condition which can and must be claimed and it has become the epitome of an individual's potential. In turn, these changes have a sensitively responding addressee. They affect the moral values and the sense of identity of health care workers and especially of physicians. Thus, it is a network of interlinked external and internal factors that are reshaping the core values and professional identity of medicine. In these times of change it is pivotal to ponder about the basic task of medicine and what medicine is actually meant to be. Replacing health care providers for patients by economically focused traders serving the needs of demanding clients constitutes a shift in paradigm. It is medicine as a health care profession and the specific needs of suffering patients and disabled individuals what is at stake here.

  11. 78 FR 8589 - Verizon Services Corporation, Customer Services Clerk, General Clerk, Clarksburg, WV; Notice of...

    Science.gov (United States)

    2013-02-06

    ... Employment and Training Administration Verizon Services Corporation, Customer Services Clerk, General Clerk... of Verizon Services Corporation, Customer Services Clerk, General Clerk, Clarksburg, West Virginia... country the supply of services like or directly competitive with those supplied by the workers and did not...

  12. 47 CFR 76.1602 - Customer service-general information.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 4 2010-10-01 2010-10-01 false Customer service-general information. 76.1602... MULTICHANNEL VIDEO AND CABLE TELEVISION SERVICE Notices § 76.1602 Customer service—general information. (a) A cable franchise authority may enforce the customer service standards set forth in paragraph (b) of this...

  13. Citation distribution profile in Brazilian journals of general medicine

    Directory of Open Access Journals (Sweden)

    Luiggi Araujo Lustosa

    Full Text Available CONTEXT AND OBJECTIVE: Impact factors are currently the bibliometric index most used for evaluating scientific journals. However, the way in which they are used, for instance concerning the study or journal types analyzed, can markedly interfere with estimate reliability. This study aimed to analyze the citation distribution pattern in three Brazilian journals of general medicine. DESIGN AND SETTING: This was a descriptive study based on numbers of citations of scientific studies published by three Brazilian journals of general medicine. METHODS: The journals analyzed were São Paulo Medical Journal, Clinics and Revista da Associação Médica Brasileira. This survey used data available from the Institute for Scientific Information (ISI platform, from which the total number of papers published in each journal in 2007-2008 and the number of citations of these papers in 2009 were obtained. From these data, the citation distribution was derived and journal impact factors (average number of citations were estimated. These factors were then compared with those directly available from the ISI Journal of Citation Reports (JCR. RESULTS: Respectively, 134, 203 and 192 papers were published by these journals during the period analyzed. The observed citation distributions were highly skewed, such that many papers had few citations and a small percentage had many citations. It was not possible to identify any specific pattern for the most cited papers or to exactly reproduce the JCR impact factors. CONCLUSION: Use of measures like "impact factors", which characterize citations through averages, does not adequately represent the citation distribution in the journals analyzed.

  14. Outpatient Management of Hypertension By General Medicine and Traditional Track Residents.

    Science.gov (United States)

    Robie, Peter W.; Andrus, Peter L.

    1982-01-01

    A study to determine whether general internal medicine and traditional track medicine residents differed in their outpatient management of essential hypertension is discussed. General internal medicine residents seem to do better in the areas of assessment of drug side effects and patient education. (MLW)

  15. Comparison of pharmacist and public views and experiences of community pharmacy medicines-related services in England

    Directory of Open Access Journals (Sweden)

    Rodgers RM

    2016-09-01

    Full Text Available Ruth M Rodgers, Shivaun M Gammie, Ruey Leng Loo, Sarah A Corlett, Janet Krska Medway School of Pharmacy, The Universities of Greenwich and Kent, Chatham Maritime, UK Background: Services provided by community pharmacists designed to support people using medicines are increasing. In England, two national services exist: Medicine Use Reviews (MUR and New Medicines Service (NMS. Very few studies have been conducted seeking views of the public, rather than service users, on willingness to use these services or expectations of these services, or determined whether views align with pharmacist perceptions. Objective: To compare the perceptions of pharmacists and the general public on medicines-related services, particularly MUR and NMS services. Methods: Two parallel surveys were conducted in one area of England: one involved the general public and was administered using a street survey, and the other was a postal survey of community pharmacists. Similar questionnaires were used, seeking views of services, awareness, reasons for using services, and perceived benefits. Results: Response rates were 47.2% (1,000/2,012 approached for the public and 40.8% (341/836 for pharmacists. Few people had experienced a discussion in a private consultation room or were aware of the two formal services, although their willingness to use them was high. Pharmacists estimated time spent on service provision as 10 minutes for MUR and 12 minutes for NMS, which aligned with acceptability to both pharmacists and the public. Pharmacists underestimated the willingness of the public to wait for an informal discussion or to make appointments for formal services. Both pharmacists and the public had high expectations that services would be beneficial in terms of increasing knowledge and understanding, but public expectations and experiences of services helping to sort out problems fell well below pharmacists’ perceptions. People who had experienced a pharmacy service had

  16. 78 FR 10174 - Public Availability of General Services Administration FY 2012 Service Contract Inventory

    Science.gov (United States)

    2013-02-13

    ... ADMINISTRATION Public Availability of General Services Administration FY 2012 Service Contract Inventory AGENCY: General Services Administration (GSA). ACTION: Notice of Public Availability of FY 2012 Service Contract... Appropriations Act Public Law 111-117, GSA is publishing this notice to advise the public of the availability...

  17. The validity of peer review in a general medicine journal.

    Directory of Open Access Journals (Sweden)

    Jeffrey L Jackson

    Full Text Available UNLABELLED: All the opinions in this article are those of the authors and should not be construed to reflect, in any way, those of the Department of Veterans Affairs. BACKGROUND: Our study purpose was to assess the predictive validity of reviewer quality ratings and editorial decisions in a general medicine journal. METHODS: Submissions to the Journal of General Internal Medicine (JGIM between July 2004 and June 2005 were included. We abstracted JGIM peer review quality ratings, verified the publication status of all articles and calculated an impact factor for published articles (Rw by dividing the 3-year citation rate by the average for this group of papers; an Rw>1 indicates a greater than average impact. RESULTS: Of 507 submissions, 128 (25% were published in JGIM, 331 rejected (128 with review and 48 were either not resubmitted after revision was requested or were withdrawn by the author. Of 331 rejections, 243 were published elsewhere. Articles published in JGIM had a higher citation rate than those published elsewhere (Rw: 1.6 vs. 1.1, p = 0.002. Reviewer quality ratings of article quality had good internal consistency and reviewer recommendations markedly influenced publication decisions. There was no quality rating cutpoint that accurately distinguished high from low impact articles. There was a stepwise increase in Rw for articles rejected without review, rejected after review or accepted by JGIM (Rw 0.60 vs. 0.87 vs. 1.56, p<0.0005. However, there was low agreement between reviewers for quality ratings and publication recommendations. The editorial publication decision accurately discriminated high and low impact articles in 68% of submissions. We found evidence of better accuracy with a greater number of reviewers. CONCLUSIONS: The peer review process largely succeeds in selecting high impact articles and dispatching lower impact ones, but the process is far from perfect. While the inter-rater reliability between individual

  18. [About development of All-Russian Service for Disaster Medicine at the present stage].

    Science.gov (United States)

    Goncharov, S F; Fisun, A Ia; Bobiĭ, B V

    2013-10-01

    The information about foundation, development and main areas of activity of All-Russian Service for Disaster Medicine is given. Almost 20 years professional staff members help to save lives and health of people injured in emergency situations in Russia and other countries. There are 81 territorial centers for disaster medicine. The main center is All-Russian center for disaster medicine Zaschita. Its organizational structure, performance indexes including development of information and communication technology, telehealth, organization of firs-aid in a traffic collision are considered. The main ways of improvement of the whole service for disaster medicine including service for disaster medicine of Ministry of Defense are shown.

  19. Differences in prescribing patterns for anxiety and depression between General Internal Medicine and Family Medicine.

    Science.gov (United States)

    Brieler, Jay A; Scherrer, Jeffrey F; Salas, Joanne

    2015-02-01

    Depression and anxiety are routinely managed by physicians in Family Medicine (FM) or General Internal Medicine (GIM). Because FM requires more behavioral health training than GIM, we sought to determine if prescribing patterns for patients with anxiety, depression, or both differed between FM vs. GIM providers. In a cross-sectional design, patient data and provider type were obtained from 2008 to 2013 electronic medical record patient data registry (n=27,225 (FM=10,994, GIM=16,231)) Prescription orders were modeled for specific benzodiazepines and antidepressants and by drug class. Covariates included gender, age, race, marital status and comorbidity index. Separate logistic regression models were computed, before and after adjusting for covariates, to estimate the odds of FM vs. GIM providers prescribing benzodiazepine or antidepressant medication to patients with anxiety, depression, and both disorders. After adjusting for covariates, patients with anxiety alone, depression alone, and both had significantly greater odds of receiving an antidepressant (OR=2.08;95%CI:1.46-2.96, OR=2.13;95%CI:1.48-3.06, and OR=2.26;95%CI:1.09-4.66, respectively) if treated by FM vs. GIM. Benzodiazepine prescription did not differ by physician type. It is not known if results will generalize to other regions of the United States. Patients with anxiety, depression, and both seen by FM providers, as compared to GIM providers, are more likely to receive antidepressant medications. Further investigation into the determinants of these differences is warranted. Under-treatment in GIM may result in less advantageous outcomes. Copyright © 2014 Elsevier B.V. All rights reserved.

  20. 29 CFR 552.103 - Babysitting services in general.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Babysitting services in general. 552.103 Section 552.103 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS APPLICATION OF THE FAIR LABOR STANDARDS ACT TO DOMESTIC SERVICE Interpretations § 552.103 Babysitting services...

  1. The British Telecom radiopaging service in general practice.

    Science.gov (United States)

    Cole, F H

    1981-10-01

    This paper reports a new radiopaging service supplied by British Telecom that will eventually cover the whole United Kingdom. The use of this service by a three-man practice is described. The service is considered to be a major development in communications that will be of interest to most general practitioners.

  2. Algebraic Generalization Strategies Used by Kuwaiti Pre-Service Teachers

    Science.gov (United States)

    Alajmi, Amal Hussain

    2016-01-01

    This study reports on the algebraic generalization strategies used by elementary and middle/high school pre-service mathematics teachers in Kuwait. They were presented with 9 tasks that involved linear, exponential, and quadratic situations. The results showed that these pre-service teachers had difficulty in generalizing algebraic rules in all 3…

  3. 48 CFR 7.403 - General Services Administration assistance.

    Science.gov (United States)

    2010-10-01

    ...; and (4) Industry or market trends. (b) Agencies may request information from the following GSA offices... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false General Services... REGULATION ACQUISITION PLANNING ACQUISITION PLANNING Equipment Lease or Purchase 7.403 General Services...

  4. Description of the General Equilibrium Model of Ecosystem Services (GEMES)

    Science.gov (United States)

    Travis Warziniack; David Finnoff; Jenny Apriesnig

    2017-01-01

    This paper serves as documentation for the General Equilibrium Model of Ecosystem Services (GEMES). GEMES is a regional computable general equilibrium model that is composed of values derived from natural capital and ecosystem services. It models households, producing sectors, and governments, linked to one another through commodity and factor markets. GEMES was...

  5. The General Agreement on Trade in Services

    Directory of Open Access Journals (Sweden)

    Francina Esteve García

    1995-07-01

    Full Text Available The conclusion of GATS and its inclusion as an annex in the constitutive Agreement of the World Trade Organization (WTO responds to the need for disposing of a stable juridical instrument which, given the current economic interdependence between States, can be applied to the international trade in services.One of the main new features of this agreement is its field of application given that it includes all service sectors (except those provided for in the name of governmental authorities and the four forms of carrying out trade in services and, as regards the principle of market access and that of national treatment, will be regulated according to those respective obligations which the Members have assumed.In exchange for not accepting the exclusion of any service sector, the negotiations concerning some fundamental sectors could not be totally closed and deadlines were extended in order to unblock the most controversial themes.One of the fundamental principles of the GATS is the most favoured nation clause of inconditional character but its consecration has been attenuated by the possibility of maintaining important exceptions in its application. The principle of transparency is also essential in the field of services, given that this sector is characterised by large public interventionism in access regulation and the exercise of the different economic activities which form it.The balance of the GATS is globally positive given that it includes a multilateral framework of principles and disciplines which is administered in the headquarters of the WTO, which have been accepted by a great majority of States within the international community and which remain subject to the WTO’s mechanism for the solution of differences.However, the opening of the market and the suppression of restrictions which derive from internal regulations have not been achieved given that, orientating itself around the objectives of national politics, liberalization is

  6. How to rationally use information diagnostic technologies in family and general medicine practice.

    Science.gov (United States)

    Sivić, Suad; Masic, Izet; Petkovic, Darko; Huseinagic, Senad; Tandir, Salih; Zunic, Lejla

    2009-01-01

    cost-effective health care, use of defined procedures and evidence-based medicine, and more adequate education can empower and stimulate general practice doctors, especially family medicine specialists, who have passed various forms of training and courses in this area, to more rational and efficient use of diagnostic technology in their daily practice, without unnecessary duplication of tests. With this they make savings to the healthcare system, improve the financial position of overall health system, especially in the PHC segment, increase satisfaction of doctors providing that health care, but also the users of health services.

  7. Access to complementary medicine in general practice: survey in one UK health authority.

    Science.gov (United States)

    Wearn, A M; Greenfield, S M

    1998-09-01

    Complementary therapy (CT) has become increasingly popular with the general public and interest from the health professions has been rising. There has been no study focusing on the pattern of availability of CT within urban and inner-city general practice. We aimed to describe the prevalence and pattern of access to complementary therapy in this setting, identifying the characteristics of practices offering CT and the perceived barriers to service provision. We sent a postal questionnaire to all 254 general practices on the Birmingham Family Health Services Authority list. Practices were asked whether they offered any access to CTs, how services were organized and which therapies were available and to identify any barriers to provision. 175 practices (68.9%) responded. Half of the practices offered access to CT. Of these, half offered an in-house service, usually provided by the doctor (81.8%). Of GPs practising therapies themselves, 58% began in or after 1990. Seventeen separate therapies were offered, most commonly acupuncture, osteopathy, chiropractic, hypnotherapy and homoeopathy. Practices significantly more likely to offer access to CT were of larger list size and training or teaching practices. They were equally likely to be fundholders or non-fundholders. Practices offering an in-house service tended to be fundholding, training and of larger list size. Finance was perceived as the major barrier. In the area studied, many patients now have some access to CT within primary care, often within their own practice. In the main, therapies offered are the 'medically acceptable face' of complementary medicine.

  8. 76 FR 5375 - Public Availability of General Services Administration FY 2010 Service Contract Inventory

    Science.gov (United States)

    2011-01-31

    ... ADMINISTRATION Public Availability of General Services Administration FY 2010 Service Contract Inventory AGENCY: Office of Acquisition Policy; General Services Administration (GSA). ACTION: Notice. SUMMARY: This notice... Consolidated Appropriations Act of 2010 (Pub. L. 111-117), GSA is publishing this notice to advise the...

  9. 77 FR 5253 - Public Availability of General Services Administration FY 2011 Service Contract Inventory

    Science.gov (United States)

    2012-02-02

    ... ADMINISTRATION Public Availability of General Services Administration FY 2011 Service Contract Inventory AGENCY: Office of Acquisition Policy (MV); General Services Administration (GSA). ACTION: Notice of public... Act Public Law 111-117, GSA is publishing this notice to advise the public of the availability of...

  10. Improving Injectable Medicines Prescription in Outpatient Services: A Path Towards Rational Use of Medicines in Iran

    Directory of Open Access Journals (Sweden)

    Firoozeh Bairami

    2016-05-01

    Full Text Available Injection is one of the most common medical procedures in the health sector. Annually up to 16 billion injections are prescribed in low- and middle-income countries (LMICs, many of them are not necessary for the patients, increase the healthcare costs and may result in side effects. Currently over 40% of outpatient prescriptions in Iran contain at least one injectable medicine. To address the issue, a working group was established (August 2014 to April 2015 to provide a comprehensive policy brief to be used by national decision-makers. This report is the extract of methods that were followed and the main policy options for improving injectable medicines prescribing in outpatient services. Thirty-three potential policy options were developed focusing on different stakeholders. The panel reached consensus on seven policy options, noting effectiveness, cost, durability, and feasibility of each policy. The recommended policy options are targeted at patients and public (2 policies, insurers (2, physicians (1, pharmacies (1, and the Ministry of Health and Medical Education (MoHME (1.

  11. Comparison of Patient Health History Questionnaires Used in General Internal and Family Medicine, Integrative Medicine, and Complementary and Alternative Medicine Clinics.

    Science.gov (United States)

    Laube, Justin G R; Shapiro, Martin F

    2017-05-01

    Health history questionnaires (HHQs) are a set of self-administered questions completed by patients prior to a clinical encounter. Despite widespread use, minimal research has evaluated the content of HHQs used in general internal medicine and family medicine (GIM/FM), integrative medicine, and complementary and alternative medicine (CAM; chiropractic, naturopathic, and Traditional Chinese Medicine [TCM]) clinics. Integrative medicine and CAM claim greater emphasis on well-being than does GIM/FM. This study investigated whether integrative medicine and CAM clinics' HHQs include more well-being content and otherwise differ from GIM/FM HHQs. HHQs were obtained from GIM/FM (n = 9), integrative medicine (n = 11), naturopathic medicine (n = 5), chiropractic (n = 4), and TCM (n = 7) clinics in California. HHQs were coded for presence of medical history (chief complaint, past medical history, social history, family history, surgeries, hospitalizations, medications, allergies, review of systems), health maintenance procedures (immunization, screenings), and well-being components (nutrition, exercise, stress, sleep, spirituality). In HHQs of GIM/FM clinics, the average number of well-being components was 1.4 (standard deviation [SD], 1.4) compared with 4.0 (SD, 1.1) for integrative medicine (p medicine (p = 0.04), 2.0 (SD, 1.4) for chiropractic (p = 0.54), and 2.0 (SD, 1.5) for TCM (p = 0.47). In HHQs of GIM/FM clinics, the average number of medical history components was 6.4 (SD, 1.9) compared with 8.3 (SD, 1.2) for integrative medicine (p = 0.01), 9.0 (SD, 0) for naturopathic medicine (p = 0.01), 7.1 (SD, 2.8) for chiropractic (p = 0.58), and 7.1 (SD, 1.7) for TCM (p = 0.41). Integrative and naturopathic medicine HHQs included significantly more well-being and medical history components than did GIM/FM HHQs. Further investigation is warranted to determine the optimal HHQ content to support the clinical and preventive

  12. National Health Service and Military Medicine in Great Britain

    Science.gov (United States)

    1978-11-07

    medicine. These guidelines, along with creation of a two-year Masters degree (Master of Science in Social Medicine ) were designed to train physicians for...MSc Social Medicine and pass appropriate examinations. It is difficult for one unaccustomed to the system to determine what is really different about a

  13. Interactions between modern and Chinese medicinal drugs: a general review.

    Science.gov (United States)

    Cheng, K F; Leung, K S; Leung, P C

    2003-01-01

    While the use of health food and over-the-counter drugs for health promotion and adjuvant therapy is becoming increasingly popular, the concern about adverse effects is mounting. The possible adverse effects that may arise from drug interactions between these herbal preparations and standard modem therapy are equally worrying. Herbal toxicity and adverse effects are well documented in classical Chinese medicinal volumes. Interactions between herbal preparations and standard modem therapy are known. Extensive work needs to be done before useful guidelines can be established. However, based on available reports and clinical observations, some commonly used herbs and Chinese medicines have already demonstrated the need for special attention when used together with modern therapy. This paper analyzes the important material already available, and would serve as a preliminary checklist for patients who are taking herbal preparations, while at the same time receiving treatment from modern medicine.

  14. Overcoming Barriers to Generalism in Medicine: The Residents' Perspective.

    Science.gov (United States)

    Steiner, Elizabeth; Stoken, Jacqueline M.

    1995-01-01

    This paper presents medical residents' opinions regarding barriers to producing more generalist physicians, such as lack of appropriate training in ambulatory generalist practice and the increased prestige given to specialists. Recommendations are offered to medical schools, residency programs, the community, and the culture of medicine to…

  15. General sale of non-prescription medicinal products

    DEFF Research Database (Denmark)

    Lind, Johanna Lena Maria; Schafheutle, Ellen; Hägg, Annika Nordén

    2016-01-01

    between Sweden and the UK. METHOD: The main method was analysis of legislative text and policy documents, conducted in 2012. RESULTS: Both countries had specified medicines available to the public in non-pharmacy outlets, but with restrictions on different factors, e.g. placement and package size...

  16. The business of palliative medicine - part 5: service utilization in a comprehensive integrated program.

    Science.gov (United States)

    Estfan, Bassam; Davis, Mellar P; Walsh, Declan; Heintz, Jessica; Shaheen, Philip E; Cheema, Bushra; LeGrand, Susan B; Lagman, Ruth L

    2007-01-01

    The aim of palliative medicine is to provide multidisciplinary comprehensive care in advanced illness. Patient and family utilization of various product service lines offered by the Harry R Horvitz Center for Palliative Medicine at the Cleveland Clinic Foundation was studied. Newly referred patients were followed up prospectively until 85% had either died or been lost to follow-up. Demographic, clinical, and referral data were recorded; subsequent product service line utilization was updated daily. The total study period was 171 days, and 238 patients entered. Acute care inpatient unit, outpatient clinic visits, and 24-hour phone contacts were the most frequently used product service lines. Patients had a median of 3 contacts (range, 1 to 27) with individual service lines. Multiple palliative medicine product service lines were utilized often, with repeated use of the individual service lines. A comprehensive integrated palliative medicine program is necessary to fully meet the complex needs of those with advanced disease.

  17. A generalized Web Service response time metric to support collaborative and corroborative Web Service monitoring

    CSIR Research Space (South Africa)

    Makitla, I

    2015-12-01

    Full Text Available In this paper, we describe the development of a generalized metric for computing response time of a web service. Such a generalized metric would help to develop consensus with regards to the meanings of contracted Quality of Service (QoS) parameters...

  18. The application status of Chinese herbal medicine in military health service in China.

    Science.gov (United States)

    Yang, Ge-Liang; Gu, Wei; Zhang, Hui-Qing; Zhai, Xiao-Feng; Li, Xiao-Qian; Ling, Chang-Quan

    2016-07-01

    Military medicine has had a long history in China since the emergence of the war. Chinese medicine, especially Chinese herbs, was widely used in China as well as other Asian countries for the prevention and treatment of diseases in the military for hundreds of years. However, the use of Chinese medicine in military health service has never been well studied. In this article, we briefly summarize the application status of Chinese herbal medicine in military health service in China, putting particular emphasis on special military environment, in an attempt to build a bridge between Chinese medicine and military health service and promote the quality of health service for the military and maintain world peace.

  19. Update in outpatient general internal medicine: practice-changing evidence published in 2014.

    Science.gov (United States)

    Sundsted, Karna K; Wieland, Mark L; Szostek, Jason H; Post, Jason A; Mauck, Karen F

    2015-10-01

    The practice of outpatient general internal medicine requires a diverse and evolving knowledge base. General internists must identify practice-changing shifts in the literature and reflect on their impact. Accordingly, we conducted a review of practice-changing articles published in outpatient general internal medicine in 2014. To identify high-quality, clinically relevant publications, we reviewed all titles and abstracts published in the following primary data sources in 2014: New England Journal of Medicine, Journal of the American Medical Association (JAMA), Annals of Internal Medicine, JAMA Internal Medicine, and the Cochrane Database of Systematic Reviews. All 2014 primary data summaries from Journal Watch-General Internal Medicine and ACP JournalWise also were reviewed. The authors used a modified Delphi method to reach consensus on inclusion of 8 articles using the following criteria: clinical relevance to outpatient internal medicine, potential for practice change, and strength of evidence. Clusters of important articles around one clinical question were considered as a single-candidate series. The article merits were debated until consensus was reached on the final 8, spanning a variety of topics commonly encountered in outpatient general internal medicine.

  20. Knowledge, Attitude and Practice of General Practitioners toward Complementary and Alternative Medicine: a Cross-Sectional Study.

    Science.gov (United States)

    Barikani, Ameneh; Beheshti, Akram; Javadi, Maryam; Yasi, Marzieh

    2015-08-01

    Orientation of public and physicians to the complementary and alternative medicine (CAM) is one of the most prominent symbols of structural changes in the health service system. The aim of his study was a determination of knowledge, attitude, and practice of general practitioners in complementary and alternative medicine. This cross- sectional study was conducted in Qazvin, Iran in 2013. A self-administered questionnaire was used for collecting data including four information parts: population information, physicians' attitude and knowledge, methods of getting information and their function. A total of 228 physicians in Qazvin comprised the population of study according to the deputy of treatment's report of Qazvin University of Medical Sciences. A total of 150 physicians were selected randomly, and SPSS Statistical program was used to enter questionnaires' data. Results were analyzed as descriptive statistics and statistical analysis. Sixty percent of all responders were male. About sixty (59.4) percent of participating practitioners had worked less than 10 years.96.4 percent had a positive attitude towards complementary and alternative medicine. Knowledge of practitioners about traditional medicine in 11 percent was good, 36.3% and 52.7% had average and little information, respectively. 17.9% of practitioners offered their patients complementary and alternative medicine for treatment. Although there was little knowledge among practitioners about traditional medicine and complementary approaches, a significant percentage of them had attitude higher than the lower limit.

  1. 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…

  2. [Pulmonary medicine 2012: news for the general practitioner].

    Science.gov (United States)

    Gex, G; Petitpierre, N; Charbonnier, F; Rochat, T

    2013-01-16

    This review reports on papers published in 2012 that will most likely impact on daily medical practice in four different areas of pulmonary medicine. How should treatment of asthma with inhaled corticosteroids be adjusted on the long run? Should idiopathic pulmonary fibrosis receive treatment with immunosuppressive drugs? Is a long-term treatment with azithromycine for bronchiectasis supported by evidence, apart from patients with cystic fibrosis? And finally, can treatment of obstructive sleep apnea with continuous positive pressure (CPAP) prevent the occurrence of new, systemic hypertension?

  3. Service-Learning General Chemistry: Lead Paint Analyses

    Science.gov (United States)

    Kesner, Laya; Eyring, Edward M.

    1999-07-01

    Houses painted with lead-based paints are ubiquitous in the United States because the houses and the paint have not worn out two decades after federal regulations prohibited inclusion of lead in paint. Remodeling older homes thus poses a health threat for infants and small children living in those homes. In a service-learning general chemistry class, students disseminate information about this health threat in an older neighborhood. At some of the homes they collect paint samples that they analyze for lead both qualitatively and quantitatively. This service-learning experience generates enthusiasm for general chemistry through the process of working on a "real" problem. Sample collection familiarizes the students with the concept of "representative" sampling. The sample preparation for atomic absorption spectroscopic (AAS) analysis enhances their laboratory skills. The focus of this paper is on the mechanics of integrating this particular service project into the first-term of the normal general chemistry course.

  4. 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

  5. WebGen-WPS – Web service for cartographic generalization

    Directory of Open Access Journals (Sweden)

    Kristina Jezdić

    2013-06-01

    Full Text Available The development of web services technology and standardization of spa­tial data usage have initiated the process of automatization of cartogra­phic generalization on the Internet.There are two ways by which web supported cartographic generalization can be accomplished (Foerster 2010:1. Limited control of data representation (selection of layers and symbolization2. Complete control of the generalization process (usage of all generalization procedures with selection of specific parametersThe first option is for users that are amateurs in cartographic generalization, and it enables them to have limited control over the shaping of map content. The second option is intended to be used by experts in cartographic generalization which would support development of automated systems for cartographic generalization.

  6. Referrals from general practitioners to a social services department.

    Science.gov (United States)

    Sheppard, M G

    1983-01-01

    One year's referrals from general practitioners to a social services department were studied. There was a low referral rate and a bias towards women, the elderly and the less affluent. The referrals were predominantly made for practical help with problems of ill health. A high proportion of clients were allocated to non-social work staff, and the social service intervention, generally of short duration, showed a sympathetic response to the practical requests of general practitioners. The limited use of social workers by doctors is considered to be the result of ignorance or scepticism about psychodynamic social work skills. Closer liaison between general practitioners and social workers, and a clearer presentation by social workers of their professional skills, are suggested solutions to this problem.

  7. Prevalence of delirium in hospitalized patients from an internal medicine service

    National Research Council Canada - National Science Library

    González Pezoa, Ana Carolina; Carrillo Venezian, Bernardita Claudia; Castillo Rojas, Sandra

    2015-01-01

    .... To determine the rate of prevalence of delirium in Internal Medicine Service patients and evaluate missed diagnosis of the syndrome made by attending physicians, medical residents or interns in charge...

  8. Distribution of nuclear medicine service in Brazil; Distribuicao do servico de medicina nuclear no Brasil

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Ana Carolina Costa da; Duarte, Alessandro; Santos, Bianca Maciel dos [Faculdade Metodo de Sao Paulo (FAMESP), Sao Paulo, SP (Brazil)

    2011-10-26

    The Brazil does not posses a good distribution of nuclear medicine service por all his territory. This paper shows the difference among country regions as far the number of clinics of nuclear medicine as is concerning, and also doctors licensed in the area and radioprotection supervisors, both licensed by the Brazilian Nuclear Energy Commission (CNEN)

  9. 77 FR 5020 - General Services Administration Acquisition Regulation; Information Collection; GSA Form 527...

    Science.gov (United States)

    2012-02-01

    ... ADMINISTRATION General Services Administration Acquisition Regulation; Information Collection; GSA Form 527... and Financial Information'' on your attached document. Fax: (202) 501-4067. Mail: General Services... provided. SUPPLEMENTARY INFORMATION: A. Purpose The General Services Administration will be requesting...

  10. Empiricism in Hellenistic MedicineGeneralizations without Aetiologies

    Directory of Open Access Journals (Sweden)

    Maja Grgic Hudoletnjak

    2006-06-01

    Full Text Available The Empiricists argued that medical knowledge is a matter of experience, and that no theory is required either for its formation or application. The central part of their position was rejecting the possibility of the discovery of causal connections by the use of reason. The theorems that make up medical knowledge are empirical generalizations that do not include the specification of the cause. However, the Greek authors outside Empiricism, both medical and philosophical, made a strong case for the claim that a generalization must be explanatory to be scientific or artistic. In this paper I discuss how non-explanatory generalizations, being statements of frequency of joint occurrences which are statistically accurate, can be taken by the Empiricists as scientific.

  11. 24 CFR 203.500 - Mortgage servicing generally.

    Science.gov (United States)

    2010-04-01

    ... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Servicing Responsibilities General Requirements § 203.500... for denial of insurance benefits, but failure to comply will be cause for imposition of a civil...

  12. Facilitating and securing offline e-medicine service through image steganography.

    Science.gov (United States)

    Kamal, A H M; Islam, M Mahfuzul

    2014-06-01

    E-medicine is a process to provide health care services to people using the Internet or any networking technology. In this Letter, a new idea is proposed to model the physical structure of the e-medicine system to better provide offline health care services. Smart cards are used to authenticate the user singly. A very unique technique is also suggested to verify the card owner's identity and to embed secret data to the card while providing patients' reports either at booths or at the e-medicine server system. The simulation results of card authentication and embedding procedure justify the proposed implementation.

  13. Control flow of radiopharmaceuticals in nuclear medicine by means of an E-service; Control flujo de radiofarmacos en medicine nuclear por medio de un E-servicio

    Energy Technology Data Exchange (ETDEWEB)

    Nunez Martin, L.; Gonzalez de Mingo, M. A.; Fragua Redondo, J. A.; Martinez Ortega, J.; Gutierrez Camunas, S.; Redondo Miguel, A. B.

    2013-07-01

    The almost generalized use of single-dose Nuclear Medicine for performing diagnostic tests or treatments, and the consequent complexity that accompanies its management, has resulted in the need to control the flow of material radioisotopic tools. An e-service is designed to manage the flow of radiopharmaceuticals and control its use and spending. This control does not only affect the efficiency in the use and cost of material, but in the radioactive waste associated with the non-use and waste reduction and a more effective organization of the Department. (Author)

  14. ['Translational medicine as a way from fundamental biomedical science to public health services].

    Science.gov (United States)

    Ipatova, O M; Medvedeva, N V; Archakov, A I; Grigor'ev, A I

    2012-01-01

    Increasing distance between practical public health services and collecting of theoretical information in the field of biomedical researches reflects the necessity of professional contact between clinicians and scientists in many areas associated with medicine for active carrying over ("translation") of the modern basic researches in which mechanisms of basic metabolic processes and possibilities of their correction are detected, to effective medical help to individual patient, i.e., personified medicine. Such approach was called transmitting medicine. Examples of the personified medicine in which biomedical researches together with the anamnesis morbi of individual patient that are responsible for treatment strategy including doses and regimens are discussed.

  15. The Nazi cosmetic: medicine in the service of beauty.

    Science.gov (United States)

    Efstathiou, Sophia

    2012-09-01

    This paper examines how aesthetic ideals shaped the practice of Nazi medicine. It proposes that Nazi eugenics relied on the conflation of norms of health with norms of beauty determined and performed by Nazi cultures of action. Though theories of biological holism served as vehicles of Nazi ideology, they did so contingently. The anti-totalitarian thinking of biological holist Kurt Goldstein shows that the use of biological holism to promote Nazi ideology was not inevitable. This examination of aesthetic influences on Nazi medicine shows that traditionally speaking 'non-rational' factors shaped the Nazi biomedical program's aims and methods.

  16. Prevalence of medicinal drugs in suspected impaired drivers and a comparison with the use in the general Dutch population

    NARCIS (Netherlands)

    Bezemer, Karlijn D B; Smink, Beitske E; van Maanen, Rianne; Verschraagen, Miranda; de Gier, Johan J

    2014-01-01

    The aim of this study was to investigate the prevalence of psychotropic medicines in drivers suspected of driving under the influence of medicinal and illicit drugs in The Netherlands and to compare the prevalence of selected impairing medicines with the use of these medicines in the general Dutch p

  17. Medicine-related services in community pharmacy: public preferences for pharmacy attributes and promotional methods and comparison with pharmacists' perceptions.

    Science.gov (United States)

    Gammie, Shivaun M; Rodgers, Ruth M; Loo, Ruey Leng; Corlett, Sarah A; Krska, Janet

    2016-01-01

    Public awareness of pharmacy services designed to support the use of medicines is low, yet little is known about how the public view promotion of these services, or their preferences for the attributes of pharmacies from which they would like to receive them. To compare the public's preferred attributes of pharmacies and methods for promoting medicine-related services with community pharmacists' perceptions of their customers' views. Parallel surveys were conducted in South East England, using a street survey for the general public and a postal survey for community pharmacists. Response rates were as follows: public 47.2% (1,000/2,012) and pharmacists 40.8% (341/836). Pharmacists' perceptions of customer preferences for using the same pharmacy, independent ownership, and personal knowledge of the pharmacist were higher than actual public preferences. More pharmacists than public respondents also believed that approachability and previous good service would be important. The public's desires for long opening hours and for a pharmacy with a good relationship with their doctor's surgery were higher than pharmacists believed. The majority of the public prefer not to interrupt a pharmacist who is busy in the dispensary, which was not perceived by pharmacists as a factor. Pharmacists' perceptions aligned more with the preferences of regular medicine users and frequent pharmacy users. Both groups viewed direct recommendation as the most effective approach for promoting pharmacy services, particularly by doctors and pharmacy staff. Pharmacists' expectations of the effectiveness of posters and mass media methods were much higher than those of the public. Pharmacists and pharmacy owners must ensure good relationships with local medical practices to enable them to maximize opportunities for using the promotional methods judged most effective in encouraging the use of medicine-related services. Staff must be approachable and enable access to pharmacists, ensuring that

  18. [The role of the German public health service in social medicine].

    Science.gov (United States)

    Leidel, J

    2005-10-01

    Although the German public health service is mainly concerned with social medical tasks there is too little awareness of the fact that social medicine forms the scientific basis of most actions. As a matter of fact social medicine in public health departments is often reduced to mere medical insurance and expert reports. This is mainly due to the historical development of social medicine in Germany. Among the numerous important social medical tasks of the public health service, this article mainly concentrates on local coordination, health promotion, health care, and social compensation, including subsidiary medical care of certain groups of the population and aspects of infectious disease control with particular attention to measures against AIDS. The further development of both the public health service and social medicine requires a closer cooperation between them.

  19. General Survey of Traditional Chinese Medicine and Western Medicine Researches on Tumor Metastasis

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Metastasis and recurrence of tumors is the chief cause of death for such patients. Therefore,researches on the mechanism of its metastasis, prevention and treatment are the focal points in the field of traditional Chinese medicine (TCM) and Western medicine (WM) at present. WM practitioners' study on tumor metastasis involved its occurrence and development including every detail and process, and now it even has developed into the molecular biological field. In treatment surgical operation and radio- chemotherapy is used as the main means, but the efficacy is not too optimistic. In recent years, TCM, as part of the comprehensive therapy, has been gradually gaining attention of oncologists. Aimed at solving the difficult problems in metastasis of tumor, many TCM practitioners on the basis of syndrome differentiation have raised theories about the cause of tumor metastasis. On the basis of these theories, some TCM recipes against tumor metastasis have been developed to serve as an effective supplement to surgical operation, radio- and chemotherapy. The present article summarizes research results in recent years about the cause of formation of tumor and its metastasis by TCM and WM, so as to offer some theoretical clues to the study of tumors metastasis.

  20. Impact of waiting on the perception of service quality in nuclear medicine

    NARCIS (Netherlands)

    De Man, S; Vlerick, P; Gemmel, P; De Bondt, P; Matthys, D; Dierckx, RA

    2005-01-01

    Background This is the first study examining the link between waiting and various dimensions of perceived service quality in nuclear medicine. Methods We tested the impact of selected waiting experience variables on the evaluation of service quality, measured using the Servqual tool, of 406 patients

  1. 31 CFR 597.511 - In-kind donations of medicine, medical devices, and medical services.

    Science.gov (United States)

    2010-07-01

    ..., medical devices, and medical services. 597.511 Section 597.511 Money and Finance: Treasury Regulations... Licensing Policy § 597.511 In-kind donations of medicine, medical devices, and medical services. (a) Effective July 6, 2006, U.S. financial institutions are authorized to conduct all transactions...

  2. Computer-Based Information Services in Medicine: A Feasibility Study.

    Science.gov (United States)

    Cox, P. H.; And Others

    The objectives of this study were to examine the need and potential demand for computer-based information services in the University of Otago medical libraries, to evaluate the various databases of interest, and to recommend the best means of access to such services. Data were collected through user and library surveys, an extensive literature…

  3. Provision of general paediatric surgical services in a regional hospital.

    LENUS (Irish Health Repository)

    Zgraj, O

    2012-01-31

    BACKGROUND: In Ireland, specialist paediatric surgery is carried out in paediatric hospitals in Dublin. General surgeons\\/consultants in other surgical specialities provide paediatric surgical care in regional centres. There has been a failure to train general surgeons with paediatric skills to replace these surgeons upon retirement. AIM: To assess paediatric surgical workload in one regional centre to focus the debate regarding the future provision of general paediatric surgery in Ireland. METHODS: Hospital in-patient enquiry (HIPE) system was used to identify total number of paediatric surgical admissions and procedures. Cases assessed requiring hospital transfer. RESULTS: Of 17,478 surgical patients treated, 2,584 (14.8%) were under 14 years. A total of 2,154 procedures were performed. CONCLUSION: Regional centres without dedicated paediatric surgeons deliver care to large numbers of paediatric patients. The demand for care highlights the need for formal paediatric services\\/appropriate surgical training for general surgical trainees.

  4. What Is a Service of General Economic Interest?

    DEFF Research Database (Denmark)

    Ølykke, Grith Skovgaard; Møllgaard, Peter

    2016-01-01

    The definition of the concept a “service of general economic interest” (SGEI) known from Article 106(2) treaty of the functioning of the European Union is clarified. When a service is determined to be an SGEI, Member States may enact measures and undertakings entrusted with the provision...... is subject only to a test for manifest error of assessment by the Commission. To increase legal certainty, ensure effective intervention in markets and prevent their use in industrial policy, it is highly relevant to clarify what SGEIs are. The various definitions published by the Commission...... and in the literature are examined, and a new definition of an SGEI based on economic theory (networks and network effects) is formed. This definition is consistent with the case law of the Court of Justice of the European Union and the General Court. On the basis of the definition, implications for efficiency...

  5. [Deafness in adults. Study of practices in general medicine].

    Science.gov (United States)

    Leveque, P; Kossowski, M; Pons, Y

    2012-01-01

    Deafness is a sensory disability responsible for communication disorder, sometimes impairing social life. In children, the hearing is an important concern for all stakeholders in early childhood (systematic neonatal screening, etc.). On the other hand, in the adult, it is rarely tested, and patients do consult when their audiometric status is already badly impaired. But their care is all the better if the deafness diagnosis is made early, as for the audio-prosthetic rehabilitation for example. Today, the general practitioner is the first link of the diagnostic and therapeutic management chain. The objective of this study was to evaluate the diagnostic practices of practitioners in front of deafness in adults. This prospective study included 74 practitioners based in "Ile de France" interviewed using a multiple choice questionnaire (MCQ) on otoscopic and audiometric diagnostics and a Script Concordance test (SC) on clinical adult deafness situations validated by a 5 experts panel. The obtained average score was 66.35% of correct answers to the MCQ and 47.76% to the SC. In our study, the surveyed practitioners showed a good level of otoscopic and audiometric diagnosis in the MCQ. However, their answers were not concordant with those of the expert panel in the SC. They have been particularly poorly performing on issues related to functional signs and their use in a given clinical situation, often driving to establish an otoscopic misdiagnosis while their diagnostic recognition of a pathological eardrum in the MCQ was rather good. These results reflect a lack of confidence in their otoscopic diagnosis related to the lack of knowledge of the causes of deafness in adults and their symptoms.

  6. Leadership and cooperation at the general medicine department of LMU Munich: Good grades despite difficult conditions.

    Science.gov (United States)

    Schelling, Jörg; Braun, Susanne

    2011-01-01

    The relevance of general medicine at German universities will increase over the next few years. Consequently, the discussion of teaching content and even more the improvement of the structures within the still small and dependent departments of general medicine are of major importance. The example of our department at LMU Munich shows which challenges for leadership and cooperation result from lack of financial and personnel structure. The project "cooperation culture" that the department has conducted in collaboration with the LMU Center for Leadership and People Management is presented as a means to promote leadership and cooperation. This project can serve as an inspiration for the coordinators of smaller departments of general medicine at other German universities that are also striving to improve their structure and their position within the university.

  7. Responsibility loadings for dental services by general dentists

    Directory of Open Access Journals (Sweden)

    Spencer A John

    2010-06-01

    Full Text Available Abstract Background Responsibility loadings determine relative value units of dental services that translate services into a common scale of work effort. The aims of this paper were to elicit responsibility loadings for a subset of dental services and to relate responsibility loadings to ratings of importance of the components of responsibility. Methods Responsibility loadings and ratings of components of responsibility were collected using mailed questionnaires from a random sample of Australian private general practice dentists in 2007 (response rate = 77%. Results Median responsibility loadings were 1.25 for an initial oral examination and for a 3+-surface amalgam restoration, 1.50 for a simple extraction and for root canal obturation (single canal, and 1.75 for subgingival curettage (per quadrant. Across the five services coefficients from a multivariate logit model showed that ratings of importance of knowledge (0.34, dexterity (0.24, physical effort (0.28 and mental effort (0.48 were associated with responsibility loadings (P Conclusions The elicited median responsibility loadings showed agreement with previous estimates indicating convergent validity. Components of responsibility were associated with loadings indicating that components can explain and predict responsibility aspects of dental service provision.

  8. Medicine-related services in community pharmacy: public preferences for pharmacy attributes and promotional methods and comparison with pharmacists' perceptions

    Directory of Open Access Journals (Sweden)

    Gammie SM

    2016-11-01

    Full Text Available Shivaun M Gammie, Ruth M Rodgers, Ruey Leng Loo, Sarah A Corlett, Janet Krska Medway School of Pharmacy, The Universities of Greenwich and Kent, Chatham Maritime, Kent, UK Background: Public awareness of pharmacy services designed to support the use of medicines is low, yet little is known about how the public view promotion of these services, or their preferences for the attributes of pharmacies from which they would like to receive them.Objective: To compare the public’s preferred attributes of pharmacies and methods for promoting medicine-related services with community pharmacists’ perceptions of their customers’ views.Methods: Parallel surveys were conducted in South East England, using a street survey for the general public and a postal survey for community phar­macists.Results: Response rates were as follows: public 47.2% (1,000/2,012 and pharmacists 40.8% (341/836. Pharmacists’ perceptions of customer preferences for using the same pharmacy, independent ownership, and personal knowledge of the pharmacist were higher than actual public preferences. More pharmacists than public respondents also believed that approachability and previous good service would be important. The public’s desires for long opening hours and for a pharmacy with a good relationship with their doctor’s surgery were higher than pharmacists believed. The majority of the public prefer not to interrupt a pharmacist who is busy in the dispensary, which was not perceived by pharmacists as a factor. Pharmacists’ perceptions aligned more with the preferences of regular medicine users and frequent pharmacy users. Both groups viewed direct recommendation as the most effective approach for promoting pharmacy services, particularly by doctors and pharmacy staff. Pharmacists’ expectations of the effectiveness of posters and mass media methods were much higher than those of the public.Conclusion: Pharmacists and pharmacy owners must ensure good relationships with

  9. Is There a Core General Vocabulary? Introducing the "New General Service List"

    Science.gov (United States)

    Brezina, Vaclav; Gablasova, Dana

    2015-01-01

    The current study presents a "New General Service List (new-GSL)", which is a result of robust comparison of four language corpora ("LOB," "BNC," "BE06," and "EnTenTen12") of the total size of over 12 billion running words. The four corpora were selected to represent a variety of corpus sizes and…

  10. Information Resources in Clinical Medicine: Family Practice, Pediatrics, Obstetrics and Gynecology, General Surgery, Internal Medicine.

    Science.gov (United States)

    Schwank, Jean; Allen, Joyce

    Designed for beginning health science librarians, this continuing education course syllabus presents a guide to information resources for answering physicians' questions about patient care. Sources from standard core lists, such as the Alfred Brandon list, are highlighted and described, along with additional titles. General resources covered…

  11. Japanese representation in leading general medicine and basic science journals: a comparison of two decades.

    Science.gov (United States)

    Fukui, Tsuguya; Takahashi, Osamu; Rahman, Mahbubur

    2013-01-01

    During 1991-2000, Japan contribution to the top general medicine journals was very small although the contribution to the top basic science journals was sizeable. However, it has not been examined whether the contribution to the top general medicine and basic science journals has changed during the last decade (2001-2010). The objective of this study was to compare Japan representation in high-impact general medicine and basic science journals between the years 1991-2000 and 2001-2010. We used PubMed database to examine the frequency of articles originated from Japan and published in 7 high-impact general medicine and 6 high-impact basic science journals. Several Boolean operators were used to connect name of the journal, year of publication and corresponding authors' affiliation in Japan. Compared to the 1991-2000 decade, Japan contribution to the top general medicine journals did not increase over the 2001-2010 period (0.66% vs. 0.74%, P = 0.255). However, compared to the same period, its contribution to the top basic science journals increased during 2001-2010 (2.51% vs. 3.60%, P journals showed an upward trend over the 1991-2000 period (P journals remained flat both during 1991-2000 (P = 0.273) and 2001-2010 (P = 0.073). Overall, Japan contribution to the top general medicine journals has remained small and unchanged over the last two decades. However, top basic science journals had higher Japan representation during 2001-2010 compared to 1991-2000.

  12. Utilization of Western Medicine and Traditional Chinese Medicine Services by Physicians and Their Relatives: The Role of Training Background

    Directory of Open Access Journals (Sweden)

    Nicole Huang

    2011-01-01

    Full Text Available Despite extensive efforts to improve the attitude and practice of physicians with respect to complementary and alternative medicine (CAM, the role of training background on physician's own utilization of mainstream Western medicine (WM and CAM remains unclear. We aimed to compare personal utilizations of WM and traditional Chinese medicine (TCM among doctors trained in WM only, TCM only or both. A retrospective population-based study was conducted using the 2004 Taiwan's National Health Insurance data. A total of 103 879 doctors and their relatives and 2 623 658 other adults with equivalent socioeconomic status were analyzed. Ambulatory care utilization of WM and TCM services was compared using the following three measures: probability of any use, number of visits and total annual expenditure. Doctors who were trained in Western medicine only (WMDs had the highest WM use, followed by doctors who were trained in both (WMD-CMDs, while Chinese medicine-trained doctors (CMDs had the lowest use. For TCM use, a reverse pattern was observed. Similar patterns were found among doctors' relatives. Compared with other adults with equivalent socioeconomic status, both the CMDs and WMD-CMDs had a greater use of TCM services. For WM, although the WMDs' probability and frequency of usage were similar to other adults, they incurred considerably higher expenditure. The use of WM and TCM by doctors and their relatives was significantly associated with the training background of the doctors. This highlights the importance of how increasing knowledge and understanding of other medical discipline may influence a practitioner's care-providing behaviors.

  13. Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2015.

    Science.gov (United States)

    Szostek, Jason H; Wieland, Mark L; Post, Jason A; Sundsted, Karna K; Mauck, Karen F

    2016-08-01

    Identifying new practice-changing articles is challenging. To determine the 2015 practice-changing articles most relevant to outpatient general internal medicine, 3 internists independently reviewed the titles and abstracts of original articles, synopses of single studies and syntheses, and databases of syntheses. For original articles, internal medicine journals with the 7 highest impact factors were reviewed: New England Journal of Medicine, Lancet, Journal of the American Medical Association (JAMA), British Medical Journal, Public Library of Science Medicine, Annals of Internal Medicine, and JAMA Internal Medicine. For synopses of single studies and syntheses, collections in American College of Physicians Journal Club, Journal Watch, and Evidence-Based Medicine were reviewed. For databases of synthesis, Evidence Updates and the Cochrane Library were reviewed. More than 100 articles were identified. Criteria for inclusion were as follows: clinical relevance, potential for practice change, and strength of evidence. Clusters of important articles around one topic were considered as a single-candidate series. The 5 authors used a modified Delphi method to reach consensus on inclusion of 7 topics for in-depth appraisal.

  14. Strong medicine: rethinking the PFS (patient financial services) director's role.

    Science.gov (United States)

    Bradford, C; Simoni, A

    1991-08-01

    Burdened by accounts receivable problems and the growing complexity of patient accounting, hospitals soon may require an enhanced resume for individuals responsible for patient financial services (PFS) departments. Advanced skills in management, productivity, budgeting, analysis, and other areas increasingly must be put to work. Outdated perceptions also must change, giving PFS directors the influence needed to make change happen. A hospital's options include supporting course work toward an advanced degree, organizing rotation training in other hospital departments, or filling a PFS director position by searching for parallel skills in other service industries.

  15. Integrative Western and Traditional Chinese Medicine service model for low back pain.

    Science.gov (United States)

    Sit, Regina W S; Wong, Wendy; Law, Sheung Wai; Wu, Justin C Y

    2016-07-01

    Low back pain (LBP) is a common, costly, and debilitating condition that creates a heavy socioeconomic burden on the global health care systems. In Western Medicine (WM), the treatment goals are to relieve pain, reduce disability, and enhance rehabilitation. In Traditional Chinese Medicine (TCM), acupuncture is frequently used to rebalance the vital energy "Qi". Whilst numerous literatures are available from WM and TCM in the management of LBP, the value of an integrative WMTCM therapy remains unknown. This article aims to introduce an integrative WM-TCM service model for LBP, which is now available at the Hong Kong Institute of Integrative Medicine, the Chinese University of Hong Kong.

  16. [Establishment of knowledge, attitudes and opinions of general population about rational use of medicines].

    Science.gov (United States)

    Puig Soler, Rita; Perramon Colet, Meritxell; Yahni, Corinne Zara; Garcia Puig, Anna M

    2015-01-01

    Identify the level of knowledge, opinions and attitudes of medicines in general population. Descriptive transversal study realised in a sample of≥18 years old public health users from primary health centres in the city of Barcelona. Sample has been chosen using a two phases sampling, stratified by district, gender and age. Questionnaire administered face-to-face. SPSSv15 used for the analysis. December 2011. 484 surveys has been done (IC 95%, α=5%). 53% were women and 21,3% had university studies. Medicine use: 81% had taken medicines in the last 3 months; average of 2,34. 80% of medicated people know what they take and its indication. 55,6% don't know active ingredient concept. Only 35% recognise the active ingredient showed in the box of the medicine (3 cases shown) and 44,5% not one. 22,7% know the meaning of security concepts contraindication, adverse effect and drug interaction. 20% ignore. This fact grows with age and reduces with high study levels. Global rational use of medicines indicator obtains 5,03 from 10: 3,42 opinion and 6,51 attitude. 70% of people think there is no rational use of medicines in general and 21,3% would promote raising awareness. Low level of knowledge and poor attitude and opinion in rational use of medicines have been shown in this study. It is necessary involve citizens and improve their basic knowledge to promote rational use of medicines. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  17. Using a cognitive architecture for general purpose service robot control

    Science.gov (United States)

    Puigbo, Jordi-Ysard; Pumarola, Albert; Angulo, Cecilio; Tellez, Ricardo

    2015-04-01

    A humanoid service robot equipped with a set of simple action skills including navigating, grasping, recognising objects or people, among others, is considered in this paper. By using those skills the robot should complete a voice command expressed in natural language encoding a complex task (defined as the concatenation of a number of those basic skills). As a main feature, no traditional planner has been used to decide skills to be activated, as well as in which sequence. Instead, the SOAR cognitive architecture acts as the reasoner by selecting which action the robot should complete, addressing it towards the goal. Our proposal allows to include new goals for the robot just by adding new skills (without the need to encode new plans). The proposed architecture has been tested on a human-sized humanoid robot, REEM, acting as a general purpose service robot.

  18. General medicine advanced training: lessons from the John Hunter training programme.

    Science.gov (United States)

    Jackel, D; Attia, J; Pickles, R

    2014-03-01

    Recent years have seen a rapid growth in the number of advanced trainees pursuing general medicine as a specialty. This reflects an awareness of the need for broader training experiences to equip future consultant physicians with the skills to manage the healthcare challenges arising from the demographic trends of ageing and increasing comorbidity. The John Hunter Hospital training programme in general medicine has several characteristics that have led to the success in producing general physicians prepared for these challenges. These include support from a core group of committed general physicians, an appropriate and sustainable funding model, flexibility with a focus on genuine training and developing awareness of a systems approach, and strong links with rural practice.

  19. [Social medicine service of undergraduate medicine students in the Hospitalary Donation Coordination area of the Mexican Institute of Social Security].

    Science.gov (United States)

    Maya-Álvarez, Jorge Arturo; Lechuga-García, Rafael; Querevalú-Murillo, Walter

    2012-01-01

    The cadaveric or donor-related transplant is a worldwide priority program. In Mexico, the human hospitalary resources primarily assigned to issues about donation and transplant are scarce. In our country, recent legal changes permit that undergraduate medicine students under University linking programs can be integrated in activities that guarantee a social profit, for example, the hospitalary donation coordination of the Mexican Institute of Social Security. This is a proposal with a legal framework, based in experiences of the Barcelona Provincial Hospital Clínic, that integrate undergraduate medicine students as monitors in the Hospitalary Donation Coordination area of the Mexican Institute of Social Security who are available 24 hours. During this social service stage, undergraduate medical students can benefit their community by optimizing potential for transplants via hospital organ donations.

  20. Enhancing student perspectives of humanism in medicine: reflections from the Kalaupapa service learning project.

    Science.gov (United States)

    Lee, Winona K; Harris, Chessa C D; Mortensen, Kawika A; Long, Linsey M; Sugimoto-Matsuda, Jeanelle

    2016-05-09

    Service learning is endorsed by the Liaison Committee on Medical Education (LCME) as an integral part of U.S. medical school curricula for future physicians. Service learning has been shown to help physicians in training rediscover the altruistic reasons for pursuing medicine and has the potential to enhance students' perspectives of humanism in medicine. The Kalaupapa service learning project is a unique collaboration between disadvantaged post-baccalaureate students with an underserved rural community. This study was conducted to determine whether the Kalaupapa service learning curricula enhanced student perspectives of humanism in medicine at an early stage of their medical training. Program participants between 2008 and 2014 (n = 41) completed written reflections following the conclusion of the service learning project. Four prompts guided student responses. Reflections were thematically analyzed. Once all essays were read, team members compared their findings to condense or expand themes and assess levels of agreement. Emerging themes of resilience and unity were prominent throughout the student reflections. Students expressed respect and empathy for the patients' struggles and strengths, as well as those of their peers. The experience also reinforced students' commitment to service, particularly to populations in rural and underserved communities. Students also gained a deeper understanding of the patient experience and also of themselves as future physicians. To identify and address underserved and rural patients' health care needs, training programs must prepare an altruistic health care workforce that embraces the humanistic element of medicine. The Kalaupapa service learning project is a potential curricular model that can be used to enhance students' awareness and perspectives of humanism in medicine.

  1. Alternative medicine and general practitioners in The Netherlands: towards acceptance and integration.

    NARCIS (Netherlands)

    Visser, G.J.; Peters, L.

    1990-01-01

    A questionnaire on alternative medicine was sent to 600 general practitioners in the Netherlands. Most of the 360 (60%) GPs who replied expressed on interest in alternative practice; and 47% revealed that they used one or more alternative methods themselves, most often homoeopathy. However, the

  2. Alternative medicine and general practitioners in The Netherlands: towards acceptance and integration.

    NARCIS (Netherlands)

    Visser, G.J.; Peters, L.

    1990-01-01

    A questionnaire on alternative medicine was sent to 600 general practitioners in the Netherlands. Most of the 360 (60%) GPs who replied expressed on interest in alternative practice; and 47% revealed that they used one or more alternative methods themselves, most often homoeopathy. However, the numb

  3. The Kaleidoscope of General Internist Careers: A Challenge for Internal Medicine Training.

    Science.gov (United States)

    Parenti, Connie M.

    1995-01-01

    As internal medicine residency programs struggle to produce enough general internists adequately prepared for practice, the graduate medical education system must have a clear picture of what competencies these practitioners will need. It must constantly monitor the changing practice environment and its varied generalist career choices.…

  4. Student performance of the general physical examination in internal medicine: an observational study

    NARCIS (Netherlands)

    Haring, C.M.; Cools, B.M.; Meer, J.W.M. van der; Postma, C.T.

    2014-01-01

    BACKGROUND: Many practicing physicians lack skills in physical examination. It is not known whether physical examination skills already show deficiencies after an early phase of clinical training. At the end of the internal medicine clerkship students are expected to be able to perform a general phy

  5. A General Introduction of HIV/AIDS Treatment with Traditional Chinese Medicine in China

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    This paper gives a general introduction of HIV/AIDS treatment with Traditional Chinese Medicine (TCM) in China during the past 20 years. Although the role of TCM in treatment of HIV/AIDS is promising, there is still a long way to go.

  6. Understanding support for complementary and alternative medicine in general populations: use and perceived efficacy.

    Science.gov (United States)

    Stoneman, Paul; Sturgis, Patrick; Allum, Nick

    2013-09-01

    Proponents of complementary and alternative medicine argue that these treatments can be used with great effect in addition to, and sometimes instead of, conventional medicine, a position which has drawn sustained opposition from those who advocate an evidence-based approach to the evaluation of treatment efficacy. Using recent survey data from the United Kingdom, this article seeks to establish a clearer understanding of the nature of the public's relationship with complementary and alternative medicine within the general population by focusing on beliefs about the perceived effectiveness of homeopathy, in addition to its reported use. Using recent data from the United Kingdom, we initially demonstrate that reported use and perceived effectiveness are far from coterminous and argue that for a proper understanding of the motivations underpinning public support of complementary and alternative medicine, consideration of both reported use and perceived effectiveness is necessary. We go on to demonstrate that although the profile of homeopathy users differs from those who support this form of medicine, neither outcome is dependent upon peoples' levels of knowledge about science. Instead, the results suggest a far greater explanatory role for need and concerns about conventional medicine.

  7. General practitioners using complementary and alternative medicine differ from general practitioners using conventional medicine in their view of the risks of electromagnetic fields: a postal survey from Germany.

    Science.gov (United States)

    Kowall, Bernd; Breckenkamp, Jürgen; Berg-Beckhoff, Gabriele

    2015-01-01

    General practitioners (GPs) play a key role in consulting patients worried about health effects of electromagnetic fields (EMF). We compared GPs using conventional medicine (COM) with GPs using complementary and alternative medicine (CAM) concerning their perception of EMF risks. Moreover, we assessed whether the kind of alternative medicine has an influence on the results. A total of 2795 GPs drawn randomly from lists of German GPs were sent an either long or short self-administered postal questionnaire on EMF-related topics. Adjusted logistic regression models were fitted to assess the association of an education in alternative medicine with various aspects of perceiving EMF risks. Concern about EMF, misconceptions about EMF, and distrust toward scientific organizations are more prevalent in CAM-GPs. CAM-GPs more often falsely believed that mobile phone use can lead to head warming of more than 1°C (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.5-3.3), more often distrusted the Federal Office for Radiation Protection (OR = 2.2, 95% CI = 1.4-3.6), were more often concerned about mobile phone base stations (OR = 2.4, 95% CI = 1.6-3.6), more often attributed own health complaints to EMF (OR = 3.2, 95% CI = 1.8-5.6), and more often reported at least 1 EMF consultation (OR = 2.5, 95% CI = 1.6-3.9). GPs using homeopathy perceived EMF as more risky than GPs using acupuncture or naturopathic treatment. Concern about common EMF sources is highly prevalent among German GPs. CAM-GPs perceive stronger associations between EMF and health problems than COM-GPs. There is a need for evidence-based information about EMF risks for GPs and particularly for CAM-GPs. This is the precondition that GPs can inform patients about EMF and health in line with current scientific knowledge. © The Author(s) 2014.

  8. Redesigning the practice model for general internal medicine. A proposal for coordinated care: a policy monograph of the Society of General Internal Medicine.

    Science.gov (United States)

    2007-03-01

    General Internal Medicine (GIM) faces a burgeoning crisis in the United States, while patients with chronic illness confront a disintegrating health care system. Reimbursement that rewards using procedures and devices rather than thoughtful examination and management, plus onerous administrative burdens, are prompting physicians to pursue specialties other than GIM. This monograph promotes 9 principles supporting the concept of Coordinated Care--a strategy to sustain quality and enhance the attractiveness and viability of care delivered by highly trained General Internists who specialize in the longitudinal care of adult patients with acute and chronic illness. This approach supplements and extends the concept of the Advanced Medical Home set forth by the American College of Physicians. Specific components of Coordinated Care include clinical support, information management, and access and scheduling. Success of the model will require changes in the payment system that fairly reimburse physicians who provide leadership to teams that deliver high quality, coordinated care.

  9. [The Teratology Information Service: medicines during pregnancy and lactation].

    Science.gov (United States)

    de Vries, Loes C; de Swart, Irene W; van Puijenbroek, Eugène P

    2016-01-01

    Many women use medication during pregnancy. Both the healthcare professional and the pregnant woman often have many questions about the possible adverse effects of the medication that are not always answered in the product information. The Teratology Information Service (TIS), a part of the Netherlands Pharmacovigilance Centre Lareb, is a centre of expertise in the field of the safety of medication use and other external influences during spermatogenesis, pregnancy and lactation. The TIS collects, interprets, and disseminates information that can contribute to patient care. Healthcare professionals can contact the TIS for information and individual risk assessments. In this article we discuss the background and positioning of the TIS, the characteristics of telephone consultations, the collection of data and the considerations that are important for the use of medication during pregnancy and lactation.

  10. Development and professional qualification of general practice and family medicine in Germany

    Directory of Open Access Journals (Sweden)

    Markus Herrmann

    2013-04-01

    Full Text Available Objective: This article aims to analyze the professional and faculty development of general practice and family medicine (GP/FM in Germany and discuss its facing challenges. Methods: It is a case study identifying characteristics and potential intervention tools, describing training and qualification requirements in family medicine in Germany. Results: The traditional caring role of GP in Germany has a long history, but GP has no gatekeeper function, which weakens its position in the system. In the past decades, GP has undergone several transformations; it is no longer a practice based on the traditional “Hausarzt” style. It has become a medical specialty of primary care with more modern foundations; it requires five years of practical training in internal medicine, paediatrics, surgery and general medicine, and it is governed by the Physician Chambers. In undergraduate education, courses in General Practice are mandatory. In recent years, the new curriculum requirements have led to an intense process of academic development with the creation of General Practice departments in 20 of the 36 public medical schools in the country. Conclusions: The process of professionalization and faculty development in GP/FM as well as the expansion of undergraduate training in the specialty aim to enhance the appeal of GP/FM to young doctors. This development strengthens academic research on GP/FM, which contributes to enhancing the institutional basis of GP/FM as a science, allowing bolder interaction and collaboration with other branches of medicine and real appreciation of this subject (GP/FM.

  11. Clinical preventive services in Guatemala: a cross-sectional survey of internal medicine physicians.

    Directory of Open Access Journals (Sweden)

    Juan E Corral

    Full Text Available BACKGROUND: Guatemala is currently undergoing an epidemiologic transition. Preventive services are key to reducing the burden of non-communicable diseases, and smoking counseling and cessation are among the most cost-effective and wide-reaching strategies. Internal medicine physicians are fundamental to providing such services, and their knowledge is a cornerstone of non-communicable disease control. METHODS: A national cross-sectional survey was conducted in 2011 to evaluate knowledge of clinical preventive services for non-communicable diseases. Interns, residents, and attending physicians of the internal medicine departments of all teaching hospitals in Guatemala completed a self-administered questionnaire. Participants' responses were contrasted with the Guatemalan Ministry of Health (MoH prevention guidelines and the US Preventive Services Task Force (USPSTF recommendations. Analysis compared knowledge of recommendations within and between hospitals. RESULTS: In response to simulated patient scenarios, all services were recommended by more than half of physicians regardless of MoH or USPSTF recommendations. Prioritization was adequate according to the MoH guidelines but not including other potentially effective services (e.g. colorectal cancer and lipid disorder screenings. With the exception of colorectal and prostate cancer screening, less frequently recommended by interns, there was no difference in recommendation rates by level. CONCLUSION: Guatemalan internal medicine physicians' knowledge on preventive services recommendations for non-communicable diseases is limited, and prioritization did not reflect cost-effectiveness. Based on these data we recommend that preventive medicine training be strengthened and development of evidence-based guidelines for low-middle income countries be a priority.

  12. Receiving a pharmaceutical care service compared to receiving standard pharmacy service in Sweden--How do patients differ with regard to perceptions of medicine use and the pharmacy encounter?

    Science.gov (United States)

    Montgomery, Anna T; Kälvemark Sporrong, Sofia; Manap, Nila; Tully, Mary P; Lindblad, Asa Kettis

    2010-09-01

    Qualitative research has shown that gaining control of medicine treatment and increased feelings of safety and empowerment are central concepts in patients' perceptions of a pharmaceutical care (PC) service provided in Sweden. However, little is known about any unique differences among patients receiving PC versus standard pharmacy services (SSs) and the impact of these services on patient-perceived outcomes. To describe and compare patients who had previously received a PC service and patients who had received a SS with regard to their perceptions of medicine use and the pharmacy encounter. Cross-sectional survey design comparing matched groups of patients who were previously elected to receive a PC service or who had received SS. Patients who were 60 years or older and used 5 or more prescription medicines concomitantly were included in the survey. Questionnaires included questions about perceptions of safety in drug therapy, general health, drug-related problems (DRPs), medication beliefs, adherence, and experiences of pharmacy encounters. Patients receiving the PC service used more prescription medicines, reported poorer self-reported health, and less perceived safety in their medicine therapy than did patients in SS. PC patients reported that they felt safer with medications, felt a genuine interest from the pharmacist, received important information, and felt more prepared to see the doctor after having spoken to the pharmacist than did patients in SS. DRPs reported to a greater extent by patients receiving the PC service included difficulties opening containers, worries about side effects, experiences of side effects, worries about drug-drug interactions, and inadequate treatment effects. Adherence and medication beliefs showed no statistical difference between groups. Patients receiving a PC service are a worried, vulnerable, and information-seeking group. When compared with patients receiving SS, the PC patients are more insecure about their medicine

  13. 75 FR 52605 - Veterinary Medicine Advisory Committee; Notice of Meeting

    Science.gov (United States)

    2010-08-26

    ... HUMAN SERVICES Food and Drug Administration Veterinary Medicine Advisory Committee; Notice of Meeting... the public. Name of Committee: Veterinary Medicine Advisory Committee. General Function of the...-1100. Contact Person: Aleta Sindelar, Center for Veterinary Medicine (HFV-3), Food and...

  14. Canadian Cancer Society Information Services: lessons learned about complementary medicine information needs.

    Science.gov (United States)

    Eng, J L; Monkman, D A; Verhoef, M J; Ramsum, D L; Bradbury, J

    2001-01-01

    The use of complementary and alternative medicine (CAM) in cancer patients is very common. However, currently valid and reliable information on CAM treatments for cancer is limited. The purpose of this study was to identify the information needs those who called the Canadian Cancer Society's Cancer Information Service (CIS) requesting information on CAM. CIS Information Specialists completed two-page questionnaires for 109 callers who inquired about CAM therapies. Findings show that the majority of callers were women between the ages of 30 and 59, and that most of their questions concerned the safety and/or effectiveness of herbs and compounds like Essiac and 714X. Information Specialists generally utilized one or more of four resources upon receiving a CAM-related call. These resources, while mostly Canadian and reviewed by content experts, are not specific to the type of cancer and are no longer the most up- to-date. To address this issue we have included an appendix that outlines some current CAM resources and websites for cancer patients.

  15. An evaluation of career paths among 30 years of general internal medicine/primary care internal medicine residency graduates.

    Science.gov (United States)

    Chen, Dan; Reinert, Steven; Landau, Carol; McGarry, Kelly

    2014-10-01

    Interest in primary care careers has been dwindling among medical trainees over the past decade, with poor quality of life among the perceived disadvantages. We sought to evaluate factors influencing career satisfaction among graduates of Brown's General Internal Medicine (GIM)/Primary Care residency program and assess its contribution to the primary care work force. Using an anonymous online survey, we queried GIM alumni from 1981-2012 to obtain information about demographics, job characteristics and career satisfaction measures. Fifty-nine percent of Brown's GIM/Primary Care residency graduates practice primary care, a rate higher than most primary care track programs. Seventy-six percent of respondents were "satisfied" or "very satisfied" with their current jobs. Career satisfaction correlated with self-rating of physical and emotional health and did not correlate with age, gender, income, debt burden, or practice setting. Among the diverse factors associated with attaining career satisfaction, attention to personal health plays a central role.

  16. [The general physician, essential actor in the medicine of the future].

    Science.gov (United States)

    Sotelo, Julio

    2004-01-01

    In most countries, the number of general practitioners is double that of specialists: This single feature makes evident the fact that the medical profession depends, to a great extent, on the effects that the entire spectrum of professionals devoted to health produces on the society, not only those who, for obvious reasons, have been trained as specialists to acquire knowledge in depth in a specific field of human pathology. In a considerable proportion of cases, the general physician represents the first contact of the patient with the medical profession and in many cases this is the only relationship that the patient requires. The general physician should be the doctor to decide whether the ailment would be better studied by a specialist. During the second part of the 20th Century, great importance was given to the consolidation and expansion of medical specialties; however, in many instances an inadequate image of medicine was produced. The performance of specialists in some cases was seen as excessively reductionistic, complex, detached, and unnecessarily expensive. This vision was frustrating to a large number of patients. The general practice of medicine has a primordial place in medicine, and we all must contribute to its academic progress as well as to the precise delineation of its areas of efficiency, to reintegrate the classical image of kindness, solidarity, and humanism into novel concepts of scientific and technological capabilities from which we all will benefit.

  17. 42 CFR 410.24 - Limitations on services of a doctor of dental surgery or dental medicine.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Limitations on services of a doctor of dental surgery or dental medicine. 410.24 Section 410.24 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Medical and Other Health Services § 410.24 Limitations on services of a doctor of dental surgery or dental...

  18. Preparedness of Lithuanian general practitioners to provide mental healthcare services

    DEFF Research Database (Denmark)

    Jaruseviciene, Lina; Sauliune, Skirmante; Jarusevicius, Gediminas

    2014-01-01

    BACKGROUND: A large unmet need for mental healthcare in Lithuania is partially attributable to a lack of primary care providers with skills in this area. The aim of this study was to assess general practitioners' (GPs) experience in mental healthcare and their perceptions about how to increase...... their involvement in the field. METHODS: In this cross-sectional study, a 41-item questionnaire was distributed to a random sample of 797 Lithuanian GPs in order to investigate current practices in their provision of mental healthcare as well as their suggestions for the improvement of mental healthcare services...... specialists with whom 32% of the respondents discuss the management of their patients with a mental disorder. Collaboration with psychologists and social workers was almost threefold lower (11.6% and 12.5%). Capacity-building of GPs was found to be among the most promising initiatives to improve mental health...

  19. 75 FR 13763 - General Services Administration Acquisition Regulation; Submission for OMB Review; GSA Form 1217...

    Science.gov (United States)

    2010-03-23

    ... ADMINISTRATION DEPARTMENT OF DEFENSE NATIONAL AERONAUTICS AND SPACE ADMINISTRATION General Services Administration Acquisition Regulation; Submission for OMB Review; GSA Form 1217, Lessor's Annual Cost Statement AGENCY: Department of Defense (DOD), General Services Administration (GSA), and National Aeronautics...

  20. Characterization of Complementary and Alternative Medicine-Related Consultations in an Academic Drug Information Service.

    Science.gov (United States)

    Gregory, Philip J; Jalloh, Mohamed A; Abe, Andrew M; Hu, James; Hein, Darren J

    2016-12-01

    To characterize requests received through an academic drug information consultation service related to complementary and alternative medicines. A retrospective review and descriptive analysis of drug information consultations was conducted. A total of 195 consultations related to complementary and alternative medicine were evaluated. All consultation requests involved questions about dietary supplements. The most common request types were related to safety and tolerability (39%), effectiveness (38%), and therapeutic use (34%). Sixty-eight percent of the requests were from pharmacists. The most frequent consultation requests from pharmacists were questions related to drug interactions (37%), therapeutic use (37%), or stability/compatibility/storage (34%). Nearly 60% of complementary and alternative medicine-related consultation requests were able to be completely addressed using available resources. Among review sources, Natural Medicines Comprehensive Database, Clinical Pharmacology, Micromedex, and Pharmacist's Letter were the most common resources used to address consultations. Utilization of a drug information service may be a viable option for health care professionals to help answer a complementary and alternative medicine-related question. Additionally, pharmacists and other health care professionals may consider acquiring resources identified to consistently answering these questions. © The Author(s) 2015.

  1. 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.

  2. Seven years of teenage pregnancy in an inner London genitourinary medicine service - a retrospective cohort study.

    Science.gov (United States)

    Hegazi, Aseel; Daley, Natalie; Williams, Elizabeth; McLeod, Felicity; Rafiezadeh, Saba; Prime, Katia

    2014-12-01

    Young people attending genitourinary medicine services are at high risk of unplanned pregnancy. We performed a retrospective cohort study to identify characteristics of pregnant teenagers accessing an inner London genitourinary medicine service. There were 481 pregnancies in 458 teenagers with 54 previous pregnancies and 46 previous terminations of pregnancy. The under-18 and under-16 teenage pregnancy rates were 92.1 and 85.8 per 1000 age-matched clinic attendees, respectively. Median age was 17.1 years. 'Black Other' teenagers ('Black British', 'Mixed White-Black Caribbean' and 'Mixed White-Black African') were over-represented, compared to our clinic population, while those of White ethnicity were under-represented. Few pregnancies (1.5%) were planned with the majority (64%) intending terminations of pregnancy. Most teenagers did not use consistent contraception. Two-thirds of patients had attended genitourinary medicine services in the past and sexually transmitted infection prevalence at presentation was high. Effectively targeting the sexual and reproductive health needs of teenage genitourinary medicine clinic attendees may have a significant impact on reducing sexually transmitted infections, unplanned pregnancy and terminations of pregnancy in this group. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  3. Generalized access control strategies for integrated services token passing systems

    Science.gov (United States)

    Pang, Joseph W. M.; Tobagi, Fouad A.; Boyd, Stephen

    1994-08-01

    The demand for integrated services local area networks is increasing at a rapid pace with the advent of many new and exciting applications: office and factory automation, distributed computing, and multimedia communications. To support these new applications, it is imperative to integrate traffic with diverse statistical characteristics and differing delay requirements on the same network. An attractive approach for integrating traffic has been adopted in two token passing local area network standards, the IEEE 802.4 token bus standard and FDDI. The idea is to control the transmissions of each station based on a distributed timing algorithm, so as to achieve the following goals: (1) to limit the token cycles so that time-critical traffic can be accommodated, and (2) to allocate pre-specified bandwidths to different stations when the network is overloaded. We have investigated the analysis and design of this protocol. In this paper, we generalize the transmission control algorithm used previously. The major advantages of the generalization over the original protocol are: (1) it provides a much expanded design space, (2) it guarantees convergent behavior, and (3) it gives meaningful insights into the dynamics of the basic control algorithm.

  4. 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.

  5. Assessing the Subject General Medicine VII in the University Polyclinic Evaluación de la asignatura Medicina General Integral VII en el policlínico universitario

    Directory of Open Access Journals (Sweden)

    Cynthia Olivia Morales Pérez

    2012-06-01

    Full Text Available Background: the subject General Medicine VII is part of the guiding discipline in Medicine studies. It ensures that when Medicine Doctors obtain their degrees they have acquired all the knowledge that allows them to perform multiple tasks in health care services. Objective: to assess the subject General Medicine VII, in the university polyclinic as part of the educational process. Methods: we conducted a mixed research using quantitative and qualitative methods through a methodology that included the level of satisfaction of students, teachers, managers, and knowledge levels obtained by students. This methodology was applied in the fourth year of Medicine studies and in the four university polyclinics in the municipality of Cienfuegos, inserted into the new training model. Results: managers referred insufficient chances for exchanging with subordinates as well as for the profits of methodological activities, teachers were dissatisfied because of insufficient educational preparation and high work load and students reported difficulties with the availability and on-time delivery of textbooks, in addition to not having the necessary instrumentation for skills appropriation. Conclusions: we found that managers were dissatisfied with organizational and functional aspects, teachers with planning and implementation of the teaching process and students with the literature and the necessary tools while in teaching practice.Fundamento: la asignatura Medicina General Integral VII es parte de la disciplina rectora de la carrera de Medicina, que garantiza que una vez graduado el Médico General, posea conocimientos que le permitan desempeñar múltiples tareas en los servicios de atención médica. Objetivo: evaluar la asignatura Medicina General Integral VII en el policlínico universitario como parte del proceso docente educativo.

  6. Social service in medicine in Mexico. An urgent and possible reform.

    Directory of Open Access Journals (Sweden)

    Gustavo Nigenda

    2013-09-01

    Full Text Available One third of the primary care units in the public system keeps being covered exclusively by interns. It is shown that with the resources available in the System for Social Protection in Health it is possible to hire graduate health personnel for all Ministry of Health rural units. It is necessary to modify the current legislation to impede an intern to be located in units without supervision of a graduate doctor. There is an urgent need for a reform of social service in medicine that responds both to the institutional modernization and to the increased capacity of the newly insured to demand high-quality services.

  7. How Many Graduating Family Medicine Residents Have Chosen Financial Support for Service Commitments?

    Science.gov (United States)

    Phillips, Julie; Peterson, Lars E; Fang, Bo; Kovar-Gough, Iris; Phillips, Robert L

    2017-09-01

    New family physicians have opportunities to avoid accruing educational debt or have loans repaid by making a commitment to public service. Little information is available about the numbers of early career family physicians who have made service commitments to fund their education. The purpose of this study is to describe the proportion of graduating family medicine residents who have enrolled in US military and National Health Service Corps (NHSC) scholarship and loan repayment programs, thus obligating them to future public service. The study was a secondary analysis of de-identified data from the 2014 and 2015 American Board of Family Medicine examination registration questionnaire, which is required of all residents applying for board certification. Descriptive statistics were used to indicate the numbers and proportions of respondents who indicated military or NHSC financial support. Chi square analyses were used to analyze differences between groups. Of the 6,231 residents studied, 271 (4.4%) had either obtained military support (n=191, 3.1%) or enrolled in the NHSC (n=80, 1.3%). More men had enrolled in the military than women (4.2% vs 2.2%, P<0.01), but there was no significant NHSC gender difference. Underrepresented minorities (URM) were twice as likely to have enrolled in NHSC as non-URM residents (2.5% vs 1.0%, P<0.01). Only a small fraction of graduating family medicine residents have used either military enrollment or NHSC scholarships to fund their education. Family medicine should advocate strongly for expansion of the NHSC scholarship program, which receives many more applications than it can support.

  8. International VLBI Service for Geodesy and Astrometry: General Meeting Proceedings

    Science.gov (United States)

    Vandenberg, Nancy R. (Editor); Baver, Karen D. (Editor)

    2002-01-01

    This volume contains the proceedings of the second General Meeting of the International VLBI Service for Geodesy and Astrometry (IVS), held in Tsukuba, Japan, February 4-7, 2002. The contents of this volume also appear on the IVS Web site at http://ivscc.gsfc.nasa.gov/publications/gm2002. The key-note of the second GM was prospectives for the future, in keeping with the re-organization of the IAG around the motivation of geodesy as 'an old science with a dynamic future' and noting that providing reference frames for Earth system science that are consistent over decades on the highest accuracy level will provide a challenging role for IVS. The goal of the meeting was to provide an interesting and informative program for a wide cross section of IVS members, including station operators, program managers, and analysts. This volume contains 72 papers and five abstracts of papers presented at the GM. The volume also includes reports about three splinter meetings held in conjunction with the GM: a mini-TOW (Technical Operations Workshop), the third IVS Analysis Workshop and a meeting of the analysis working group on geophysical modeling.

  9. Patients' experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care.

    Science.gov (United States)

    Chung, Vincent Ch; Yip, Benjamin Hk; Griffiths, Sian M; Yu, Ellen Lm; Liu, Siya; Ho, Robin St; Wu, Xinyin; Leung, Albert Wn; Sit, Regina Ws; Wu, Justin Cy; Wong, Samuel Ys

    2015-12-21

    Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients' experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients' perspective; and (ii) to investigate how quality varies with patients' demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of "coordination of patient information", "continuity of care", and "range of service provided". Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services.

  10. Patients’ experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care

    Science.gov (United States)

    Chung, Vincent CH; Yip, Benjamin HK; Griffiths, Sian M; Yu, Ellen LM; Liu, Siya; Ho, Robin ST; Wu, Xinyin; Leung, Albert WN; Sit, Regina WS; Wu, Justin CY; Wong, Samuel YS

    2015-01-01

    Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients’ experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients’ perspective; and (ii) to investigate how quality varies with patients’ demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of “coordination of patient information”, “continuity of care”, and “range of service provided”. Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services. PMID:26686267

  11. 26 CFR 49.4252-1 - General telephone service.

    Science.gov (United States)

    2010-04-01

    ... operated by a person engaged in the business of furnishing communication service, and if by means of such..., and whether or not the person engaged in the business of furnishing communication service permits the... the business of furnishing communication service, if by means of such connection communication may be...

  12. Assessment of general public perceptions toward traditional medicines used for aphrodisiac purpose in state of Penang, Malaysia.

    Science.gov (United States)

    Hassali, Mohamed Azmi; Saleem, Fahad; Shafie, Asrul Akmal; Al-Qazaz, Harith Khalid; Farooqui, Maryam; Aljadhey, Hisham; Atif, Muhammad; Masood, Imran

    2012-11-01

    The study aims to evaluate general public perceptions regarding the use of Traditional and Complementary Medicines (TCM) for aphrodisiac purposes. A questionnaire based, cross-sectional study was undertaken. Respondents were selected in the state of Penang, Malaysia. A total of 392 respondents were included in the study. Descriptive statistics were used for data analysis. Chi Square/Fischer Exact tests were used where appropriate. Out of 392 respondents, 150 (38.26%) reported using specific Traditional medicines for aphrodisiac purposes. Most respondents (46.94%) agreed that aphrodisiac medicines were easily available t. Moreover, 40.31% of the respondents reported that traditional aphrodisiac medicines were cheaper than modern (prescription) medicines. This study highlights limited public knowledge regarding the use of traditional aphrodisiac medicine. Healthcare professionals should be aware of informal TCM usage when prescribing allopathic medicines. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. FOREST-BASED MEDICINAL PLANTS RENDERING THEIR SERVICES TO THE RURAL COMMUNITY OF ASSAM, INDIA

    Directory of Open Access Journals (Sweden)

    Ratul Arya Baishya

    2013-12-01

    Full Text Available Forests are the main biological resource areas from where reportedly 80% of the medicinal plants are collected by the rural communities of the state. Traditional folk medicines, mainly based on plants, occupy a significant position today, especially in the developing countries, where modern health care service is limited. Medicinal plants are gaining global importance owing to the fact that herbal drugs are cost-effective, easily available and most reportedly, with negligible side effects. Safe, effective and inexpensive indigenous remedies had been practiced by the people of both tribal and rural society of Assam from time immemorial. Therefore, the need of the hour is to harness this natural resource sustainably for the socio-economic development of the indigenous communities. Hence, a strategy for sustainable harvesting practice needs to be developed that would ensure preservation of the valuable medicinal plants in situ while addressing the needs of the rural communities. The present study is, thus, an attempt to highlight the common medicinal plants of forested region as used by the rural poor community for different kinds of treatment as the rural local healers usually practice for treatment of diseases in their locality.

  14. Communication channels in general internal medicine: a description of baseline patterns for improved interprofessional collaboration.

    Science.gov (United States)

    Conn, Lesley Gotlib; Lingard, Lorelei; Reeves, Scott; Miller, Karen-Lee; Russell, Ann; Zwarenstein, Merrick

    2009-07-01

    General internal medicine (GIM) is a communicatively complex specialty because of its diverse patient population and the number and diversity of health care providers working on a medicine ward. Effective interprofessional communication in such information-intensive environments is critical to achieving optimal patient care. Few empirical studies have explored the ways in which health professionals exchange patient information and the implications of their chosen communication forms. In this article, we report on an ethnographic study of health professionals' communication in two GIM wards through the lens of communication genre theory. We categorize and explore communication in GIM into two genre sets-synchronous and asynchronous-and analyze the relationship between them. Our findings reveal an essential relationship between synchronous and asynchronous modes of communication that has implications for the effectiveness of interprofessional collaboration in this and similar health care settings, and is intended to inform efforts to overcome existing interprofessional communication barriers.

  15. Academic medicine amenities unit: developing a model to integrate academic medical care with luxury hotel services.

    Science.gov (United States)

    Kennedy, David W; Kagan, Sarah H; Abramson, Kelly Brennen; Boberick, Cheryl; Kaiser, Larry R

    2009-02-01

    The interface between established values of academic medicine and the trend toward inpatient amenities units requires close examination. Opinions of such units can be polarized, reflecting traditional reservations about the ethical dilemma of offering exclusive services only to an elite patient group. An amenities unit was developed at the University of Pennsylvania Health System in 2007, using an approach that integrated academic medicine values with the benefits of philanthropy and service excellence to make amenities unit services available to all patients. Given inherent internal political concerns, a broadly based steering committee of academic and hospital leadership was developed. An academically appropriate model was conceived, anchored by four principles: (1) integration of academic values, (2) interdisciplinary senior leadership, (3) service excellence, and (4) recalibrated occupancy expectations based on multiple revenue streams. Foremost is ensuring the same health care is afforded all patients throughout the hospital, thereby overcoming ethical challenges and optimizing teaching experiences. Service excellence frames the service ethic for all staff, and this, in addition to luxury hotel-style amenities, differentiates the style and feel of the unit from others in the hospital. Recalibrated occupancy creates program viability given revenue streams redefined to encompass gifts and patient revenue, including both reimbursement and self-pay. The medical-surgical amenities patient-care unit has enjoyed a successful first year and a growing stream of returning patients and admitting physicians. Implications for other academic medical centers include opportunities to extrapolate service excellence throughout the hospital and to cultivate philanthropy to benefit services throughout the medical center.

  16. An investigation Into Traditional Chinese Medicine Hospitals in China: Development Trend and Medical Service Innovation

    Directory of Open Access Journals (Sweden)

    Liang Wang

    2017-01-01

    Full Text Available Background This paper aims to investigate the development trend of traditional Chinese medicine (TCM hospitals in China and explore their medical service innovations, with special reference to the changing co-existence with western medicine (WM at TCM hospitals. Methods Quantitative data at macro level was collected from official databases of China Health Statistical Yearbook and Extracts of Traditional Chinese Medicine Statistics. Qualitative data at micro level was gathered through interviews and second-hand material collection at two of the top-level TCM hospitals. Results In both outpatient and inpatient sectors of TCM hospitals, drug fees accounted for the biggest part of hospital revenue. Application of WM medical exanimation increased in both outpatient and inpatient services. Even though the demand for WM drugs was much higher in inpatient care, TCM drugs was the winner in the outpatient. Also qualitative evidence showed that TCM dominated the outpatient hospital service with WM incorporated in the assisting role. However, it was in the inpatient medical care that WM prevailed over TCM which was mostly applied to the rehabilitation of patients. Conclusion By drawing on WM while keeping it active in supporting and strengthening the TCM operation in the TCM hospital, the current system accommodates the overriding objective which is for TCM to evolve into a fully informed and more viable medical field.

  17. An investigation Into Traditional Chinese Medicine Hospitals in China: Development Trend and Medical Service Innovation

    Science.gov (United States)

    Wang, Liang; Suo, Sizhuo; Li, Jian; Hu, Yuanjia; Li, Peng; Wang, Yitao; Hu, Hao

    2017-01-01

    Background: This paper aims to investigate the development trend of traditional Chinese medicine (TCM) hospitals in China and explore their medical service innovations, with special reference to the changing co-existence with western medicine (WM) at TCM hospitals. Methods: Quantitative data at macro level was collected from official databases of China Health Statistical Yearbook and Extracts of Traditional Chinese Medicine Statistics. Qualitative data at micro level was gathered through interviews and second-hand material collection at two of the top-level TCM hospitals. Results: In both outpatient and inpatient sectors of TCM hospitals, drug fees accounted for the biggest part of hospital revenue. Application of WM medical exanimation increased in both outpatient and inpatient services. Even though the demand for WM drugs was much higher in inpatient care, TCM drugs was the winner in the outpatient. Also qualitative evidence showed that TCM dominated the outpatient hospital service with WM incorporated in the assisting role. However, it was in the inpatient medical care that WM prevailed over TCM which was mostly applied to the rehabilitation of patients. Conclusion: By drawing on WM while keeping it active in supporting and strengthening the TCM operation in the TCM hospital, the current system accommodates the overriding objective which is for TCM to evolve into a fully informed and more viable medical field. PMID:28005539

  18. An investigation Into Traditional Chinese Medicine Hospitals in China: Development Trend and Medical Service Innovation.

    Science.gov (United States)

    Wang, Liang; Suo, Sizhuo; Li, Jian; Hu, Yuanjia; Li, Peng; Wang, Yitao; Hu, Hao

    2016-06-07

    This paper aims to investigate the development trend of traditional Chinese medicine (TCM) hospitals in China and explore their medical service innovations, with special reference to the changing co-existence with western medicine (WM) at TCM hospitals. Quantitative data at macro level was collected from official databases of China Health Statistical Yearbook and Extracts of Traditional Chinese Medicine Statistics. Qualitative data at micro level was gathered through interviews and second-hand material collection at two of the top-level TCM hospitals. In both outpatient and inpatient sectors of TCM hospitals, drug fees accounted for the biggest part of hospital revenue. Application of WM medical exanimation increased in both outpatient and inpatient services. Even though the demand for WM drugs was much higher in inpatient care, TCM drugs was the winner in the outpatient. Also qualitative evidence showed that TCM dominated the outpatient hospital service with WM incorporated in the assisting role. However, it was in the inpatient medical care that WM prevailed over TCM which was mostly applied to the rehabilitation of patients. By drawing on WM while keeping it active in supporting and strengthening the TCM operation in the TCM hospital, the current system accommodates the overriding objective which is for TCM to evolve into a fully informed and more viable medical field.

  19. Radioactive waste management of the nuclear medicine services; Gestao de rejeitos radioativos em servicos de medicina nuclear

    Energy Technology Data Exchange (ETDEWEB)

    Barboza, Alex

    2009-07-01

    Radioisotope applications in nuclear medicine services, for diagnosis and therapy, generate radioactive wastes. The general characteristics and the amount of wastes that are generated in each facility are function of the number of patients treated, the procedures adopted, and the radioisotopes used. The management of these wastes embraces every technical and administrative activity necessary to handle the wastes, from the moment of their generation, till their final disposal, must be planned before the nuclear medicine facility is commissioned, and aims at assuring people safety and environmental protection. The regulatory framework was established in 1985, when the National Commission on Nuclear Energy issued the regulation CNEN-NE-6.05 'Radioactive waste management in radioactive facilities'. Although the objective of that regulation was to set up the rules for the operation of a radioactive waste management system, many requirements were broadly or vaguely defined making it difficult to ascertain compliance in specific facilities. The objective of the present dissertation is to describe the radioactive waste management system in a nuclear medicine facility and provide guidance on how to comply with regulatory requirements. (author)

  20. 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.

  1. Patient empowerment, an additional characteristic of the European definitions of general practice/family medicine.

    Science.gov (United States)

    Mola, Ernesto

    2013-06-01

    Growing evidence supports the inclusion of patient empowerment as a key ingredient of care for patients with chronic conditions. In recent years, several studies based on patient empowerment, have been carried out in different European countries in the context of general practice and primary care to improve management of chronic diseases. These studies have shown good results of the care model, increasing patient and health professionals' satisfaction, adherence to guidelines and to treatment, and improving clinical outcomes. In 2011, the Wonca European Council included as the twelfth characteristic of the European definitions of general practice/family medicine: 'promote patient empowerment'. The aim of this paper is to clarify the meaning of 'patient empowerment' and to explain why family medicine should be considered the most suitable setting to promote it. The inclusion of patient empowerment as one of the essential characteristics of general practice fills a conceptual gap and clearly suggests to the European health care systems a tested model to face chronic diseases: involving and empowering patients in managing their own conditions to improve health and well-being.

  2. Techniques and Behaviors Associated with Exemplary Inpatient General Medicine Teaching: An Exploratory Qualitative Study.

    Science.gov (United States)

    Houchens, Nathan; Harrod, Molly; Moody, Stephanie; Fowler, Karen; Saint, Sanjay

    2017-07-01

    Clinician educators face numerous obstacles to their joint mission of facilitating high-quality learning while also delivering patient-centered care. Such challenges necessitate increased attention to the work of exemplary clinician educators, their respective teaching approaches, and the experiences of their learners. To describe techniques and behaviors utilized by clinician educators to facilitate excellent teaching during inpatient general medicine rounds. An exploratory qualitative study of inpatient teaching conducted from 2014 to 2015. Inpatient general medicine wards in 11 US hospitals, including university-affiliated hospitals and Veterans Affairs medical centers. Participants included 12 exemplary clinician educators, 57 of their current learners, and 26 of their former learners. In-depth, semi-structured interviews of exemplary clinician educators, focus group discussions with their current and former learners, and direct observations of clinical teaching during inpatient rounds. Interview data, focus group data, and observational field notes were coded and categorized into broad, overlapping themes. Each theme elucidated a series of actions, behaviors, and approaches that exemplary clinician educators consistently demonstrated during inpatient rounds: (1) they fostered positive relationships with all team members by building rapport, which in turn created a safe learning environment; (2) they facilitated patient-centered teaching points, modeled excellent clinical exam and communication techniques, and treated patients as partners in their care; and (3) they engaged in coaching and collaboration through facilitation of discussion, effective questioning strategies, and differentiation of learning among team members with varied experience levels. This study identified consistent techniques and behaviors of excellent teaching during inpatient general medicine rounds.

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

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    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.

  4. Retractions in general and internal medicine in a high-profile scientific indexing database

    Directory of Open Access Journals (Sweden)

    Renan Moritz Varnier Rodrigues de Almeida

    Full Text Available CONTEXT AND OBJECTIVE: Increased frequency of retractions has recently been observed, and retractions are important events that deserve scientific investigation. This study aimed to characterize cases of retraction within general and internal medicine in a high-profile database, with interest in the country of origin of the article and the impact factor (IF of the journal in which the retraction was made. DESIGN AND SETTING: This study consisted of reviewing retraction notes in the Thomson-Reuters Web of Knowledge (WoK indexing database, within general and internal medicine. METHODS: The retractions were classified as plagiarism/duplication, error, fraud and authorship problems and then aggregated into two categories: "plagiarism/duplication" and "others." The countries of origin of the articles were dichotomized according to the median of the indicator "citations per paper" (CPP, and the IF was dichotomized according to its median within general and internal medicine, also obtained from the WoK database. These variables were analyzed using contingency tables according to CPP (high versus low, IF (high versus low and period (1992-2002 versus 2003-2014. The relative risk (RR and 95% confidence interval (CI were estimated for plagiarism/duplication. RESULTS: A total of 86 retraction notes were identified, and retraction reasons were found for 80 of them. The probability that plagiarism/duplication was the reason for retraction was more than three times higher for the low CPP group (RR: 3.4; 95% CI: [1.9-6.2], and similar results were seen for the IF analysis. CONCLUSION: The study identified greater incidence of plagiarism/duplication among retractions from countries with lower scientific impact.

  5. 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.

  6. Lead optimization attrition analysis (LOAA): a novel and general methodology for medicinal chemistry.

    Science.gov (United States)

    Munson, Mark; Lieberman, Harvey; Tserlin, Elina; Rocnik, Jennifer; Ge, Jie; Fitzgerald, Maria; Patel, Vinod; Garcia-Echeverria, Carlos

    2015-08-01

    Herein, we report a novel and general method, lead optimization attrition analysis (LOAA), to benchmark two distinct small-molecule lead series using a relatively unbiased, simple technique and commercially available software. We illustrate this approach with data collected during lead optimization of two independent oncology programs as a case study. Easily generated graphics and attrition curves enabled us to calibrate progress and support go/no go decisions on each program. We believe that this data-driven technique could be used broadly by medicinal chemists and management to guide strategic decisions during drug discovery. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. 29 CFR 779.319 - A retail or service establishment must be open to general public.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false A retail or service establishment must be open to general... FAIR LABOR STANDARDS ACT AS APPLIED TO RETAILERS OF GOODS OR SERVICES Exemptions for Certain Retail or Service Establishments Making Sales of Goods and Services ârecognized As Retailâ § 779.319 A retail...

  8. Characteristics of qualitative studies in influential journals of general medicine: a critical review.

    Science.gov (United States)

    Yamazaki, Hiroshi; Slingsby, Brian Taylor; Takahashi, Miyako; Hayashi, Yoko; Sugimori, Hiroki; Nakayama, Takeo

    2009-12-01

    Although qualitative studies have increased since the 1990s, some reports note that relatively few influential journals published them up until 2000. This study critically reviewed the characteristics of qualitative studies published in top tier medical journals since 2000. We assessed full texts of qualitative studies published between 2000 and 2004 in the Annals of Internal Medicine, BMJ, JAMA, Lancet, and New England Journal of Medicine. We found 80 qualitative studies, of which 73 (91%) were published in BMJ. Only 10 studies (13%) combined qualitative and quantitative methods. Sixty-two studies (78%) used only one method of data collection. Interviews dominated the choice of data collection. The median sample size was 36 (range: 9-383). Thirty-three studies (41%) did not specify the type of analysis used but rather described the analytic process in detail. The rest indicated the mode of data analysis, in which the most prevalent methods were the constant comparative method (23%) and the grounded theory approach (22%). Qualitative data analysis software was used by 33 studies (41%). Among influential journals of general medicine, only BMJ consistently published an average of 15 qualitative study reports between 2000 and 2004. These findings lend insight into what qualities and characteristics make a qualitative study worthy of consideration to be published in an influential journal, primarily BMJ.

  9. Correlation of the Emergency Medicine Resident In-service Examination with the American Osteopathic Board of Emergency Medicine Part I

    Directory of Open Access Journals (Sweden)

    David Levy

    2014-02-01

    Full Text Available Introduction: Eligible residents during their fourth postgraduate year (PGY-4 of emergency medicine (EM residency training who seek specialty board certification in emergency medicine may take the American Osteopathic Board of Emergency Medicine (AOBEM Part 1 Board Certifying Examination (AOBEM Part 1. All residents enrolled in an osteopathic EM residency training program are required to take the EM Resident In-service Examination (RISE annually. Our aim was to correlate resident performance on the RISE with performance on the AOBEM Part 1. The study group consisted of osteopathic EM residents in their PGY-4 year of training who took both examinations during that same year. Methods: We examined data from 2009 to 2012 from the National Board of Osteopathic Medical Examiners (NBOME. The NBOME grades and performs statistical analyses on both the RISE and the AOBEM Part 1. We used the RISE exam scores, as reported by percentile rank, and compared them to both the score on the AOBEM Part 1 and the dichotomous outcome of passing or failing. A receiver operating characteristic (ROC curve was generated to depict the relationship. Results: We studied a total of 409 residents over the 4-year period. The RISE percentile score correlated strongly with the AOBEM Part 1 score for residents who took both exams in the same year (r¼0.61, 95% confidence interval [CI] 0.54 to 0.66. Pass percentage on the AOBEM Part 1 increased by resident percent decile on the RISE from 0% in the bottom decile to 100% in the top decile. ROC analysis also showed that the best cutoff for determining pass or fail on the AOBEM Part 1 was a 65th percentile score on the RISE. Conclusion: We have shown there is a strong correlation between a resident’s percentile score on the RISE during their PGY-4 year of residency training and first-time success on the AOBEM Part 1 taken during the same year. This information may be useful for osteopathic EM residents as an indicator as to how well

  10. Mobile satellite services for public safety, disaster mitigation and disaster medicine

    Science.gov (United States)

    Freibaum, Jerry

    Between 1967 and 1987 nearly three million lives were lost and property damage of $25 to $100 billion resulted form natural disasters that adversely affected more than 829 million people. The social and economic impacts have been staggering and are expected to grow more serious as a result of changing demographic factors. The role that the Mobile Satellite Service can play in the International Decade is discussed. MSS was not available for disaster relief operations during the recent Loma Prieta/San Francisco earthquake. However, the results of a review of the performance of seven other communication services with respect to public sector operations during and shortly after the earthquake are described. The services surveyed were: public and private telephone, mobile radio telephone, noncellular mobile radio, broadcast media, CB radio, ham radio, and government and nongovernment satellite systems. The application of MSS to disaster medicine, particularly with respect to the Armenian earthquake is also discussed.

  11. Secure Grid Services for Cooperative Work in Medicine and Life Science

    Science.gov (United States)

    Weisbecker, Anette; Falkner, Jürgen

    MediGRID provides a grid infrastructure to solve challenging problems in medical and life sciences by enhancing the productivity and by enabling locationindependent, interdisciplinary collaboration. The usage of grid technology has enabled the development of new application and services for research in medical and life sciences. In order to enlarge the range of services and to get a broader range of users sustainable business models are needed. In Services@MediGRID methods for monitoring, accounting, and billing which fulfilled the high security demands within medicine and life sciences will be developed. Also different requirements of academic and industrial grid customers are considered in order to establish the sustainable business models for grid computing.

  12. 75 FR 82029 - General Services Administration Acquisition Regulation; Submission for OMB Review; GSA Form 1217...

    Science.gov (United States)

    2010-12-29

    ... Doc No: 2010-32775] GENERAL SERVICES ADMINISTRATION [OMB Control No. 3090-00XX; Docket 2010-0002; Sequence 15] General Services Administration Acquisition Regulation; Submission for OMB Review; GSA Form 1217, Lessor's Annual Cost Statement AGENCY: Department of Defense (DOD), General...

  13. 7 CFR 800.73 - Computation and payment of service fees; general fee information.

    Science.gov (United States)

    2010-01-01

    ... AGRICULTURE GENERAL REGULATIONS Fees § 800.73 Computation and payment of service fees; general fee information... 7 Agriculture 7 2010-01-01 2010-01-01 false Computation and payment of service fees; general fee information. 800.73 Section 800.73 Agriculture Regulations of the Department of Agriculture (Continued)...

  14. 76 FR 34886 - General Services Administration Acquisition Regulation; Implementation of Information Technology...

    Science.gov (United States)

    2011-06-15

    ... of Information Technology Security Provision AGENCY: Office of Acquisition Policy, General Services... to implement policy and guidelines for contracts and orders that include information technology (IT... information technology (IT) supplies, services and systems with security requirements. Comment...

  15. Teaching wound care to family medicine residents on a wound care service

    Directory of Open Access Journals (Sweden)

    Little SH

    2013-08-01

    Full Text Available Sahoko H Little,1,2 Sunil S Menawat,1,3 Michael Worzniak,1 Michael D Fetters2 1Oakwood Annapolis Family Medicine Residency, Wayne, Michigan, USA; 2University of Michigan, Department of Family Medicine, Ann Arbor, Michigan, USA; 3Ghent Family Medicine Residency, Eastern Virginia Medical School, Norfolk, Virginia, USA Abstract: Primary care physicians often care for patients with chronic wounds, and they can best serve patients if they have knowledge and proficient skills in chronic wound care, including sharp debridement. The Oakwood Annapolis Family Medicine Residency in Michigan, USA developed a Wound Care Service, incorporating wound care training during the surgical rotation. Effectiveness of the wound care training was evaluated through pre- and posttesting of residents, to assess changes in knowledge and comfort in treating chronic wounds. The results demonstrate significant improvement in residents’ knowledge and comfort in wound care. This innovation demonstrates the feasibility of educating residents in chronic wound care through hands-on experience. Keywords: wound care education, primary care, residency education, surgery rotation, curriculum development

  16. Evaluation of pharmacy students’ clinical interventions on a general medicine practice experience

    Directory of Open Access Journals (Sweden)

    Jones JD

    2011-03-01

    Full Text Available As colleges of pharmacy prepare a new generation of practitioners, it is important that during practice experiences students learn the impact of clinical interventions. For over ten years, pharmacy students have been a vital part of the multidisciplinary team at the military treatment facility. The overall impact of the student interventions on patient care has not been evaluated. To evaluate the impact, the students began documenting their clinical interventions in Medkeeper RxInterventions™, an online database. The program is used to document faculty and fourth year pharmacy students’ pharmaceutical interventions.Objective: The objective of this study was to analyze the interventions completed by fourth year pharmacy students during a general medicine advanced pharmacy practice experience at a military treatment facility.Methods: The students completing their general medicine advanced pharmacy practice experience at the military treatment facility are responsible for self reporting all interventions made during clinical rounds into the Medkeeper RxIntervention™ database. The researchers retrospectively collected and analyzed interventions made from June 2008 to June 2009.Results: The total number of interventions recorded by 8 fourth year pharmacy students was 114. Students averaged a number of 14.3 interventions during an eight week practice experience. Students spent an average of 5 minutes per intervention. Ninety- five percent of the interventions were accepted.Conclusion: Fourth year pharmacy students’ recommendations were accepted at a high rate by resident physicians. The high acceptance rate may have the ability to positively impact patient care.

  17. 77 FR 14016 - General Services Administration Acquisition Regulation; Preparation, Submission, and Negotiation...

    Science.gov (United States)

    2012-03-08

    ...] General Services Administration Acquisition Regulation; Preparation, Submission, and Negotiation of... Negotiation of Subcontracting Plans; Correction. Correction In the information collection document...

  18. [Prevalence of delirium in hospitalized patients from an internal medicine service].

    Science.gov (United States)

    González Pezoa, Ana Carolina; Carrillo Venezian, Bernardita Claudia; Castillo Rojas, Sandra

    2015-11-11

    Delirium is a common neurocognitive syndrome that takes place during hospitalizations, associated with worse global outcomes in patients who present it. Despite this, it is usually under-recognized as a disease that needs specific treatment. To determine the rate of prevalence of delirium in Internal Medicine Service patients and evaluate missed diagnosis of the syndrome made by attending physicians, medical residents or interns in charge. This is a descriptive observational study carried out in the Internal Medicine Service of Dr. Eduardo Pereira Hospital (April 12 - May 12, 2014) evaluating 125 patients who were admitted to this service. Through the Confusion Assessment Method Instrument, the prevalence of delirium disease and the number of missed diagnosis was established. One hundred and two (102) patients met the inclusion criteria. Nineteen (19) (18.6%) of them were diagnosed with delirium. In the diagnosed patient group, 13 (68.4%) were women. Delirium diagnosis was missed in eight patients (42.1%). The prevalence of delirium in this specific Hospital is as expected, according to the literature. Considering the diagnostic tools available, it is crucial to train health workers to improve recognition and management of this syndrome.

  19. Severe exacerbations of chronic obstructive pulmonary disease: management with noninvasive ventilation on a general medicine ward

    Directory of Open Access Journals (Sweden)

    Sirio Fiorino

    2013-04-01

    Full Text Available Introduction: Recent evidence suggests that, with a well-trained staff, severe exacerbations of chronic obstructive pulmonary disease (COPD with moderate respiratory acidosis (pH > 7.3 can be successfully treated with noninvasive mechanical ventilation (NIMV on a general respiratory care ward. We conducted an open prospective study to evaluate the efficacy of this approach on a general medicine ward. Material and methods: This study population consisted in 27 patients admitted to a general medicine ward (median nurse:patient ratio 1:12 December 1, 2004 May 31, 2006 for acute COPD exacerbation with hypercapnic respiratory failure and acidosis (arterial pH < 7.34, PaC02 > 45 mmHg. All received assist-mode NIMV (average 12 h / day via oronasal masks (inspiratory pressure 10-25 cm H2O, expiratory pressure 4-6 cm H2O to maintain O2 saturation at 90-95%. Treatment was supervised by an experienced pulmonologist, who had also provided specific training in NIMV for medical and nursing staffs (90-day course followed by periodic refresher sessions. Arterial blood pressure, O2 saturation, and respiratory rate were continuously monitored during NIMV. Based on baseline arterial pH, the COPD was classified as moderate (7.25-7.34 or severe (< 7.25. Results: In patients with moderate and severe COPD, significant improvements were seen in arterial pH after 2 (p < 0.05 and 24 h (p< 0.05 of NIMV and in the PaC02 after 24 hours (p < 0.05. Four (15% of the 27 patients died during the study hospitalization (in-hospital mortality 15%, in 2 cases due to NIMV failure. For the other 23, mean long-term survival was 14.5 months (95% CI 10.2 to 18.8, and no significant differences were found between the moderate and severe groups. Over half (61% the patients were alive 1 year after admission. Conclusions: NIMV can be a cost-effective option for management of moderate or severe COPD on a general medicine ward. Its proper use requires: close monitoring of ventilated subjects

  20. Proceso organizacional del departamento de Medicina General Integra Organizational process of the Department of Comprehensive General Medicine

    Directory of Open Access Journals (Sweden)

    Alcides Abad Ochoa Alonso

    2005-04-01

    Full Text Available Se realizó un estudio descriptivo para analizar el desarrollo organizativo del Departamento de Medicina General Integral de la Facultad de Ciencias Médicas "Mariana Grajales Coello", de Holguín, desde su constitución a inicios del curso académico 1988-1989 hasta la culminación del curso académico 2000-2001. Se definieron las variables y factores clave de éxito que integraron las 2 matrices construidas como instrumento de evaluación. Los resultados obtenidos en ambas matrices muestran que el proceso organizacional en el departamento se fortaleció al alcanzar para los factores de carácter externo un resultado total ponderado de 2,5 en el curso académico 2000-2001, superior al 2,1 del curso 1988-1989, y de 3,5 y 1,45, respectivamente para los factores de carácter interno, lo que indica un fortalecimiento general del proceso. Particularmente se transforman de manera favorable aquellos factores susceptibles de intervenciones administrativas. Se identificaron además, las áreas en que deben intensificarse o modificarse las estrategias en curso.A descriptive study was conducted to analyze the organizational development of the Department of Comprehensive General Medicine of "Mariana Grajales Coello" Medical Faculty, in Holguín since it was founded at the beginning of the academic course 1988-2001. The variables and key factors for success that integrated the 2 matrixes created as evaluation tools were defined. The results obtained in both matrixes showed that the organizational process in the department was strenghthened on obtaining a total weighted result for the factors of external character of 2.5 in the academic course 2000-2001, which was higher than the achieved in the course 1988-1989 (2-1, whereas 3.5 and 1.45 were attained, respectively, for the factors of internal character, which proved that there was a general strenghthening of the process. Those factors susceptible to managerial interventions were particularly transformed in

  1. [Essential medicines and the selection process in management practices of pharmaceutical services in Brazilian states and municipalities].

    Science.gov (United States)

    Magarinos-Torres, Rachel; Pepe, Vera Lucia Edais; Oliveira, Maria Auxiliadora; Osorio-de-Castro, Claudia Garcia Serpa

    2014-09-01

    The selection of medicines is a skilled process that produces an essential medicines list (EML) and substantiates rational management of pharmaceutical services. This paper presents the selection of essential medicines in Brazilian states and municipalities. It discusses the perception of pharmaceutical services managers regarding the concept of essential medicines and strategies adopted for their implementation, in addition to investigating how the National Essential Medicines List was adopted and is supporting local pharmaceutical services actions. A nationwide study was carried out adopting a qualitative methodological approach in health. State and municipal managers from the five Brazilian regions were interviewed. The findings point to weaknesses in local selection procedures and in the use of the National Essential Medicines List (Rename). Barriers such as lack of formalization of pharmaceutical services at regional levels, difficulties in drafting and maintaining a pharmacy and therapeutics committee and the acritical incorporation of drugs on the EML were identified. States and municipalities have distortions that exclude the EML form the concept of essential medicines.

  2. Implementing evidence-based medicine in general practice: a focus group based study

    Directory of Open Access Journals (Sweden)

    Aertgeerts Bert

    2005-09-01

    Full Text Available Abstract Background Over the past years concerns are rising about the use of Evidence-Based Medicine (EBM in health care. The calls for an increase in the practice of EBM, seem to be obstructed by many barriers preventing the implementation of evidence-based thinking and acting in general practice. This study aims to explore the barriers of Flemish GPs (General Practitioners to the implementation of EBM in routine clinical work and to identify possible strategies for integrating EBM in daily work. Methods We used a qualitative research strategy to gather and analyse data. We organised focus groups between September 2002 and April 2003. The focus group data were analysed using a combined strategy of 'between-case' analysis and 'grounded theory approach'. Thirty-one general practitioners participated in four focus groups. Purposeful sampling was used to recruit participants. Results A basic classification model documents the influencing factors and actors on a micro-, meso- as well as macro-level. Patients, colleagues, competences, logistics and time were identified on the micro-level (the GPs' individual practice, commercial and consumer organisations on the meso-level (institutions, organisations and health care policy, media and specific characteristics of evidence on the macro-level (policy level and international scientific community. Existing barriers and possible strategies to overcome these barriers were described. Conclusion In order to implement EBM in routine general practice, an integrated approach on different levels needs to be developed.

  3. [Comprehensive and competition-oriented quality management in social medicine expert services].

    Science.gov (United States)

    Seger, W

    1996-05-01

    In free competition expert services in Social Medicine must supply their expertise with high quality in a short time and at low cost. The demands by customers in respect of motivation of the staff and innovative organisation are as important competitive factors as high quality standards for expertise production. These guiding principles completed by "Kaizen" and "Lean production" are necessary requirements for the further existence of the enterprise in competition. Quality assurance must be promoted in a process looking to the future in active quality management.

  4. Comparison of the activity measurements in nuclear medicine services in the Brazilian northeast region.

    Science.gov (United States)

    de Farias Fragoso, Maria da Conceição; de Albuquerque, Antônio Morais; de Oliveira, Mércia L; de Lima, Fabiana Farias; Barreto, Flávio Chiappetta Paes; de Andrade Lima, Ricardo

    2013-12-01

    The Northeastern Regional Centre for Nuclear Sciences (CRCN-NE), National Nuclear Energy Commission, has organized for the first time in nuclear medicine services (NMSs) in the Brazilian northeast region a comparison of activity measurements for (99m)Tc, (131)I, (67)Ga, (201)Tl and (57)Co. This tool is widely utilized to evaluate not only the accuracy of radionuclide calibrators, but also the competence of NMSs to measure the activity of the radiopharmaceuticals and the performance of the personnel involved in these measurements. The comparison results showed that 90% of the results received from participants are within the ±10% limit established by the Brazilian Norm.

  5. Numeric data services and sources for the general reference librarian

    CERN Document Server

    Kellam, Lynda

    2011-01-01

    The proliferation of online access to social science statistical and numeric data sources, such as the U.S. Census Bureau's American Fact Finder, has lead to an increased interest in supporting these sources in academic libraries. Many large libraries have been able to devote staff to data services for years, and recently smaller academic libraries have recognized the need to provide numeric data services and support. This guidebook serves as a primer to developing and supporting social science statistical and numerical data sources in the academic library. It provides strategies for the estab

  6. Test Pricing and Reimbursement in Genomic Medicine: Towards a General Strategy.

    Science.gov (United States)

    Vozikis, Athanassios; Cooper, David N; Mitropoulou, Christina; Kambouris, Manousos E; Brand, Angela; Dolzan, Vita; Fortina, Paolo; Innocenti, Federico; Lee, Ming Ta Michael; Leyens, Lada; Macek, Milan; Al-Mulla, Fahd; Prainsack, Barbara; Squassina, Alessio; Taruscio, Domenica; van Schaik, Ron H; Vayena, Effy; Williams, Marc S; Patrinos, George P

    2016-01-01

    This paper aims to provide an overview of the rationale and basic principles guiding the governance of genomic testing services, to clarify their objectives, and allocate and define responsibilities among stakeholders in a health-care system, with a special focus on the EU countries. Particular attention is paid to issues pertaining to pricing and reimbursement policies, the availability of essential genomic tests which differs between various countries owing to differences in disease prevalence and public health relevance, the prescribing and use of genomic testing services according to existing or new guidelines, budgetary and fiscal control, the balance between price and access to innovative testing, monitoring and evaluation for cost-effectiveness and safety, and the development of research capacity. We conclude that addressing the specific items put forward in this article will help to create a robust policy in relation to pricing and reimbursement in genomic medicine. This will contribute to an effective and sustainable health-care system and will prove beneficial to the economy at large. © 2016 S. Karger AG, Basel.

  7. Knowledge and risk behaviors related with HIV infect in Communitarian General Medicine students.

    Directory of Open Access Journals (Sweden)

    Luis Manuel Padrón Velázquez

    2009-03-01

    Full Text Available Background: The worldwide epidemic outburst cause by the HIV and lack of effective vaccines against it make of human sexual behavior the most important element to fight this disease. Objective: To identify knowledge level and risk behaviors associated with the infection with this virus in students of second year of Community General Medicine. Methods: A cross-sectional, descriptive, epidemiological, observational study was developed from July to December 2006 including 44 Venezuelan Medicine students, from Giradot municipality, Aragua state, who referred having had sexual intercourse in the last semester of 2006. Results: Most of the students (77,3 % were females. More that half of them was between 20 and 29 years of age and 61, 4% admitting having knowledge about the different ways of infection. 255 recognized that every sexual orientation could be risky, with less percentage for females. All the surveyed persons agreed to through the test to identify the virus and only 2 of them (4, 5% referred not confidentiality. young males showed higher percentage of unprotected intercourse and couple stability. Conclusions: Results show that it is important to stress preventive activities to avoid HIV infection in male students and to raise their responsibility regarding safe sexual relations.

  8. A Methodological Strategy for the Family Health Course in General Internal Medicine Residency

    Directory of Open Access Journals (Sweden)

    Mabel Rocha Vázquez

    2011-04-01

    Full Text Available Background: the continuous improvement of the educational process is one of the permanent challenges of medical education in Cuba. When dealing particularly with family medicine it must be ensured that physicians are always getting a better clinical approach to the management of families, since this is one of the key areas that have been identified as problematic in professional practices. Objective: to design a methodological strategy for the improvement of educational activities in the Family Health Course of the General Internal Medicine Residency. Method: a development research, conducted at the University of Medical Sciences of Cienfuegos, from November 2005 to January 2007 is presented. Document analysis and validation by expert criteria were also implemented. Results: for each of the four themes that make up this course, the following aspects are stated: teaching organization, length, contents, activity objectives, methodological guidelines to implement these activities, assessment proposals for some of them and some literature. Conclusions: the design of educational activities, with emphasis on actual or simulated medical practice, could help improving the quality of the teaching process. In addition, following the logical structure of activities, teachers can develop similar proposals to address other health problems according to the different learning needs.

  9. An investigation into the use of complementary and alternative medicine in an urban general practice.

    LENUS (Irish Health Repository)

    Mc Kenna, F

    2010-11-05

    Several International studies have shown the substantial growth in the use of complementary and alternative medicine (CAM). However, no study in the Republic of Ireland to date has looked at its use among the population. A cross-sectional survey of 328 patients attending an urban general practice was conducted. A high number of respondents reported having visited a CAM practitioner within the past 12 months (89 patients; 27%). A significant positive association was found between CAM use and female gender (p = 0.006), middle-aged (p = 0.013), private health insurance (p = 0.016) and full time employment (p = 0.031). Massage was the most common modality used (35 patients; 39.8%), the most common reason for use was \\'to treat an illness for which conventional medicine was already sought\\' (31 patients; 42%), a high rate of non-disclosure to GPs was found (34 patients; 41%) and personal recommendation was the most important source of information (42 patients; 53.2%). This study demonstrates the current popularity of an alternative healthcare system.

  10. Service Learning Track in General Chemistry: Giving Students a Choice

    Science.gov (United States)

    Donaghy, Kelley J.; Saxton, Kathleen J.

    2012-01-01

    Experiential learning is a foundation in chemistry courses from the introductory-level course to upper-level courses through laboratory experiences. Service learning is another type of experiential learning that is slowly gaining momentum in the sciences. There have been several reports in this "Journal" on this pedagogy with respect to student…

  11. Service Learning Track in General Chemistry: Giving Students a Choice

    Science.gov (United States)

    Donaghy, Kelley J.; Saxton, Kathleen J.

    2012-01-01

    Experiential learning is a foundation in chemistry courses from the introductory-level course to upper-level courses through laboratory experiences. Service learning is another type of experiential learning that is slowly gaining momentum in the sciences. There have been several reports in this "Journal" on this pedagogy with respect to student…

  12. Using the framework of corporate culture in “mergers” to support the development of a cultural basis for integrative medicine – guidance for building an integrative medicine department or service

    Directory of Open Access Journals (Sweden)

    Witt CM

    2015-01-01

    merger. In a merger, two or more organizations - usually companies - are combined into one in order to strengthen the companies financially and strategically. The corporate culture of both merger partners has an important influence on the integration.Purpose: The aim of this project was to transfer the concept of corporate culture in mergers to the merging of two medical systems.Methods: A two-step approach (literature analyses and expert consensus procedure was used to develop practical guidance for the development of a cultural basis for integrative medicine, based on the framework of corporate culture in “mergers,” which could be used to build an integrative medicine department or integrative medicine service.Results: Results include recommendations for general strategic dimensions (definition of the medical model, motivation for integration, clarification of the available resources, development of the integration team, and development of a communication strategy, and recommendations to overcome cultural differences (the clinic environment, the professional language, the professional image, and the implementation of evidence-based medicine.Conclusion: The framework of mergers in corporate culture provides an understanding of the difficulties involved in integrative medicine projects. The specific recommendations provide a good basis for more efficient implementation. Keywords: integrative medicine, mergers, corporate culture

  13. [Security of the medicinal therapy: Cartography of risks a priori within service of orthopaedic surgery].

    Science.gov (United States)

    Razurel, A; Bertrand, É; Deranlot, J; Benhamou, F; Tritz, T; Le Mercier, F; Hardy, P

    2015-11-01

    Security and quality of the Medicinal Therapy are one of the most important objectives of the April 6th, 2011 order. The objective is to realize this study of the risks incurred by patients related to management and security of medicinal therapy in order to establish a plan to reduce the risks of drug's dispensation. The method of the Preliminary Risk Analysis (PRA) has been implemented by a multidisciplinary group in a hospital service of orthopaedic surgery. The study focused on the dispensation phase of medicinal circuit. This analysis revealed 148 scenarii, 35 were criticality unacceptable. Fifty-four initial risk control actions were proposed and their stress levels to put them in place were evaluated. The main measures of risk management are: training, information, communication, computerization, automation, dual control, updating the documentation system, drug reconciliation and respect for Best Practices Hospitallers (BPH). Risk management requires a significant human and financial investment as well as, material resources and multidisciplinary expertise in order to offer the best solutions. Copyright © 2015 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

  14. Telemental Health Technology in Deaf and General Mental-Health Services: Access and Use

    Science.gov (United States)

    Austen, Sally; McGrath, Melissa

    2006-01-01

    Long-distance travel to provide mental health services for deaf people has implications for efficiency, safety, and equality of service. However, uptake of Telemental Health (TMH) has been slow in both deaf and general mental health services. A quantitative study was used to investigate access to TMH and whether staff confidence, experience, or…

  15. An analysis of the quality of research reports in the Journal of General Internal Medicine.

    Science.gov (United States)

    Cooper, G S; Zangwill, L

    1989-01-01

    Forty-four "original articles" published in the Journal of General Internal Medicine were reviewed using a rating instrument with 13 items developed from previously published standards for the design, analysis, and presentation of medical research. Each item was rated on a four-point (poor-to-excellent) scale. Inter-rater agreement was good (86% agreement; kappa = 0.65). Seven items received excellent or good ratings in 80% or more of the articles, but six problem areas were identified: description of study scope (generalizability), informed consent procedures, reliability assessments, references for statistical procedures or computer programs, and the use of descriptive and comparative statistics. Guidelines for these and other criteria are offered to help researchers prepare clear and informative reports.

  16. Abstract presentations: what do SGIM presenters prefer? Society of General Internal Medicine.

    Science.gov (United States)

    Tulsky, A A; Kouides, R W

    1998-06-01

    We surveyed physicians presenting abstracts at the 1995 Society of General Internal Medicine annual meeting to determine whether the oral or poster format better achieved their presentation goals. Poster presentations better met respondents' objectives for feedback and criticism and for networking and developing collaborative projects, while oral presentations better met their objectives for national visibility and sharing knowledge within one's field. Sixty-nine percent of respondents preferred to present oral abstracts. The majority of these presenters preferred to present their research in an oral format although poster presentations still played an important role for them, particularly as a venue for feedback on their work. As meeting size increases, different presentation formats should be explored that best meet the needs of the academic community.

  17. 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

  18. Actionable Data Projects: Social Science and Service-Learning in General Education Courses

    Science.gov (United States)

    Maloyed, Christie L.

    2016-01-01

    The use of service-learning pedagogies in general education courses is often limited to increasing volunteerism or civic literacy with problem-based or research-based projects reserved for upper level courses. This article examines the implementation of an "actionable data" service-learning project in an introductory, general studies…

  19. 76 FR 79221 - Penske Logistics, LLC, Customer Service Department General Motors and Tier Finished Goods...

    Science.gov (United States)

    2011-12-21

    ... Employment and Training Administration Penske Logistics, LLC, Customer Service Department General Motors and... workers of Penske Logistics, LLC, Customer Service Department, a subsidiary of General Electric/Penske... correct name of the worker group department of the subject firm should read Penske Logistics, LLC...

  20. 41 CFR 105-1.101 - General Services Administration Property Management Regulations.

    Science.gov (United States)

    2010-07-01

    ...-INTRODUCTION 1.1-Regulations System § 105-1.101 General Services Administration Property Management Regulations... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false General Services Administration Property Management Regulations. 105-1.101 Section 105-1.101 Public Contracts and Property...

  1. Actionable Data Projects: Social Science and Service-Learning in General Education Courses

    Science.gov (United States)

    Maloyed, Christie L.

    2016-01-01

    The use of service-learning pedagogies in general education courses is often limited to increasing volunteerism or civic literacy with problem-based or research-based projects reserved for upper level courses. This article examines the implementation of an "actionable data" service-learning project in an introductory, general studies…

  2. 78 FR 73863 - Public Availability of General Services Administration FY 2013 Federal Activities Inventory...

    Science.gov (United States)

    2013-12-09

    ... ADMINISTRATION Public Availability of General Services Administration FY 2013 Federal Activities Inventory Reform (FAIR) Act Inventory AGENCY: General Services Administration (GSA). ACTION: Notice of public... the Federal Activities Inventory Reform (FAIR) Act of 1998, Public Law 105-270, and Office...

  3. 77 FR 54917 - Public Availability of General Services Administration FY 2012 Federal Activities Inventory...

    Science.gov (United States)

    2012-09-06

    ... ADMINISTRATION Public Availability of General Services Administration FY 2012 Federal Activities Inventory Reform (FAIR) Act Inventory AGENCY: General Services Administration (GSA). ACTION: Notice of Public... accordance with the FAIR Act of 1998, Public Law 105-270, and Office of Management and Budget (OMB)...

  4. European Council of Legal Medicine (ECLM) accreditation of forensic pathology services in Europe.

    Science.gov (United States)

    Mangin, P; Bonbled, F; Väli, M; Luna, A; Bajanowski, T; Hougen, H P; Ludes, B; Ferrara, D; Cusack, D; Keller, E; Vieira, N

    2015-03-01

    Forensic experts play a major role in the legal process as they offer professional expert opinion and evidence within the criminal justice system adjudicating on the innocence or alleged guilt of an accused person. In this respect, medico-legal examination is an essential part of the investigation process, determining in a scientific way the cause(s) and manner of unexpected and/or unnatural death or bringing clinical evidence in case of physical, psychological, or sexual abuse in living people. From a legal perspective, these types of investigation must meet international standards, i.e., it should be independent, effective, and prompt. Ideally, the investigations should be conducted by board-certified experts in forensic medicine, endowed with a solid experience in this field, without any hierarchical relationship with the prosecuting authorities and having access to appropriate facilities in order to provide forensic reports of high quality. In this respect, there is a need for any private or public national or international authority including non-governmental organizations seeking experts qualified in forensic medicine to have at disposal a list of specialists working in accordance with high standards of professional performance within forensic pathology services that have been successfully submitted to an official accreditation/certification process using valid and acceptable criteria. To reach this goal, the National Association of Medical Examiners (NAME) has elaborated an accreditation/certification checklist which should be served as decision-making support to assist inspectors appointed to evaluate applicants. In the same spirit than NAME Accreditation Standards, European Council of Legal Medicine (ECLM) board decided to set up an ad hoc working group with the mission to elaborate an accreditation/certification procedure similar to the NAME's one but taking into account the realities of forensic medicine practices in Europe and restricted to post

  5. Short-term return visits of 'general internal medicine' patients to the emergency department: extent and risk factors.

    Science.gov (United States)

    Vanbrabant, P; Knockaert, D

    2009-01-01

    Although emergency department (ED) return visits are a significant problem universally, it has not been previously studied in our ED. The aim of this study was to determine the extent of the problem in our ED, to identify the relevant clinical predictor variables and to detect diagnostic errors. A retrospective observational study of ED return visits by patients managed by the General Internal Medicine (GIM) service was performed. The study was performed over a one year period at a tertiary hospital ED. Data are reported as relative risk (RR) and 95% confidence interval (CI). There were a total of 51.210 ED visits during the study period. The total number of ED return visits within 72 hours was 1.124 (2,19%; 95% CI 2,07 to 2,32). The total number of ED patients managed by the GIM service was 9.511. The percentage of patients treated by the GIM service who returned to the ED within 72 hours was 1,48% (95% CI 1,25 to 1,74) when calculated for the whole group and 2,9 % (95% CI 2,46-3,41) for those discharged home from the ED (n = 4.860). The majority (82,98%) of ED return visits by patients discharged from the GIM service were unscheduled and related to their index presenting complaint. Abdominal pain was the commonest initial presenting symptom in the patients who returned to the ED after discharge. Patients with diarrhoea as the initial initial presenting symptom had the highest relative risk of an ED return visit (RR = 4.07). The percentage ED return visits by patients discharged from the ED by the GIM service is 1,48%. Patients presenting with diarrhoea as the initial presenting symptom have the highest relative risk of an early ED return visit. Our main practical conclusion is that patients with abdominal pain need to be re-examined carefully and instructed about potential evolution before discharge.

  6. Efficacy of Yiqiyangxin Chinese medicine compound combined with cognitive therapy in the treatment of generalized anxiety disorders

    Institute of Scientific and Technical Information of China (English)

    Ting Wang; Jing-Yuan Ding; Guang-Xing Xu; Yu Zeng; San-Rong Xiao

    2012-01-01

    Objective:To observe the clinical efficacy of Yiqiyangxin Chinese medicine compound combined with cognitive therapy on generalized anxiety disorders. Methods: A total of 202 generalized anxiety disorders patients were randomly allocated to a control condition (Paroxetine combined with cognitive therapy) or a treatment condition (Yiqiyangxin Chinese medicine compound combined with cognitive therapy). Subsequently, scores of Hamilton Anxiety Scale (HAMA), Zung Self-rating Anxiety Scale (SAS) and blood routine, urine routine, liver function, renal function, electrocardiogram were detected before treatment, 3 months, 6 months after treatment and 6 months after medicine withdrawal, respectively. Results: HAMA and SAS scores were significantly reduced in two groups (P0.05). HAMA and SAS scores were significantly increased in two groups (P<0.05) after medicine withdrawal, and there were significant differences in HAMA and SAS scores, recurrent disease and adverse reaction (P<0.001). The incidence of recurrent disease and adverse reaction in treatment group was low. Both two groups showed no apparent abnormality in blood routine, urine routine, liver and renal function, and electrocardiogram. Conclusions: Yiqiyangxin Chinese medicine compound combined with cognitive therapy can significantly reduce the recurrence after medicine withdrawal and is effective on generalized anxiety disorders. Furthermore, the incidence of adverse reactions is low. The treatment program is worthy clinic application in the further.

  7. General Report & Recommendations in Predictive, Preventive and Personalised Medicine 2012: White Paper of the European Association of Predictive, Preventive and Personalised Medicine

    Directory of Open Access Journals (Sweden)

    Golubnitschaja Olga

    2012-11-01

    Full Text Available Abstract This report is the collective product of word-leading experts working in the branches of integrative medicine by predictive, preventive and personalised medicine (PPPM under the coordination of the European Association for Predictive, Preventive and Personalised Medicine. The general report has been prepared as the consortium document proposed at the EPMA World Congress 2011 which took place in Bonn, Germany. This forum analyzed the overall deficits and trends relevant for the top-science and daily practice in PPPM focused on the patient. Follow-up consultations resulted in a package of recommendations for consideration by research units, educators, healthcare industry, policy-makers, and funding bodies to cover the current knowledge deficit in the field and to introduce integrative approaches for advanced diagnostics, targeted prevention, treatments tailored to the person and cost-effective healthcare.

  8. General public perceptions towards medicines in the state of penang Malaysia

    Directory of Open Access Journals (Sweden)

    Mahmoud Sa′di Al-Haddad

    2012-01-01

    Conclusion: Results of this study urge for a national awareness program to the public regarding medicines. Decision makers have to consider these findings since high proportion of the public perceive and consume medicines irrationally.

  9. A cloud system for mobile medical services of traditional Chinese medicine.

    Science.gov (United States)

    Hu, Nian-Ze; Lee, Chia-Ying; Hou, Mark C; Chen, Ying-Ling

    2013-12-01

    Many medical centers in Taiwan have started to provide Traditional Chinese Medicine (TCM) services for hospitalized patients. Due to the complexity of TCM modality and the increasing need for providing TCM services for patients in different wards at distantly separate locations within the hospital, it is getting difficult to manage the situation in the traditional way. A computerized system with mobile ability can therefore provide a practical solution to the challenge presented. The study tries to develop a cloud system equipped with mobile devices to integrate electronic medical records, facilitate communication between medical workers, and improve the quality of TCM services for the hospitalized patients in a medical center. The system developed in the study includes mobile devices carrying Android operation system and a PC as a cloud server. All the devices use the same TCM management system developed by the study. A website of database is set up for information sharing. The cloud system allows users to access and update patients' medical information, which is of great help to medical workers for verifying patients' identification and giving proper treatments to patients. The information then can be wirelessly transmitted between medical personnel through the cloud system. Several quantitative and qualitative evaluation indexes are developed to measure the effectiveness of the cloud system on the quality of the TCM service. The cloud system is tested and verified based on a sample of hospitalized patients receiving the acupuncture treatment at the Lukang Branch of Changhua Christian Hospital (CCH) in Taiwan. The result shows a great improvement in operating efficiency of the TCM service in that a significant saving in labor time can be attributable to the cloud system. In addition, the cloud system makes it easy to confirm patients' identity through taking a picture of the patient upon receiving any medical treatment. The result also shows that the cloud system

  10. How to Measure Quality of Service Using Unstructured Data Analysis: A General Method Design

    Directory of Open Access Journals (Sweden)

    Lucie Sperková,

    2015-10-01

    Full Text Available The aim of the paper is to design a general method usable for measuring the quality of the service from the customer’s point of view with the help of content analytics. Large amount of unstructured data is created by customers of the service. This data can provide a valuable feedback from the service usage. Customers talk among themselves about their experiences and feelings from consumption of the service. The design of the method is based on a systematic literature review in the area of the service quality and unstructured data analysis. Analytics and quality measurement models are collected and critically evaluated regarding their potential use for measuring IT service quality. The method can be used by IT service provider to measure and monitor service quality based on World-of-Mouth in order to continual service improvement.

  11. EU governance and social services of general interest: When even the UK is concerned

    Directory of Open Access Journals (Sweden)

    Aristea Koukiadaki

    2012-02-01

    Full Text Available The level of autonomy afforded to Member States to define certain services as ‘services of general interest’ and to shelter them from the market so as to promote social objectives has become in recent years a highly sensitive topic among EU and national policy actors and organisations. The increased activity in this area of the European Commission and the general absence of guidance on the conditions necessary to render such services of general interest by the European Court of Justice (ECJ have resulted in uncertainty concerning the interaction of EU law with social services and more generally public services in the EU Member States. By focusing on the EU regulation on social services of general interest, the paper evaluates how the nature and provision of such services in the UK has been susceptible to changes as a result of the Services Directives, EU public procurement and competition law. The implementation of liberalisation plans in the UK well before any EU initiatives in this area meant that such services have been open to market forces well before other Member States. However, this has not led to the absence of concerns regarding the precise impact of EU law in this area. Recent policy initiatives by the Coalition government may expand further the degree of marketisation and increase the scope for interaction between EU and national-level regulation.

  12. The Evolving Role of Open Source Software in Medicine and Health Services

    Directory of Open Access Journals (Sweden)

    Sevket Seref Arikan

    2013-01-01

    Full Text Available The past five decades have witnessed immense coevolution of methods and tools of information technology, and their practical and experimental application within the medical and healthcare domain. Healthcare itself continues to evolve in response to change in healthcare needs, progress in the scientific foundations of treatments, and in professional and managerial organization of affordable and effective services, in which patients and their families and carers increasingly participate. Taken together, these trends impose highly complex underlying challenges for the design, development, and sustainability of the quality of supporting information services and software infrastructure that are needed. The challenges are multidisciplinary and multiprofessional in scope, and they require deeper study and learning to inform policy and promote public awareness of the problems health services have faced in this area for many years. The repeating pattern of failure to live up to expectations of policy-driven national health IT initiatives has proved very costly and remains frustrating and unproductive for all involved. In this article, we highlight the barriers to progress and discuss the dangers of pursuing a standardization framework devoid of empirical testing and iterative development. We give the example of the openEHR Foundation, which was established at University College London (UCL in London, England, with members in 80 countries. The Foundation is a not-for-profit company providing open specifications and working for generic standards for electronic records, informed directly by a wide range of implementation experience. We also introduce the Opereffa open source framework, which was developed at UCL based on these specifications and which has been downloaded in some 70 countries. We argue that such an approach is now essential to support good discipline, innovation, and governance at the heart of medicine and health services, in line with the

  13. THERAPEUTIC BENEFITS OF HOLY BASIL (TULSI IN GENERAL AND ORAL MEDICINE: A REVIEW

    Directory of Open Access Journals (Sweden)

    Bhateja Sumit

    2012-12-01

    Full Text Available Nature has bestowed on us a very rich botanical wealth and a large number of diverse types of plants grow in different parts of the country. Plants are the richest resource of drugs in traditional systems of medicine, modern medicines, nutraceuticals, food supplements, folk medicines, pharmaceutical intermediates and chemical entities for synthetic drugs. Medicinal plants are a source of great economic value all over the world. Ocimum sanctum Linn (Tulsi is a well-known plant used in the Indian system of medicine. This paper reviews the therapeutic potential of this plant in treatment of various medical and oral disorders.

  14. Structure analysis of aromatic medicines containing nitrogen using near-infrared spectroscopy and generalized two-dimensional correlation spectroscopy

    Science.gov (United States)

    Liu, Hao; Gao, Hongbin; Qu, Lingbo; Huang, Yanping; Xiang, Bingren

    2008-12-01

    Four aromatic medicines (acetaminophen; niacinamide; p-aminophenol; nicotinic acid) containing nitrogen were investigated by FT-NIR (Fourier transform near-infrared) spectroscopy and generalized two-dimensional (2D) correlation spectroscopy. The FT-NIR spectra were measured over a temperature range of 30-130 °C. By combining near-infrared spectroscopy, generalized 2D correlation spectroscopy and references, the molecular structures (especially the hydrogen bond related with nitrogen) were analyzed and the NIR band assignments were performed. The results will be helpful to the understanding of aromatic medicines containing nitrogen and the utility of these substances.

  15. 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.

  16. The myeloid splenomegaly in a service of nuclear medicine; La splenomegalie myeloide dans un service de Medecine Nucleaire

    Energy Technology Data Exchange (ETDEWEB)

    Rain, J-D.; Najean, Y.; Billoty, C. [Service de Medecine Nucleaire, Hopital Saint-Louis, Paris (France)

    1997-12-31

    The existence in a Nuclear Medicine service of several in-vivo (scintigraphy and kinetic) and in-vitro (dosages) sections can contribute into a better knowledge of diseases due to the complementarity of the provided information. Exploration, since 1990, of 183 primary and secondary myeloid splenomegalies (MS) is a good example. These 183 patients have had a medullary scintigraphy with Technetium colloids and Indium Transferrin, 98, a measurement of the sanguine mass, 60, a kinetic study of Iron-Chromium erythropoiesis and 180, a dosage of pro-collagen III. These four examinations allowed confirming the MS diagnosis and orienting the prognostic. The medullary scintigraphy is able to show the poverty of marrow-sustaining tissues and allows measuring the splenomegaly. It helps evaluating the wealth of myelopoietic tissue and its extensions and confirming the spleenic erythropoiesis. The measure of sanguine mass specifies the existence and importance of true anaemia and hemodilution due to the splenomegaly. The kinetic study by Iron-Chromium indicates the medullary spleenic production, degree of dys-erythropoiesis, the presence of hemolysis and its location. It brings about important prognostic arguments and is a precious aid in making the difficult decision of indication of splenectomy. The pro-collagen III dosage is of a certain prognostic interest. The patients with less than 0.70 U/ml have a slow evolutivity of their disease, those with values within 0.70 to 1 U/ml have a more severe evolution, while for those having values higher than 1 U/ml the prognostic is bad on short terms. In conclusion, the diagnosis and prognostic of these examinations in MS justify maintenance of a plurality of in-vivo and in-vitro techniques in our services

  17. European Council of Legal Medicine (ECLM) accreditation of forensic pathology services in Europe

    DEFF Research Database (Denmark)

    Mangin, P; Bonbled, F; Väli, M

    2015-01-01

    with high standards of professional performance within forensic pathology services that have been successfully submitted to an official accreditation/certification process using valid and acceptable criteria. To reach this goal, the National Association of Medical Examiners (NAME) has elaborated...... an accreditation/certification checklist which should be served as decision-making support to assist inspectors appointed to evaluate applicants. In the same spirit than NAME Accreditation Standards, European Council of Legal Medicine (ECLM) board decided to set up an ad hoc working group with the mission...... process, determining in a scientific way the cause(s) and manner of unexpected and/or unnatural death or bringing clinical evidence in case of physical, psychological, or sexual abuse in living people. From a legal perspective, these types of investigation must meet international standards, i...

  18. Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 2. Results: Primary care management and community orientation.

    Science.gov (United States)

    Hummers-Pradier, Eva; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri Ejh; Topsever, Pinar; Ungan, Mehmet; van Royen, Paul

    2010-03-01

    At the WONCA Europe conference 2009 the recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' was presented. It is a background paper and reference manual, providing advocacy of general practice/family medicine (GP/FM) in Europe. The Research Agenda summarizes the evidence relating to the core competencies and characteristics of the WONCA Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In this second article, the results for the core competencies 'primary care management' and 'community orientation' are presented. Though there is a large body of research on various aspects of 'primary care management', it represents a very scattered rather than a meta view. Many studies focus on care for specific diseases, the primary/secondary care interface, or the implications of electronic patient records. Cost efficiency or process indicators of quality are current outcomes. Current literature on community orientation is mainly descriptive, and focuses on either care for specific diseases, or specific patient populations, or on the uptake of preventive services. Most papers correspond poorly to the WONCA concept. For both core competencies, there is a lack of research with a longitudinal perspective and/or relevant health or quality of life outcomes as well as research on patients' preferences and education for organizational aspects of GP/FM.

  19. Training veterinary students in shelter medicine: a service-learning community-classroom technique.

    Science.gov (United States)

    Stevens, Brenda J; Gruen, Margaret E

    2014-01-01

    Shelter medicine is a rapidly developing field of great importance, and shelters themselves provide abundant training opportunities for veterinary medical students. Students trained in shelter medicine have opportunities to practice zoonotic and species-specific infectious disease control, behavioral evaluation and management, primary care, animal welfare, ethics, and public policy issues. A range of sheltering systems now exists, from brick-and-mortar facilities to networks of foster homes with no centralized facility. Exposure to a single shelter setting may not allow students to understand the full range of sheltering systems that exist; a community-classroom approach introduces students to a diverse array of sheltering systems while providing practical experience. This article presents the details and results of a series of 2-week elective clinical rotations with a focus on field and service learning in animal shelters. The overall aim was to provide opportunities that familiarized students with sheltering systems and delivered primary-care training. Other priorities included increasing awareness of public health concerns and equipping students to evaluate shelters on design, operating protocols, infectious disease control, animal enrichment, and community outreach. Students were required to participate in rounds and complete a project that addressed a need recognized by them during the rotation. This article includes costs associated with the rotation, a blueprint for how the rotation was carried out at our institution, and details of shelters visited and animals treated, including a breakdown of treatments provided. Also discussed are the student projects and student feedback on this valuable clinical experience.

  20. 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.

  1. What services are public? What aspects of performance are to be ranked? The case of “services of general interest”

    NARCIS (Netherlands)

    S.G.J. Van de Walle (Steven)

    2008-01-01

    textabstractIn this article, we focus on the difficulties in evaluating the performance of so-called services of general interest. These services generally include such services as water and electricity supply, telephony, postal services, and public transport, where providers are subjected to

  2. Annotation: New research into general psychiatric services for adults with intellectual disability and mental illness.

    Science.gov (United States)

    Chaplin, R

    2009-03-01

    There are a variety of models for the mental health care of adults with comorbid intellectual disability (ID) and mental illness. There has been a long-running debate as to whether this should be provided by general psychiatric or specialised ID services. A previous review concluded that there was no clear evidence to support either model with research being often of a poor quality, lacking replication, and outcome measures were often inappropriate or varied between studies. This review aims assess differences in outcome for patients with ID and mental disorders treated in general or specialised ID mental health services. A literature review was conducted using electronic databases and websites of ID and mental health organisations to locate all references where people with ID receive mental health care in general psychiatric services from 2003. No meta-analysis was attempted because of the divergent nature of the studies. People with ID (especially severe ID) have reduced access to general psychiatric services. General psychiatric inpatient care is unpopular especially with carers but can be improved by providing specially trained staff and in-reach from community ID teams. Opportunities may exist to enhance the care of people with borderline intellectual functioning within general psychiatric services. Although no new randomised controlled trials have been published, the weight of research is accumulating to suggest that provision of general psychiatric services without extra help is not sufficient to meet the needs of people with ID.

  3. [The department budget, in the context of the hospital global budget. Initial results in general medicine].

    Science.gov (United States)

    Besançon, F

    1984-02-23

    In a general hospital (Hôtel-Dieu, in the center of Paris), run with a global budget, budgets determined for each unit were introduced as an experiment in 1980. Physicians were in charge of certain expenses, mainly: linen, drugs, transportation of patients to and from other hospitals within Paris, and blood fractions. The whole does not exceed 4% of the turnover (FF 20 millions in 1980) of a 67 bed internal medicine unit. Other accounts deal with the stays, admissions, prescriptions of technical acts, laboratory analyses, and X-rays. In 1980, expenses were 11% more than budgeted, but the increase in stays and particularly in admissions was significantly greater. The resulting savings were 8.8% and 18.7% for stays and admissions respectively. Psychic reactions were variable. The subsequent budgets followed the fluctuations of recorded expenses, which were fairly important in both directions. The unit budget may be an advance or a regression, in a restrictive and past-perpetuating context. The coherence between the unit budget and the global hospital budget is questionable. Physicians were willing to take part in accounting and saving. They have good reason for not enlarging their financial responsibilities. Conversely, they may give more attention to diseases of public opinion.

  4. 智慧医疗服务平台中的移动健康服务%Mobile Health Service on Intelligence Medicine Service Platform

    Institute of Scientific and Technical Information of China (English)

    莫胜男; 尚武

    2015-01-01

    介绍智慧医疗服务平台中移动健康服务的应用,包括医疗协助、社区医疗、全面健康体检等,阐述智慧医疗信息化的关键技术,包括医疗设备互联互通与信息融合、个性化智能推送等,指出智慧医疗服务平台建设将促进健康信息共享,最终形成面向智慧医疗的健康服务体系。%〔Abstract〕 The paper introduces the application of mobile health service in intelligence medicine service platform , including medical assistance, community medical care, comprehensive health examination , etc.It elaborates the key technologies of intelligence medicine in-formatization, including medical devices interoperability and information integration , personalized intelligent pushment , etc.The construc-tion of intelligence medicine service platform could promote health information sharing , form intelligence medicine oriented health service system.

  5. 75 FR 4565 - General Services Administration Acquisition Regulation; Submission for OMB Review; Industrial...

    Science.gov (United States)

    2010-01-28

    ... ADMINISTRATION General Services Administration Acquisition Regulation; Submission for OMB Review; Industrial... reinstatement of a previously approved information collection requirement regarding industrial ] funding fee and..., Industrial Funding Fee and Sales Reporting, in all correspondence. SUPPLEMENTARY INFORMATION: A....

  6. 78 FR 27239 - General Services Administration Acquisition Regulation; Submission for OMB Review; Industrial...

    Science.gov (United States)

    2013-05-09

    ... ADMINISTRATION General Services Administration Acquisition Regulation; Submission for OMB Review; Industrial... previously approved information collection requirement regarding industrial funding fee and sales reporting....munson@gsa.gov . ADDRESSES: Submit comments identified by Information Collection 3090- 0121,...

  7. 75 FR 1788 - General Services Administration Regulation; Submission for OMB Review; Packing List Clause

    Science.gov (United States)

    2010-01-13

    ... ADMINISTRATION General Services Administration Regulation; Submission for OMB Review; Packing List Clause AGENCY... approved information collection requirement regarding the packing list clause. A request for public..., Packing List Clause, in all correspondence. FOR FURTHER INFORMATION CONTACT: Michael O....

  8. 77 FR 66466 - General Services Administration Regulation; Information Collection; Packing List Clause

    Science.gov (United States)

    2012-11-05

    ... ADMINISTRATION General Services Administration Regulation; Information Collection; Packing List Clause AGENCY... packing list clause. Public comments are particularly invited on: Whether this collection of information..., Packing List Clause, by any of the following methods: Regulations.gov :...

  9. A Decentralized VPN Service over Generalized Mobile Ad-Hoc Networks

    Science.gov (United States)

    Fujita, Sho; Shima, Keiichi; Uo, Yojiro; Esaki, Hiroshi

    We present a decentralized VPN service that can be built over generalized mobile ad-hoc networks (Generalized MANETs), in which topologies can be represented as a time-varying directed multigraph. We address wireless ad-hoc networks and overlay ad-hoc networks as instances of Generalized MANETs. We first propose an architecture to operate on various kinds of networks through a single set of operations. Then, we design and implement a decentralized VPN service on the proposed architecture. Through the development and operation of a prototype system we implemented, we found that the proposed architecture makes the VPN service applicable to each instance of Generalized MANETs, and that the VPN service makes it possible for unmodified applications to operate on the networks.

  10. 78 FR 29245 - U.S. General Services Administration Federal Property Management Regulations; Administrative Wage...

    Science.gov (United States)

    2013-05-20

    ... Administration Federal Property Management Regulations; Administrative Wage Garnishment AGENCY: Office of the... amending the U.S. General Services Administration Property Management Regulation (GSPMR) to remove... telephone number. The Administrative Wage Garnishment Code of Federal Regulations (CFR) Parts affected...

  11. The Swedish radiation protection institute's regulations and general advice on nuclear medicine; issued on April 28, 2000

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-04-01

    These regulations and general advice are applicable to nuclear medicine within human medical care. The regulations are also applicable to activities where radioactive substances are administered to individuals in connection to medical or biomedical research and medical examinations for insurance or legal purposes.

  12. Service user involvement in pre-registration general nurse education: a systematic review

    OpenAIRE

    Scammell, Janet; Heaslip, Vanessa; Crowley, Emma J.

    2016-01-01

    Aims and objectives: A systematic review of published studies on service user involvement in undergraduate, pre-registration general nursing education (excluding mental health-specific programmes). The objective is to examine how students are exposed to engagement with service users. Background: The requirement of service user involvement in all nurse education is policy expectation of health professional education providers, in response to the increased public and political expectations. Pre...

  13. Use of complementary alternative medicine for low back pain consulting in general practice: a cohort study

    Directory of Open Access Journals (Sweden)

    Baum Erika

    2007-12-01

    Full Text Available Abstract Background Although back pain is considered one of the most frequent reasons why patients seek complementary and alternative medical (CAM therapies little is known on the extent patients are actually using CAM for back pain. Methods This is a post hoc analysis of a longitudinal prospective cohort study embedded in a RCT. General practitioners (GPs recruited consecutively adult patients presenting with LBP. Data on physical function, on subjective mood, and on utilization of health services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months Results A total of 691 (51% respectively 928 (69% out of 1,342 patients received one form of CAM depending on the definition. Local heat, massage, and spinal manipulation were the forms of CAM most commonly offered. Using CAM was associated with specialist care, chronic LBP and treatment in a rehabilitation facility. Receiving spinal manipulation, acupuncture or TENS was associated with consulting a GP providing these services. Apart from chronicity disease related factors like functional capacity or pain only showed weak or no association with receiving CAM. Conclusion The frequent use of CAM for LBP demonstrates that CAM is popular in patients and doctors alike. The observed association with a treatment in a rehabilitation facility or with specialist consultations rather reflects professional preferences of the physicians than a clear medical indication. The observed dependence on providers and provider related services, as well as a significant proportion receiving CAM that did not meet the so far established selection criteria suggests some arbitrary use of CAM.

  14. General consumer communication tools for improved image management and communication in medicine.

    Science.gov (United States)

    Rosset, Chantal; Rosset, Antoine; Ratib, Osman

    2005-12-01

    We elected to explore new technologies emerging on the general consumer market that can improve and facilitate image and data communication in medical and clinical environment. These new technologies developed for communication and storage of data can improve the user convenience and facilitate the communication and transport of images and related data beyond the usual limits and restrictions of a traditional picture archiving and communication systems (PACS) network. We specifically tested and implemented three new technologies provided on Apple computer platforms. (1) We adopted the iPod, a MP3 portable player with a hard disk storage, to easily and quickly move large number of DICOM images. (2) We adopted iChat, a videoconference and instant-messaging software, to transmit DICOM images in real time to a distant computer for conferencing teleradiology. (3) Finally, we developed a direct secure interface to use the iDisk service, a file-sharing service based on the WebDAV technology, to send and share DICOM files between distant computers. These three technologies were integrated in a new open-source image navigation and display software called OsiriX allowing for manipulation and communication of multimodality and multidimensional DICOM image data sets. This software is freely available as an open-source project at http://homepage.mac.com/rossetantoine/OsiriX. Our experience showed that the implementation of these technologies allowed us to significantly enhance the existing PACS with valuable new features without any additional investment or the need for complex extensions of our infrastructure. The added features such as teleradiology, secure and convenient image and data communication, and the use of external data storage services open the gate to a much broader extension of our imaging infrastructure to the outside world.

  15. Personnel Management in Access Services: A General Overview of the Literature, 1990-2002

    Science.gov (United States)

    Lee, Leslie A.; Wu, Michelle M.

    2003-01-01

    Access services is not unique in its need for effective personnel management. A review of the literature indicates that there are many publications on or relating to library personnel administration; however, relatively few of them are dedicated to the narrow topic of access services. As such, this review encompasses literature that is general to…

  16. In-Course Instructor-Guided Service Learning in a Community College General Psychology Class

    Science.gov (United States)

    Goomas, David T.; Weston, Melissa B.

    2012-01-01

    Students enrolled in two general psychology classes at El Centro College (ECC) of the Dallas County Community College District (DCCCD) were offered the opportunity to earn extra credit by performing up to 20 hours of service learning. Benefits of service learning were observed in student development, including exploration of career possibilities,…

  17. General practice in urban and rural Europe: the range of curative services.

    NARCIS (Netherlands)

    Boerma, W.G.W.; Groenewegen, P.P.; Zee, J. van der

    1998-01-01

    The variation in the range of services provided by general practitioners (GPs) is not only related to personal characteristics and features of the country's health care system but also to the geographical circumstances of the practice location. In conurbations health services are more widely

  18. Resident satisfaction with continuity clinic and career choice in general internal medicine.

    Science.gov (United States)

    Peccoralo, Lauren A; Tackett, Sean; Ward, Lawrence; Federman, Alex; Helenius, Ira; Christmas, Colleen; Thomas, David C

    2013-08-01

    The quality of the continuity clinic experience for internal medicine (IM) residents may influence their choice to enter general internal medicine (GIM), yet few data exist to support this hypothesis. To assess the relationship between IM residents' satisfaction with continuity clinic and interest in GIM careers. Cross-sectional survey assessing satisfaction with elements of continuity clinic and residents' likelihood of career choice in GIM. IM residents at three urban medical centers. Bivariate and multivariate associations between satisfaction with 32 elements of outpatient clinic in 6 domains (clinical preceptors, educational environment, ancillary staff, time management, administrative, personal experience) and likelihood of considering a GIM career. Of the 225 (90 %) residents who completed surveys, 48 % planned to enter GIM before beginning their continuity clinic, whereas only 38 % did as a result of continuity clinic. Comparing residents' likelihood to enter GIM as a result of clinic to likelihood to enter a career in GIM before clinic showed that 59 % of residents had no difference in likelihood, 28 % reported a lower likelihood as a result of clinic, and 11 % reported higher likelihood as a result of clinic. Most residents were very satisfied or satisfied with all clinic elements. Significantly more residents (p ≤ 0.002) were likely vs. unlikely to enter GIM if they were very satisfied with faculty mentorship (76 % vs. 53 %), time for appointments (28 % vs. 11 %), number of patients seen (33 % vs. 15 %), personal reward from work (51 % vs. 23 %), relationship with patients (64 % vs. 42 %), and continuity with patients (57 % vs. 33 %). In the multivariate analysis, being likely to enter GIM before clinic (OR 29.0, 95 % CI 24.0-34.8) and being very satisfied with the continuity of relationships with patients (OR 4.08, 95 % CI 2.50-6.64) were the strongest independent predictors of likelihood to enter GIM as a result of clinic. Resident satisfaction

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

    Directory of Open Access Journals (Sweden)

    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

  20. Are Canadian General Internal Medicine training program graduates well prepared for their future careers?

    Directory of Open Access Journals (Sweden)

    Snell Linda

    2006-11-01

    Full Text Available Abstract Background At a time of increased need and demand for general internists in Canada, the attractiveness of generalist careers (including general internal medicine, GIM has been falling as evidenced by the low number of residents choosing this specialty. One hypothesis for the lack of interest in a generalist career is lack of comfort with the skills needed to practice after training, and the mismatch between the tertiary care, inpatient training environment and "real life". This project was designed to determine perceived effectiveness of training for 10 years of graduates of Canadian GIM programs to assist in the development of curriculum and objectives for general internists that will meet the needs of graduates and ultimately society. Methods Mailed survey designed to explore perceived importance of training for and preparation for various aspects of Canadian GIM practice. After extensive piloting of the survey, including a pilot survey of two universities to improve the questionnaire, all graduates of the 16 universities over the previous ten years were surveyed. Results Gaps (difference between importance and preparation were demonstrated in many of the CanMEDS 2000/2005® competencies. Medical problems of pregnancy, perioperative care, pain management, chronic care, ambulatory care and community GIM rotations were the medical expert areas with the largest gaps. Exposure to procedural skills was perceived to be lacking. Some procedural skills valued as important for current GIM trainees and performed frequently (example ambulatory ECG interpretation had low preparation ratings by trainees. Other areas of perceived discrepancy between training and practice included: manager role (set up of an office, health advocate (counseling for prevention, for example smoking cessation, and professional (end of life issues, ethics. Conclusion Graduates of Canadian GIM training programs over the last ten years have identified perceived gaps

  1. [The practice guideline 'Anemia' from the Dutch College of General Practitioners; a response from the perspective of general practice medicine

    NARCIS (Netherlands)

    Bosch, W.J.H.M. van den

    2003-01-01

    The practice guideline 'Anaemia' from the Dutch College of General Practitioners will certainly be a support for the Dutch general practitioner. The inclusion of an algorithm to make a more precise diagnosis is an experiment that needs to be evaluated in the near future. However, many general

  2. [The practice guideline 'Anemia' from the Dutch College of General Practitioners; a response from the perspective of general practice medicine

    NARCIS (Netherlands)

    Bosch, W.J.H.M. van den

    2003-01-01

    The practice guideline 'Anaemia' from the Dutch College of General Practitioners will certainly be a support for the Dutch general practitioner. The inclusion of an algorithm to make a more precise diagnosis is an experiment that needs to be evaluated in the near future. However, many general practi

  3. Prevalence and Predictors of Complementary and Alternative Medicine (CAM) Use among Ivy League College Students: Implications for Student Health Services

    Science.gov (United States)

    Versnik Nowak, Amy L.; DeGise, Joe; Daugherty, Amanda; O'Keefe, Richard; Seward, Samuel, Jr.; Setty, Suma; Tang, Fanny

    2015-01-01

    Objective: Determine prevalence and types of complementary and alternative medicine (CAM) therapies used and test the significance of demographics and social cognitive constructs as predictors of CAM use in a college sample. Secondary purpose was to guide the integration of CAM therapies into college health services. Participants: Random,…

  4. Prevalence and Predictors of Complementary and Alternative Medicine (CAM) Use among Ivy League College Students: Implications for Student Health Services

    Science.gov (United States)

    Versnik Nowak, Amy L.; DeGise, Joe; Daugherty, Amanda; O'Keefe, Richard; Seward, Samuel, Jr.; Setty, Suma; Tang, Fanny

    2015-01-01

    Objective: Determine prevalence and types of complementary and alternative medicine (CAM) therapies used and test the significance of demographics and social cognitive constructs as predictors of CAM use in a college sample. Secondary purpose was to guide the integration of CAM therapies into college health services. Participants: Random,…

  5. What proportion of prescription items dispensed in community pharmacies are eligible for the New Medicine Service?

    Science.gov (United States)

    Wells, Katharine M; Boyd, Matthew J; Thornley, Tracey; Boardman, Helen F

    2014-03-07

    The payment structure for the New Medicine Service (NMS) in England is based on the assumption that 0.5% of prescription items dispensed in community pharmacies are eligible for the service. This assumption is based on a theoretical calculation. This study aimed to find out the actual proportion of prescription items eligible for the NMS dispensed in community pharmacies in order to compare this with the theoretical assumption. The study also aimed to investigate whether the proportion of prescription items eligible for the NMS is affected by pharmacies' proximity to GP practices. The study collected data from eight pharmacies in Nottingham belonging to the same large chain of pharmacies. Pharmacies were grouped by distance from the nearest GP practice and sampled to reflect the distribution by distance of all pharmacies in Nottingham. Data on one thousand consecutive prescription items were collected from each pharmacy and the number of NMS eligible items recorded. All NHS prescriptions were included in the sample. Data were analysed and proportions calculated with 95% confidence intervals used to compare the study results against the theoretical figure of 0.5% of prescription items being eligible for the NMS. A total of 8005 prescription items were collected (a minimum of 1000 items per pharmacy) of which 17 items were eligible to receive the service. The study found that 0.25% (95% confidence intervals: 0.14% to 0.36%) of prescription items were eligible for the NMS which differs significantly from the theoretical assumption of 0.5%. The opportunity rate for the service was lower, 0.21% (95% confidence intervals: 0.10% to 0.32%) of items, as some items eligible for the NMS did not translate into opportunities to offer the service. Of all the prescription items collected in the pharmacies, 28% were collected by patient representatives. The results of this study show that the proportion of items eligible for the NMS dispensed in community pharmacies is lower than

  6. General Public Perceptions towards Medicines in the State of Penang Malaysia

    Directory of Open Access Journals (Sweden)

    Mahmoud Sa'di Al-Haddad

    2012-01-01

    Full Text Available Objectives: This study aims to evaluate patients' knowledge,sources of knowledge, and perceptions towards medicines inthe state of Penang, Malaysia.Materials and Methods: A cross sectional study design usingconvenience sampling technique was adopted in this study. Apre-validated questionnaire was developed and distributed to800 participants in the state of Penang, Malaysia. All data wasanalysed using SPSS version 16. A p-value of less than 0.05 wasconsidered significant.Results: 700 respondents successfully responded to thesurvey. One third of the respondents were aware ofconventional/modern medicines. Whereas only 3.3% knewwhat is meant by generic medicines. High proportion ofrespondents wrongly perceived the quality of medicines to berelated to the familiarity with the medicine, frequency ofadvertisements, price, packaging and country of themanufacturer. In addition, friends, family members, financialstatus, and previous history, found to play an important role inpatients decisions when selecting medicines.Conclusion: Results of this study urge for a nationalawareness program to the public regarding medicines.Decision makers have to consider these findings since highproportion of the public perceive and consume medicinesirrationally

  7. 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.

  8. 32 CFR 644.524 - Reporting contaminated land to the General Services Administration.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Reporting contaminated land to the General... and Other Contamination from Proposed Excess Land and Improvements § 644.524 Reporting contaminated land to the General Services Administration. Contaminated areas, except industrial properties...

  9. Connecting Intercultural Communication Service Learning with General Education: Issues, Outcomes, and Assessment

    Science.gov (United States)

    Littlefield, Robert S.; Rick, Jessica M.; Currie-Mueller, Jenna L.

    2016-01-01

    This study explored the intersection between service learning and general education outcomes through the self-reported perceptions of 382 college students participating in an intercultural communication course that satisfied the general education requirement at a midsized Upper Plains research university for studying cultural diversity. The data…

  10. 77 FR 59790 - General Services Administration Acquisition Regulation (GSAR); Rewrite of Part 504...

    Science.gov (United States)

    2012-10-01

    ... (GSAR); Rewrite of Part 504; Administrative Matters AGENCY: Office of Acquisition Policy, General... Administrative Matters and Forms. This final rule is part of the General Services Administration Acquisition Manual (GSAM) rewrite Project, in which all parts of the regulation are being reviewed and updated to...

  11. Community pharmacists' perceptions about pharmaceutical service of over-the-counter traditional Chinese medicine: a survey study in Harbin of China.

    Science.gov (United States)

    Song, Menghuan; Ung, Carolina Oi Lam; Lee, Vivian Wing-Yan; Hu, Yuanjia; Zhao, Jing; Li, Peng; Hu, Hao

    2017-01-05

    This study aims to investigate community pharmacist's perception on the provision of over-the-counter (OTC) traditional Chinese medicine (TCM) pharmaceutical services; focusing on the areas of their attitude, general practice, perceived barriers and suggested improvements. Questionnaire survey targeting community pharmacists in Harbin of China was applied in this study. Questionnaires were distributed and collected at community pharmacies. Data was analyzed by combining descriptive analysis and Chi-test. 280 valid questionnaires were collected, giving a response rate of 78%. Respondents generally showed positive attitude towards OTC TCM pharmaceutical services. However, they were uncertain about whether such pharmaceutical services should be considered as their primary responsibility. Respondents indicated that they acted proactively to find out all the medicines taken by their patients and to remind consumers of possible OTC TCM adverse reactions. However, they were less keen on recommending or re-directing consumers to suitable OTC TCM. The three main barriers hindering the provision of OTC TCM pharmaceutical service identified in this study were "insufficient professional knowledge" (54.6%), "ambiguity of the professional role of pharmacists" (54.6%) and "lack of scientific evidence of OTC TCM" (45.4%). The three main actions considered most relevant to improving pharmaceutical service of OTC TCM were "formulating or refining legislation to clarify the legal and professional role of pharmacists with respect to TCM" (60.7%), "strengthening training of pharmacists with respect to TCM" (57.9%), and "promoting public awareness of the pharmacist's role" (53.6%). According to the results of Chi-test, respondents' perceptions about the attitude, practice, perceived barriers, and improvement suggestions were significantly different depending on the education levels, certificate types and workloads of western medicine. The community pharmacists in Harbin, China were

  12. [Prevalence of psychiatric disorders in men and women hospitalized in a internal medicine service of a hospital of Santiago, Chile].

    Science.gov (United States)

    Hernández, G; Ibáñez, C; Kimelman, M; Orellana, G; Montino, O; Núñez, C

    2001-11-01

    Mental disorders may interfere, aggravate or mimic medical conditions. To study the prevalence of psychiatric disorders among patients hospitalized in a medical ward of a general hospital. A structured interview for DSM-III, devised for "non patients", was applied to 203 men and 203 women, aged 11 to 90 years old, hospitalized in an internal medicine service of a public hospital. Thirty four psychiatric conditions that can be discriminated with the instrument and others that complied with DSM-III criteria, were investigated. There was a 60% prevalence of mental disorders among men (alcohol dependency in 26%, delirium or dementia in 10.8%, anxiety disorders in 10.4%, major depression in 7.8% and adaptation disorders in 3%). Among women, the prevalence of mental disorders was 65% (major depression in 23.2%, anxiety disorders in 14.3%, adaptation disorders in 8.4%, dementia in 5.6%, delirium in 3% and alcohol dependency in 2.5%). Most conditions were of moderate or mild intensity. Two or more conditions coexisted in 40% of cases. Only in 8% of these subjects, a psychiatric consultation was requested. There is a high frequency of psychiatric disorders among medical patients. These must be adequately diagnosed and treated.

  13. Is it time to talk? Interpreter services use in general practice within Canterbury

    Directory of Open Access Journals (Sweden)

    Seers K

    2013-06-01

    Full Text Available INTRODUCTION: Effective communication is fundamental to successful health care service delivery, and has a positive impact on access, quality of care, health outcomes, and patient satisfaction. Although there are a growing number of New Zealanders who do not speak English proficiently, underutilisation of trained interpreter services appears to be common in primary health care settings. AIMS: To describe the pattern of interpreter service need and utilisation by general practice services, and to identify key barriers and enabling factors to the use of trained interpreters. METHODS: A mixed methods study was employed. Census and Partnership Health Canterbury Te Kei o Te Waka (PHC databases were combined, and quantitative analysis used to derive interpreter service need and utilisation patterns. Transcripts of focus groups and interviews from general practitioners, practice nurses and practice administration staff within the PHC were analysed, using qualitative methods to identify barriers and enablers to interpreter service use. RESULTS: For the years 2008-2010, approximately 10 742 consultations per year involved a non-Englishspeaking patient, yet in only approximately 74.8 (0.7% consultations per year were interpreter services utilised. Analysis of focus groups and interviews identified four global themes that represented barriers for interpreter service utilisation; namely, practicalities, expectations, knowledge of service, and systems. DISCUSSION: The current use of interpreter services in PHC general practice appears to be significantly less than the need. In order to maximise health outcomes and reduce risk, strategies must be initiated to counter the barriers currently inhibiting interpreter service use, including adopting best practice policies.

  14. Customer Representatives As Part-Time Marketers Of Online Services : Case: Tapiola General Mutual Insurance Company

    OpenAIRE

    Niemelä, Jere

    2011-01-01

    The empirical study that this thesis is based on was ordered to be conducted by Tapiola General Mutual Insurance Company, a Finnish customer-owned insurance company that offers its customers general insurance. The purpose of this thesis is to determine the current online services-related competence of customer representatives working at Tapiola General’s customer interface, namely at the company’s branch offices and its contact center. There is great demand within Tapiola General for a b...

  15. A SINGLE SERVER RETRIAL QUEUE WITH GENERAL RETRIAL TIMES AND TWO-PHASE SERVICE

    Institute of Scientific and Technical Information of China (English)

    Jinting WANG; Jianghua LI

    2009-01-01

    An M/G/1 retrial queue with a first-come-first-served (FCFS) orbit, general retrial time, two-phase service and server breakdown is investigated in this paper. Customers are allowed to balk and renege at particular times. Assume that the customers who find the server busy are queued in the orbit in accordance with an FCFS discipline. All customers demand the first "essential" service, whereas only some of them demand the second "optional" service, and the second service is multi-optional. During the service, the server is subject to breakdown and repair. Assume that the retrial time, the service time, and the repair time of the server are all arbitrarily distributed. By using the supplementary variables method, the authors obtain the steady-state solutions for both queueing and reliability measures of interest.

  16. A web-based library consult service for evidence-based medicine: Technical development

    Directory of Open Access Journals (Sweden)

    Schwartz Alan

    2006-03-01

    Full Text Available Abstract Background Incorporating evidence based medicine (EBM into clinical practice requires clinicians to learn to efficiently gain access to clinical evidence and effectively appraise its validity. Even using current electronic systems, selecting literature-based data to solve a single patient-related problem can require more time than practicing physicians or residents can spare. Clinical librarians, as informationists, are uniquely suited to assist physicians in this endeavor. Results To improve support for evidence-based practice, we have developed a web-based EBM library consult service application (LCS. Librarians use the LCS system to provide full text evidence-based literature with critical appraisal in response to a clinical question asked by a remote physician. LCS uses an entirely Free/Open Source Software platform and will be released under a Free Software license. In the first year of the LCS project, the software was successfully developed and a reference implementation put into active use. Two years of evaluation of the clinical, educational, and attitudinal impact on physician-users and librarian staff are underway, and expected to lead to refinement and wide dissemination of the system. Conclusion A web-based EBM library consult model may provide a useful way for informationists to assist clinicians, and is feasible to implement.

  17. Shifting boundaries: religion, medicine, nursing and domestic service in mid-nineteenth-century Britain.

    Science.gov (United States)

    Helmstadter, Carol

    2009-06-01

    The boundaries between medicine, religion, nursing and domestic service were fluid in mid-nineteenth-century England. The traditional religious understanding of illness conflicted with the newer understanding of anatomically based disease, the Anglican sisters were drawing a line between professional nursing and the traditional role of nurses as domestic servants who looked after sick people as one of their many duties, and doctors were looking for more knowledgeable nurses who could carry out their orders competently. This prosopographical study of the over 200 women who served as government nurses during the Crimean War 1854-56 describes the status of nursing and provides a picture of the religious and social structure of Britain in the 1850s. It also illustrates how religious, political and social factors affected the development of the new nursing. The Crimean War nurses can be divided into four major groups: volunteer secular ladies, Roman Catholic nuns, Anglican sisters and working-class hospital nurses. Of these four groups I conclude that it was the experienced working-class nurses who had the greatest influence on the organization of the new nursing.

  18. Deputy Inspector General for audit services. FY 1998 annual performance plan

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-09-30

    This plan outlines the audie strategies that the Deputy Inspector General for Audit Services intends to implement and execute in Fiscal Year (FY) 1998. The plan also includes the details of efforts to improve customer service and to implement the Inspector General`s streamlining initiatives. The FY 1997/1998 Strategic Plan emphasizes six key issue areas: Financial Management, Contract Administration, Program Management, Environmental Quality, Infrastructure and Administrative Safeguards. These issue areas were chosen to ensure that the Inspector General`s audit, inspection, and investigative functions are focused to assist the Department to reach its goals, pursue its strategies, and monitor its success indicators. This plan also establishes goals, objectives, and performance measures, which are discussed in detail in Appendix I.

  19. Interprofessional communication with hospitalist and consultant physicians in general internal medicine: a qualitative study

    Directory of Open Access Journals (Sweden)

    Gotlib Conn Lesley

    2012-11-01

    Full Text Available Abstract Background Studies in General Internal Medicine [GIM] settings have shown that optimizing interprofessional communication is important, yet complex and challenging. While the physician is integral to interprofessional work in GIM there are often communication barriers in place that impact perceptions and experiences with the quality and quantity of their communication with other team members. This study aims to understand how team members’ perceptions and experiences with the communication styles and strategies of either hospitalist or consultant physicians in their units influence the quality and effectiveness of interprofessional relations and work. Methods A multiple case study methodology was used. Thirty-one semi-structured interviews were conducted with physicians, nurses and other health care providers [e.g. physiotherapist, social worker, etc.] working across 5 interprofessional GIM programs. Questions explored participants’ experiences with communication with all other health care providers in their units, probing for barriers and enablers to effective interprofessional work, as well as the use of communication tools or strategies. Observations in GIM wards were also conducted. Results Three main themes emerged from the data: [1] availability for interprofessional communication, [2] relationship-building for effective communication, and [3] physician vs. team-based approaches. Findings suggest a significant contrast in participants’ experiences with the quantity and quality of interprofessional relationships and work when comparing the communication styles and strategies of hospitalist and consultant physicians. Hospitalist staffed GIM units were believed to have more frequent and higher caliber interprofessional communication and collaboration, resulting in more positive experiences among all health care providers in a given unit. Conclusions This study helps to improve our understanding of the collaborative environment

  20. Social network analysis. Review of general concepts and use in preventive veterinary medicine.

    Science.gov (United States)

    Martínez-López, B; Perez, A M; Sánchez-Vizcaíno, J M

    2009-05-01

    Social network analysis (SNA) and graph theory have been used widely in sociology, psychology, anthropology, biology and medicine. Social network analysis and graph theory provide a conceptual framework to study contact patterns and to identify units of analysis that are frequently or intensely connected within the network. Social network analysis has been used in human epidemiology as a tool to explore the potential transmission of infectious agents such as HIV, tuberculosis, hepatitis B and syphilis. In preventive veterinary medicine, SNA is an approach that offers benefits for exploring the nature and extent of the contacts between animals or farms, which ultimately leads to a better understanding of the potential risk for disease spread in a susceptible population. Social network analysis, however, has been applied only recently in preventive veterinary medicine, therefore the characteristics of the technique and the potential benefits of its use remain unknown for an important section of the international veterinary medicine community. The objectives of this paper were to review the concepts and theoretical aspects underlying the use of SNA and graph theory, with particular emphasis on their application to the study of infectious diseases of animals. The paper includes a review of recent applications of SNA in preventive veterinary medicine and a discussion of the potential uses and limitations of this methodology for the study of animal diseases.

  1. The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain

    Directory of Open Access Journals (Sweden)

    Katz J

    2015-10-01

    Full Text Available Joel Katz,1–3 Aliza Weinrib,1,2 Samantha R Fashler,2 Rita Katznelzon,1,3 Bansi R Shah,1 Salima SJ Ladak,1 Jiao Jiang,1 Qing Li,1 Kayla McMillan,1 Daniel Santa Mina,5,6 Kirsten Wentlandt,7 Karen McRae,1,3 Diana Tamir,1,3 Sheldon Lyn,1,3 Marc de Perrot,8 Vivek Rao,9 David Grant,10 Graham Roche-Nagle,11 Sean P Cleary,12 Stefan OP Hofer,13 Ralph Gilbert,14 Duminda Wijeysundera,1,3 Paul Ritvo,15 Tahir Janmohamed,16 Gerald O’Leary,1,3 Hance Clarke1,3 1Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, 2Department of Psychology, York University, 3Department of Anesthesia, University of Toronto, 4Palliative Care, University Health Network, University of Toronto, 5Princess Margaret Cancer Centre, University Health Network, University of Toronto, 6Faculty of Kinesiology and Physical Education, University of Toronto, 7Department of Family and Community Medicine, University of Toronto, 8Division of Thoracic Surgery, Toronto General Hospital, 9Division of Cardiovascular Surgery, Toronto General Hospital, 10Multiorgan Transplant Program, Toronto General Hospital, 11Division of Vascular Surgery, Toronto General Hospital, 12Division of General Surgery, Toronto General Hospital, 13Division of Plastic Surgery, Toronto General Hospital, 14Division of Otolaryngology – Head and Neck Surgery, Toronto General Hospital, 15Department of Kinesiology and Health Science, York University, 16ManagingLife, Toronto, ON, CanadaAbstract: Chronic postsurgical pain (CPSP, an often unanticipated result of necessary and even life-saving procedures, develops in 5–10% of patients one-year after major surgery. Substantial advances have been made in identifying patients at elevated risk of developing CPSP based on perioperative pain, opioid use, and negative affect, including depression, anxiety, pain catastrophizing, and posttraumatic stress disorder-like symptoms. The Transitional Pain Service (TPS at

  2. Four cases of dysthymic disorder and general malaise successfully treated with traditional herbal (kampo) medicines: kamiuntanto.

    Science.gov (United States)

    Kogure, Toshiaki; Tatsumi, Takeshi; Oku, Yuko

    2010-01-01

    Traditional herbal (Kampo) medicines have been used since ancient times to treat patients with mental disorders. In the present report, we describe four patients with dysthymia successfully treated with Kampo medicines: Kamiuntanto (KUT). These four patients fulfilled the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for dysthymic disorder with easy fatigability and sleeplessness, but did not fulfill the criteria for major depressive disorder. Treatment with KUT relieved depressive status, fatigue and sleeplessness in these patients. As a result, their QOL (quality of life) was considerably improved. KUT may be useful as an additional or alternative treatment for dysthymia, especially in the field of primary health care.

  3. Four Cases of Dysthymic Disorder and General Malaise Successfully Treated with Traditional Herbal (Kampo Medicines: Kamiuntanto

    Directory of Open Access Journals (Sweden)

    Toshiaki Kogure

    2010-05-01

    Full Text Available Traditional herbal (Kampo medicines have been used since ancient times to treat patients with mental disorders. In the present report, we describe four patients with dysthymia successfully treated with Kampo medicines: Kamiuntanto (KUT. These four patients fulfilled the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV criteria for dysthymic disorder with easy fatigability and sleeplessness, but did not fulfill the criteria for major depressive disorder. Treatment with KUT relieved depressive status, fatigue and sleeplessness in these patients. As a result, their QOL (quality of life was considerably improved. KUT may be useful as an additional or alternative treatment for dysthymia, especially in the field of primary health care.

  4. A review of governance of maternity services at South Tipperary general hospital

    LENUS (Irish Health Repository)

    Flory, David

    2015-09-01

    This review of the governance of maternity services at South Tipperary General Hospital has focussed on the systems and processes for assurance of service quality, risk management and patient safety primarily inside the hospital but also in the Hospital Group structure within which it operates. The effectiveness of the governance arrangements is largely determined by the quality of the leadership and management – both clinical and general – which designs, implements, and oversees those systems and processes and is ultimately responsible and accountable.\\r\

  5. Calidad de las remisiones en un servicio de medicina legal Quality of referrals at a legal medicine service

    Directory of Open Access Journals (Sweden)

    Héctor Barreiro Ramos

    2004-12-01

    the undergraduate stage. They are included in the 5th year of the medical career and the classes are generally theoretical. Nevertheless, in most of the Latin American countries, they are programmed for the 6th year and each student receives an average of 20 practical hours. In order to know these actings and the negative repercussion they have, a descriptive study of all those who died as a result of diseases, whose bodies were sent to the Provincial Center of Legal Medicine in Havana City, from 1999 to 2001, was conducted. A form was designed for collecting information and data were expressed in percentages. The results showed that 22 % of the referrals in these years corresponded to natural deaths that have nothing to do with Legal Medicine. The reasons for which they were referred were not exactly for criminal suspicion, but for not knowing the causes of death, having died in the emergency department, or on the way, or outside a health service. All this shows the lack of knowledge of the medicolegal actings regarding the dead.

  6. Brigadier General James Stevens Simmons (1890-1954), Medical Corps, United States Army: a career in preventive medicine.

    Science.gov (United States)

    Marble, Sanders

    2012-02-01

    James Simmons began his career in the US Army as a laboratory officer and his assignments progressed into tropical medicine research. His interests and work evolved into preventive medicine (PM, as the Army termed public health), and he took both a PhD and a Doctorate in Public Health. As the Army's leading PM officer he was appointed head of PM in 1940 and guided the Army's PM effort through World War II. His responsibility ran from gas masks through healthy nutrition and occupational health to an enormous variety of diseases; by the war's end, the breadth and importance of PM was reflected in the Preventive Medicine Division, having fully one-sixth of all military personnel at the Surgeon General's Office. Simmons used his strong professional credentials to tap into civilian medicine for expertise the Army lacked and he established organizations that survive to this day. After retirement, he sought to expand the field of public health and raise another generation of public health physicians.

  7. Quality evaluation of radiopharmaceuticals in nuclear medicine services in the states of Alagoas and Sergipe - Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Poliane Angelo de Lucena; Andrade, Wellington Gomes de; Lima, Fernando Roberto de Andrade, E-mail: wandrade@cnen.gov.br, E-mail: falima@cnen.gov.br [Universidade Federal de Pernambuco (DEN/UFPE), Recife, PE (Brazil). Dept. de Energia Nuclear; Centro Regional de Ciencias Nucleares do Nordeste (CRCN-NE/CNEN-PE), Recife, PE (Brazil); Lima, Fabiana Farias de, E-mail: fflima@cnen.gov.br [Centro Regional de Ciencias Nucleares do Nordeste (CRCN-NE/CNEN-PE), Recife, PE (Brazil)

    2011-07-01

    Radiopharmaceuticals are compounds associated with a radionuclide. They can be considered as vectors that have some specificity for an organ or a physiological or pathophysiological function. Assessing the radiopharmaceutical's quality is essential to obtain adequate images, avoiding repetition of examinations and unnecessary absorbed dose to the patient. Resolution no. 8 (RCD 38) of 06/04/2008 by Agencia Nacional de Vigilancia Sanitaria (ANVISA) states the obligation of performing a minimum of tests in the routines of nuclear medicine services (NMS). The aim of this work was to evaluate the radiochemical purity and pH of radiopharmaceuticals used in NMS in states of Alagoas and Sergipe - Brazil. Radiochemical purity was determined by thin layer chromatography where a paper Whatman and TLC were used as steady state and the solvents were used related to the appropriate radiopharmaceutical, both as recommended by the manufacturer's directions. The chromatographic strips were placed in closed containers to avoid contact with the walls. After, the strips were cut in 1cm pieces and the activity was determined in each NMS's activity calibrators. The radiopharmaceuticals pH was evaluated by using universal pH paper (Merck) and the obtained color was compared with its range of colors. It was observed that 33.34% and 2.3% of the tested radiopharmaceuticals showed PRQ (radiochemical purity) and pH values, respectively, are outside of the limits described by the manufacturers. The results show that the radiochemical purity assessment in the NMS's routine can indicate problems with a radioisotope tagging, allowing their exclusion before administration. (author)

  8. Use of complementary and alternative medicine by those with a chronic disease and the general population - results of a national population based survey

    Directory of Open Access Journals (Sweden)

    McChesney Jane

    2010-10-01

    Full Text Available Abstract Background The use of complementary and alternative medicine (CAM is becoming more common, but population-based descriptions of its patterns of use are lacking. This study aimed to determine the prevalence of CAM use in the general population and for those with asthma, diabetes, epilepsy and migraine. Methods Data from cycles 1.1, 2.1 and 3.1 of the Canadian Community Health Survey (CCHS were used for the study. The CCHS is a national cross-sectional survey administered to 400,055 Canadians aged ≥12 between 2001-2005. Self-reported information about professionally diagnosed health conditions was elicited. CCHS surveys use a multistage stratified cluster design to randomly select a representative sample of Canadian household residents. Descriptive data on the utilization of CAM services was calculated and logistic regression was used to determine what sociodemographic factors predict CAM use. Results Weighted estimates show that 12.4% (95% Confidence Interval (CI: 12.2-12.5 of Canadians visited a CAM practitioner in the year they were surveyed; this rate was significantly higher for those with asthma 15.1% (95% CI: 14.5-15.7 and migraine 19.0% (95% CI: 18.4-19.6, and significantly lower for those with diabetes 8.0% (95% CI: 7.4-8.6 while the rate in those with epilepsy (10.3%, 95% CI: 8.4-12.2 was not significantly different from the general population. Conclusion A large proportion of Canadians use CAM services. Physicians should be aware that their patients may be accessing other services and should be prepared to ask and answer questions about the risks and benefits of CAM services in conjunction with standard medical care.

  9. Clinical and microbiological study of catheter-associated urinary tract infections in internal medicine services of a Venezuelan university hospital

    OpenAIRE

    Quijada-Martínez, Pedro; Servicio de Medicina Interna. Instituto Autónomo Hospital Universitario de Los Andes. Mérida, Venezuela. Médico internista; Flores-Carrero, Ana; Instituto de Previsión y Asistencia Social del Ministerio de Educación. Mérida, Venezuela. Centro de Microscopia Electrónica, Universidad de Los Andes. Mérida, Venezuela. bioanalista, magíster en Ciencias Médicas Fundamentales; Labrador, Indira; Laboratorio de Microbiología Molecular, Universidad de Los Andes. Mérida, Venezuela. biólogo, magíster en Ciencias Biomédicas Experimentales; Araque, María; Laboratorio de Microbiología Molecular, Universidad de Los Andes. Mérida, Venezuela. médico cirujano, doctor en Ciencias Médicas Fundamentales.

    2017-01-01

    Objectives. To determine the clinical and microbiological characteristics of catheter-associated urinary tract infections (CA-UTI) in patients admitted to the Internal Medicine services of the Hospital Universitario de Los Andes (HULA), Mérida, Venezuela and to establish the clonal distribution of multi-resistant Enterobacteriaceae that produce this infection. Materials and Methods. Seventy-three adult patients with bladder catheterization were studied between January and July 2015. The micro...

  10. Pastoral power in the community pharmacy: A Foucauldian analysis of services to promote patient adherence to new medicine use.

    Science.gov (United States)

    Waring, Justin; Latif, Asam; Boyd, Matthew; Barber, Nick; Elliott, Rachel

    2016-01-01

    Community pharmacists play a growing role in the delivery of primary healthcare. This has led many to consider the changing power of the pharmacy profession in relation to other professions and patient groups. This paper contributes to these debates through developing a Foucauldian analysis of the changing dynamics of power brought about by extended roles in medicines management and patient education. Examining the New Medicine Service, the study considers how both patient and pharmacist subjectivities are transformed as pharmacists seek to survey patient's medicine use, diagnose non-adherence to prescribed medicines, and provide education to promote behaviour change. These extended roles in medicines management and patient education expand the 'pharmacy gaze' to further aspects of patient health and lifestyle, and more significantly, established a form of 'pastoral power' as pharmacists become responsible for shaping patients' self-regulating subjectivities. In concert, pharmacists are themselves enrolled within a new governing regime where their identities are conditioned by corporate and policy rationalities for the modernisation of primary care.

  11. Responding to GPs' information resource needs: implementation and evaluation of a complementary medicines information resource in Queensland general practice

    Directory of Open Access Journals (Sweden)

    O'Rourke Peter

    2011-09-01

    Full Text Available Abstract Background Australian General Practitioners (GPs are in the forefront of primary health care and in an excellent position to communicate with their patients and educate them about Complementary Medicines (CMs use. However previous studies have demonstrated that GPs lack the knowledge required about CMs to effectively communicate with patients about their CMs use and they perceive a need for information resources on CMs to use in their clinical practice. This study aimed to develop, implement, and evaluate a CMs information resource in Queensland (Qld general practice. Methods The results of the needs assessment survey of Qld general practitioners (GPs informed the development of a CMs information resource which was then put through an implementation and evaluation cycle in Qld general practice. The CMs information resource was a set of evidence-based herbal medicine fact sheets. This resource was utilised by 100 Qld GPs in their clinical practice for four weeks and was then evaluated. The evaluation assessed GPs' (1 utilisation of the resource (2 perceived quality, usefulness and satisfaction with the resource and (3 perceived impact of the resource on their knowledge, attitudes, and practice of CMs. Results Ninety two out of the 100 GPs completed the four week evaluation of the fact sheets and returned the post-intervention survey. The herbal medicine fact sheets produced by this study were well accepted and utilised by Qld GPs. The majority of GPs perceived that the fact sheets were a useful resource for their clinical practice. The fact sheets improved GPs' attitudes towards CMs, increased their knowledge of those herbal medicines and improved their communication with their patients about those specific herbs. Eighty-six percent of GPs agreed that if they had adequate resources on CMs, like the herbal medicine fact sheets, then they would communicate more to their patients about their use of CMs. Conclusion Further educational

  12. General Psychiatric Services for Adults with Intellectual Disability and Mental Illness

    Science.gov (United States)

    Chaplin, R.

    2004-01-01

    Adults with intellectual disability (ID) and mental illness may use general or specialist psychiatric services. This review aims to assess if there is evidence for a difference in outcome between them. A literature review was conducted using a variety of electronic databases and hand-search strategies to identify all studies evaluating the outcome…

  13. 78 FR 11188 - General Services Administration Regulation; Submission for OMB Review; Packing List Clause

    Science.gov (United States)

    2013-02-15

    ... ADMINISTRATION General Services Administration Regulation; Submission for OMB Review; Packing List Clause AGENCY... packing list clause. A notice was published in the Federal Register at 77 FR 66466, on November 5, 2012...: Submit comments identified by Information Collection 3090- 0246, Packing List Clause, by any of...

  14. Elicitation and Application of a Phonetic Description of the General Service List

    Science.gov (United States)

    Gilner, Leah; Morales, Franc

    2008-01-01

    This paper reports on a study designed to transcribe and analyze the 2284 General Service List (GSL) words. We discuss the extent to which this list of words is representative of certain aspects of the phonetics of the English language. In particular, we ask whether GSL words contain instances of all vowel and consonant segments present in the…

  15. New Research into General Psychiatric Services for Adults with Intellectual Disability and Mental Illness

    Science.gov (United States)

    Chaplin, R.

    2009-01-01

    Background: There are a variety of models for the mental health care of adults with comorbid intellectual disability (ID) and mental illness. There has been a long-running debate as to whether this should be provided by general psychiatric or specialised ID services. A previous review concluded that there was no clear evidence to support either…

  16. Logistic support service improves processes and outcomes of diabetes care in general practice.

    NARCIS (Netherlands)

    Meulepas, M.A.; Braspenning, J.C.C.; Grauw, W.J.C. de; Lucas, A.E.; Harms, L.; Akkermans, R.P.; Grol, R.P.T.M.

    2007-01-01

    BACKGROUND: Guidelines for type 2 diabetes care in general practice are well known and accepted, but the implementation falls short. OBJECTIVE: To implement these guidelines by introducing a diabetes support service (DSS) to support the care delivered by the GP. METHODS: A controlled, non-randomised

  17. Clinical Experiences of Korean Medicine Treatment against Urinary Bladder Cancer in General Practice

    Directory of Open Access Journals (Sweden)

    Taeyeol Park

    2016-01-01

    Full Text Available Urinary bladder cancer (UBC is one of the most common cancers, with 1 out of every 26 men and 1 out of every 80 women worldwide developing the disease during their lifetime. Moreover, it is a disease that predominantly affects the elderly and is becoming a major health problem as the elderly population continues to rapidly increase. In spite of the rapid development of medical science, the 5-year survival rate has remained around 75% since the 1990s, and the FDA has approved no new drugs for UBC over the last 10 years. In addition, most patients experience frequent recurrence and poor quality of life after diagnosis. Therefore, in order to solve unmet needs by alternative methods, we present our clinical cases of UBC where we observed outstanding results including regression and recurrence prevention exclusively through Traditional Korean Medicine such as (1 herbal therapy, (2 acupuncture, (3 pharmacopuncture and needle-embedding therapy, (4 moxibustion, and (5 cupping therapy. From our experience, it appears that multimodal strategies for synergistic efficiency are more effective than single Korean Medicine treatment. We hope this will encourage investigation of the efficacy of Korean Medicine treatment in clinical trials for UBC patients.

  18. Development of electronic medical record charting for hospital-based transfusion and apheresis medicine services: Early adoption perspectives

    Directory of Open Access Journals (Sweden)

    Rebecca Levy

    2010-01-01

    Full Text Available Background: Electronic medical records (EMRs provide universal access to health care information across multidisciplinary lines. In pathology departments, transfusion and apheresis medicine services (TAMS involved in direct patient care activities produce data and documentation that typically do not enter the EMR. Taking advantage of our institution′s initiative for implementation of a paperless medical record, our TAMS division set out to develop an electronic charting (e-charting strategy within the EMR. Methods: A focus group of our hospital′s transfusion committee consisting of transfusion medicine specialists, pathologists, residents, nurses, hemapheresis specialists, and information technologists was constituted and charged with the project. The group met periodically to implement e-charting TAMS workflow and produced electronic documents within the EMR (Cerner Millenium for various service line functions. Results: The interdisciplinary working group developed and implemented electronic versions of various paper-based clinical documentation used by these services. All electronic notes collectively gather and reside within a unique Transfusion Medicine Folder tab in the EMR, available to staff with access to patient charts. E-charting eliminated illegible handwritten notes, resulted in more consistent clinical documentation among staff, and provided greater real-time review/access of hemotherapy practices. No major impediments to workflow or inefficiencies have been encountered. However, minor updates and corrections to documents as well as select work re-designs were required for optimal use of e-charting by these services. Conclusion: Documentation of pathology subspecialty activities such as TAMS can be successfully incorporated into the EMR. E-charting by staff enhances communication and helps promote standardized documentation of patient care within and across service lines. Well-constructed electronic documents in the EMR may also

  19. Views and experiences of community pharmacists and superintendent pharmacists regarding the New Medicine Service in England prior to implementation.

    Science.gov (United States)

    Wells, Katharine M; Thornley, Tracey; Boyd, Matthew J; Boardman, Helen F

    2014-01-01

    The New Medicine Service (NMS) was introduced to community pharmacies in England in October 2011. The NMS aims to improve adherence to new medicines in patients with selected long term conditions. The service consists of two follow-up consultations within 1 month in addition to usual care. This study explored community pharmacist and superintendent pharmacist views and experiences of the NMS in the 5 weeks prior to its implementation to identify potential facilitators and barriers to its success. The study also investigated participant experiences of the introduction and provision of existing pharmacy services in order to contrast with the implementation of the NMS. This study consisted of four focus groups with a total of 15 community pharmacists representing locums and employees of small, medium and large chain pharmacies. In addition, 5 semi-structured interviews were conducted with superintendent pharmacists representing independent, small chain, supermarket and large multiple pharmacies. Data were audio-recorded, transcribed verbatim and thematically analyzed. Both pharmacists and superintendent pharmacists were positive about the NMS and identified potential benefits for patients and the pharmacy profession. Awareness of the service was high, however, some confusion between the NMS and changes to Medicine Use Reviews was evident in all focus groups due to their similarity and coincidental implementation. This confusion was not observed in the interviews with superintendent pharmacists. Participants identified pharmacists' positive attitude, the similarity to current practice and the self-accreditation procedure as potential facilitators to service implementation. Potential barriers identified included a perceived lack of interest and awareness by GPs of the service, and the payment structure. Participants were concerned about the speed of implementation, and the absence of some materials needed prior to the start of the service. Participants were enthusiastic

  20. A Decade of Counseling Services in One College of Veterinary Medicine: Veterinary Medical Students' Psychological Distress and Help-Seeking Trends.

    Science.gov (United States)

    Drake, Adryanna A S; Hafen, McArthur; Rush, Bonnie R

    Much has been discussed about the high prevalence of psychological distress among veterinary medical students. Studies investigating general samples of veterinary medical students indicate that, on average, depression and anxiety symptoms are present at higher rates than in comparison samples. However, little is known about veterinary medical students who seek counseling. This study intends to expand the literature on veterinary student well-being, as the first to examine a sample of veterinary medical students seeking counseling services. It offers an overview of student distress and help-seeking trends from a decade of counseling services provided in one College of Veterinary Medicine (CVM) in the US. The sample includes data from 279 participants. Results indicate a steady increase in students seeking counseling over the last decade. First-year students sought services at higher rates but second-year students experienced the greatest distress when compared to other cohorts. Students seeking counseling services experienced levels of overall distress, symptoms of anxiety and depression, and social role concerns that were, on average, above cut-off scores. Physical health was significantly associated with student distress, suggesting opportunities for intervention.

  1. Quality of psychiatric care in the general hospital: referrer perceptions of an inpatient liaison psychiatry service.

    Science.gov (United States)

    Solomons, Luke C; Thachil, Ajoy; Burgess, Caroline; Hopper, Adrian; Glen-Day, Vicky; Ranjith, Gopinath; Hodgkiss, Andrew

    2011-01-01

    To explore the experience of senior staff on acute medical wards using an established inpatient liaison psychiatry service and obtain their views on clinically relevant performance measures. Semistructured face-to-face interviews with consultants and senior nurses were taped, transcribed and analyzed manually using the framework method of analysis. Twenty-five referrers were interviewed. Four key themes were identified - benefits of the liaison service, potential areas of improvement, indices of service performance such as speed and quality of response and expanded substance misuse service. Respondents felt the liaison service benefited patients, staff and service delivery in the general hospital. Medical consultants wanted stepped management plans devised by consultant liaison psychiatrists. Senior nurses, who perceived themselves as frontline crisis managers, valued on-the-spot input on patient management. Consultants and senior nurses differed in their expectations of liaison psychiatry. Referrers valued speed of response and regarded time from referral to definitive management plan as a key performance indicator for benchmarking services. Copyright © 2011 Elsevier Inc. All rights reserved.

  2. Service quality and patient experiences of ambulatory care in a specialized clinic vs. a general hospital.

    Science.gov (United States)

    De Regge, Melissa; De Groote, Hélène; Trybou, Jeroen; Gemmel, Paul; Brugada, Pedro

    2017-04-01

    Health care organizations are constantly looking for ways to establish a differential advantage to attract customers. To this end, service quality has become an important differentiator in the strategy of health care organizations. In this study, we compared the service quality and patient experience in an ambulatory care setting of a physician-owned specialized facility with that of a general hospital. A comparative case study with a mixed method design was employed. Data were gathered through a survey on health service quality and patient experience, completed with observations, walkthroughs, and photographic material. Service quality and patient experiences are high in both the investigated health care facilities. A significant distinction can be made between the two facilities in terms of interpersonal quality (p = 0.001) and environmental quality (P ≤ 0.001), in favor of the medical center. The difference in environmental quality is also indicated by the scores given by participants who had been in both facilities. Qualitative analysis showed higher administrative quality in the medical center. Environmental quality and patient experience can predict the interpersonal quality; for environmental quality, interpersonal quality and age are significant predictors. Service quality and patient experiences are high in both facilities. The medical center has higher service quality for interpersonal and environmental service quality and is more process-centered.

  3. Client perception of service quality at the outpatient clinics of a General hospital in Lagos, Nigeria.

    Science.gov (United States)

    Ogunnowo, Babatunde Enitan; Olufunlayo, Tolulope Florence; Sule, Salami Suberu

    2015-01-01

    Service quality assessments have assumed increasing importance in the last two decades. They are useful in identifying gaps in services been provided with the ultimate aim of guaranteeing quality assurance. The objective of this study was to assess the client perception of service quality at the outpatient clinics of Randle General hospital, Lagos. A descriptive cross sectional study was conducted from March to May 2013. A multistage sampling technique was used to select respondents and data was collected with the aid of modified SERVQUAL questionnaires. The data was analysed with aid of EPI-INFO 2002 and statistical significance was set at a P value 0.05 for statistical significance. Total of 400 respondents were interviewed. The mean age was 40 years with a standard deviation of 15.2 yrs. The highest mean score of 4.35 out of a possible maximum of 5 was recorded in assurance domain while the lowest mean score of 4.00 was recorded in the responsiveness domain. The overall mean score of all the domains was 4.20 with standard deviation of 0.51. Overall majority (80.8%) of respondents rated the overall service quality as good/ very good. After linear regression, the assurance domain was the most important predictor of the overall perceived service quality (pservice quality was good. The major deficiencies were in the responsiveness domain and especially the waiting time. The hospital management should implement measures to improve the responsiveness of services by ensuring prompt delivery of services.

  4. Institute of medicine recommendations for improving the quality of cancer care: what do they mean for the general internist?

    Science.gov (United States)

    Nekhlyudov, Larissa; Wenger, Neil

    2014-10-01

    In order to evaluate and address the deficiencies in the U.S. cancer care system, particularly affecting the growing elderly population, the Institute of Medicine (IOM) convened a panel representing oncology providers, surgeons, primary care providers, researchers, policy makers and patients. The Committee concluded that cancer care is on the brink of crisis and issued recommendations targeting all stakeholders involved in cancer care. General internists play a critical role in the care of cancer patients, from the time of diagnosis, through treatment, survivorship and end of life care. We review the IOM recommendations, highlight those that are particularly relevant to the general internist, and outline clinical, research and educational opportunities where general internists should take an expanded role.

  5. Living large: the experiences of large-bodied women when accessing general practice services

    Directory of Open Access Journals (Sweden)

    Russell N

    2013-09-01

    Full Text Available INTRODUCTION: Numerous studies report high levels of stigma and discrimination experienced by obese/overweight women within the health care system and society at large. Despite general practice being the most utilised point of access for health care services, there is very little international or national exploration of the experiences of large-bodied women (LBW accessing these services. The aim of this study was to explore LBW's experiences of accessing general practice services in New Zealand. METHODS: This is a qualitative, descriptive, feminist study. Local advertising for participants resulted in eight self-identified, large-bodied women being interviewed. A post-structural feminist lens was applied to the data during thematic analysis. FINDINGS: The women in this study provided examples of verbal insults, inappropriate humour, negative body language, unmet health care needs and breaches of dignity from health care providers in general practice. Seven themes were identified: early experiences of body perception, confronting social stereotypes, contending with feminine beauty ideals, perceptions of health, pursuing health, respecting the whole person, and feeling safe to access care. CONCLUSION: Pressure for body size vigilance has, in effect, excluded the women in this study from the very locations of health that they are 'encouraged' to attend-including socialising and exercising in public, screening opportunities that require bodily exposure, and accessing first point of care health services.

  6. National Service Frameworks and UK general practitioners: street-level bureaucrats at work?

    Science.gov (United States)

    Checkland, Kath

    2004-11-01

    This paper argues that the past decade has seen significant changes in the nature of medical work in general practice in the UK. Increasing pressure to use normative clinical guidelines and the move towards explicit quantitative measures of performance together have the potential to alter the way in which health care is delivered to patients. Whilst it is possible to view these developments from the well-established sociological perspectives of deprofessionalisation and proletarianisation, this paper takes a view of general practice as work, and uses the ideas of Lipsky to analyse practice-level responses to some of these changes. In addition to evidence-based clinical guidelines, National Service Frameworks, introduced by the UK government in 1997, also specify detailed models of service provision that health care providers are expected to follow. As part of a larger study examining the impact of National Service Frameworks in general practice, the response of three practices to the first four NSFs were explored. The failure of NSFs to make a significant impact is compared to the practices' positive responses to purely clinical guidelines such as those developed by the British Hypertension Society. Lipsky's concept of public service workers as 'street-level bureaucrats' is discussed and used as a framework within which to view these findings.

  7. MedLink: A Mobile Intervention to Address Failure Points in the Treatment of Depression in General Medicine

    Directory of Open Access Journals (Sweden)

    David Mohr

    2015-11-01

    Full Text Available Major depression is common, and imposes Major depression is common, and imposes a high burden in terms of cost, morbidity, and suffering. Most people with depression are treated in general medicine using antidepressant medication. Outcomes are poor due to failure points across the care system, including patient non-adherence, failure of physicians to optimize the treatment regimens, and lack of patient-physician communication. This study reports on the 4-week pilot deployment of MedLink, a mobile intervention aimed at systemically addressing each of these failure points. A mobile app provides the patient with information and collects data on symptoms and side-effects. A cellularly enabled pill bottle monitors medication adherence. Data from these are provided to the physician and patient to foster communication and medication adjustments. Usability evaluation was generally favorable. Medication adherence rates in this first deployment were high with no patients discontinuing, and 84% of doses taken. Depressive symptom severity was significantly reduced. This study supports the use of a comprehensive, systemic approach to mHealth solutions to enhance processes of care for depression by general medicine physicians.

  8. General-Service Ballistic Computer Programming Based on B-Method

    Institute of Scientific and Technical Information of China (English)

    ZHENG Yu-jun; ZHANG Zi-qiu; WANG Jin-quan; XUE Jin-yun

    2006-01-01

    Formal methods offer the promise of significant improvement on quality and reliability of critical embedded software. B-Method is employed to develop general-service ballistic computer programs in the paper, each of which can be adapted to a family of service/weapon-specific ballistic computers. Based on the structuring mechanisms of B-method, a unified approach is proposed to systematically control the complexity of ballistic parameters in the process of type and operation refinement, and ultimately a series of high reliable, reusable, and scalable programs are produced. Experiences with the application of the method and tools are also discussed.

  9. Review of paediatric cardiology services in district general hospitals in the United Kingdom.

    Science.gov (United States)

    Andrews, Hannah; Singh, Yogen

    2016-03-01

    Following the Safe and Sustainable review of Paediatric Services in 2012/2013, National Health Service England recommended that local paediatric cardiology services should be provided by specially trained paediatricians with expertise in cardiology in all non-specialist hospitals. To understand the variation in local paediatric cardiology services provided across district general hospitals in the United Kingdom. An internet-based questionnaire was sent out via the Paediatrician with Expertise in Cardiology Special Interest Group and the Neonatologists with Interest in Cardiology and Haemodynamics contact databases and the National Health Service directory. Non-responders were followed-up via telephone. The response rate was 80% (141 of 177 hospitals), and paediatricians with expertise in cardiology were available in 68% of those. Local cardiology clinics led by paediatricians with expertise in cardiology were provided in 96 hospitals (68%), whereas specialist outreach clinics were held in 123 centres (87%). A total of 11 hospitals provided neither specialist outreach clinics nor any local cardiology clinics led by paediatricians with expertise in cardiology. Paediatric echocardiography services were provided in 83% of the hospitals, 12-lead electrocardiogram in 96%, Holter electrocardiogram in 91%, and exercise testing in only 47% of the responding hospitals. Telemedicine facilities were established in only 52% of the centres, where sharing echocardiogram images via picture archiving and communication system was used most commonly. There has been a substantial increase in the availability of paediatricians with expertise in cardiology since 2008. Most of the hospitals are well-supported by specialist cardiology centres via outreach clinics; however, there remains significant variation in the local paediatric cardiology services provided across district general hospitals in the United Kingdom.

  10. Effects of implementation of an urgent surgical care service on subspecialty general surgery training

    Science.gov (United States)

    Wood, Leanne; Buczkowski, Andrzej; Panton, Ormond M.N.; Sidhu, Ravi S.; Hameed, S. Morad

    2010-01-01

    Background In July 2007, a large Canadian teaching hospital realigned its general surgery services into elective general surgery subspecialty-based services (SUBS) and a new urgent surgical care (USC) service (also know in the literature as an acute care surgery service). The residents on SUBS had their number of on-call days reduced to enable them to focus on activities related to SUBS. Our aim was to examine the effect of the creation of the USC service on the educational experiences of SUBS residents. Methods We enrolled residents who were on SUBS for the 6 months before and after the introduction of the USC service. We collected data by use of a survey, WEB eVAL and recorded attendance at academic half days. Our 2 primary outcomes were residents’ attendance at ambulatory clinics and compliance with the reduction in the number of on-call days. Our secondary outcomes included residents’ time for independent study, attendance at academic half days, operative experience, attendance at multidisciplinary rounds and overall satisfaction with SUBS. Results Residents on SUBS had a decrease in the mean number of on-call days per resident per month from 6.28 to 1.84 (p = 0.006), an increase in mean attendance at academic half days from 65% to 87% (p = 0.028), at multidisciplinary rounds (p = 0.002) and at ambulatory clinics and an increase in independent reading time (p = 0.015), and they reported an improvement in their work environment. There was no change in the amount of time residents spent in the operating room or in their overall satisfaction with SUBS. Conclusion Residents’ education in the SUBS structure was positively affected by the creation of a USC service. Compliance with the readjustment of on-call duties was high and was identified as the single most significant factor in enabling residents to take full advantage of the unique educational opportunities available only while on SUBS. PMID:20334744

  11. General practitioners' evaluation of community psychiatric services: responsiveness to change of the General Practitioner Experiences Questionnaire (GPEQ

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    Damerell Elisabeth

    2010-04-01

    Full Text Available Abstract Background Instruments have been developed to assess professional views of the quality of care but have rarely been tested for responsiveness to change. The objective of this study was to test the responsiveness of the General Practitioner Experiences Questionnaire (GPEQ for the measurement of Community Mental Health Centres in Norway. Methods National surveys were conducted in Norway in 2006 (n = 2,415 and 2008 (n = 2,209 to measure general practitioners' evaluation of community mental health centres. GPs evaluated the centres by means of a postal questionnaire, consisting of questions focused on centre quality and cooperation with GPs. As part of the national surveys 75 GPs in 2006 and 66 GPs in 2008 evaluated Hamar community mental health centre. Between the surveys, several quality improvement initiatives were implemented which were directed at cooperation with and guidance for GPs in Stange municipality, one of eight municipalities in Hamar centre catchment area. The main outcome measures were changes in GPEQ scores from 2006 to 2008 for GPs evaluating Hamar community mental health centre from Stange municipality, and changes in scores for GPs in the other seven municipalities and nationally which were assessed for statistical significance. Results GPs in Stange municipality rated Hamar community mental health centre significantly better on the guidance scale in 2008 than in 2006; on a 0-100 scale where 100 represents the best possible experiences the score was 26.5 in 2006 and 58.3 in 2008 (p Conclusions Following the implementation of an initiative designed to enhance service quality, the GPEQ identified expected changes in the guidance scale for the intervention group, indicating that the instrument is responsive to change. The worsening of services for GPs in the control group evaluating Hamar centre warrants further study.

  12. Does deregulation in community pharmacy impact accessibility of medicines, quality of pharmacy services and costs? Evidence from nine European countries.

    Science.gov (United States)

    Vogler, Sabine; Habimana, Katharina; Arts, Danielle

    2014-09-01

    To analyse the impact of deregulation in community pharmacy on accessibility of medicines, quality of pharmacy services and costs. We analysed and compared community pharmacy systems in five rather deregulated countries (England, Ireland, the Netherlands, Norway, Sweden) and four rather regulated countries (Austria, Denmark, Finland, Spain). Data were collected by literature review, a questionnaire survey and interviews. Following a deregulation, several new pharmacies and dispensaries of Over-the-Counter (OTC) medicines tended to be established, predominantly in urban areas. Unless prevented by regulation, specific stakeholders, e.g. wholesalers, were seen to gain market dominance which limited envisaged competition. There were indications for an increased workload for pharmacists in some deregulated countries. Economic pressure to increase the pharmacy turnover through the sale of OTC medicines and non-pharmaceuticals was observed in deregulated and regulated countries. Prices of OTC medicines were not found to decrease after a deregulation in pharmacy. Access to pharmacies usually increases after a deregulation but this is likely to favour urban populations with already good accessibility. Policy-makers are recommended to take action to ensure equitable accessibility and sustainable competition in a more deregulated environment. No association between pharmaceutical expenditure and the extent of regulation/deregulation appears to exist. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  13. Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice? A cluster randomised controlled trial

    National Research Council Canada - National Science Library

    Kortekaas, M F; Bartelink, M E L; Zuithoff, N P A; van der Heijden, G J M G; de Wit, N J; Hoes, A W

    2016-01-01

    Evidence-based medicine (EBM) is an important element in the general practice (GP) specialty training. Studies show that integrating EBM training into clinical practice brings larger benefits than stand-alone modules...

  14. The perceived value of clinical pharmacy service provision by pharmacists and physicians: an initial assessment of family medicine and internal medicine providers.

    Science.gov (United States)

    Wietholter, Jon P; Ponte, Charles D; Long, Dustin M

    2016-10-24

    Few publications have addressed the perceptions of pharmacists and physicians regarding the value of clinical pharmacist services. A survey-based study was conducted to determine whether Internal Medicine (IM) and Family Medicine (FM) pharmacists and physicians differed in their attitudes regarding the benefits of collaboration in an acute care setting. The primary objective was to evaluate perceived differences regarding self-assessment of value between IM and FM pharmacists. The secondary objective was to evaluate perceived differences of clinical pharmacist benefit between IM and FM physicians. An eight-item questionnaire assessed the attitudes and beliefs of pharmacists and physicians regarding the value of clinical pharmacy services. Surveys were emailed and participants marked their responses using a 7-point Likert scale for each item. Demographic data and overall comments were collected from each participant. Overall, 167 surveys were completed. When comparing cumulative physician and pharmacist responses, none of the eight questions showed significant differences. Statistically significant differences were noted when comparing IM and FM clinical pharmacists on five of the eight survey items; for each of these items, FM pharmacists had more favourable perceptions than their IM counterparts. No statistically significant differences were noted when comparing responses of IM and FM physicians. This study found that FM pharmacists perceived a greater benefit regarding participation in inpatient acute care rounds when compared to their IM pharmacist counterparts. Future studies are necessary to determine if other medical specialties' perceptions of clinical pharmacy provision differ from our findings and to evaluate the rationale behind specific attitudes and behaviours. © 2016 Royal Pharmaceutical Society.

  15. Consultation performance of general practitioners when supported by an asthma/COPDC-service

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    Annelies Lucas EM

    2012-07-01

    Full Text Available Abstract Background General practitioners (GPs can refer patients to an asthma/COPD service (AC-service for diagnostic assessment of spirometry and medical history and for asthma or COPD monitoring. The AC-service reports diagnostic results and additional information about disease burden (BORG-score for complaints, MRC-dyspnoea score, exacerbation rate, life style, medication and compliance, to the patient’s GP. This study explores how GPs use this additional information when discussing the patient’s disease burden and how this influences GPs’ information and education provision during consultations with asthma/COPD patients. Method Patients with (a suspicion of asthma or COPD were referred to an AC-service and consulted their GPs after they had received a report from the AC-service. Retrospectively patients answered questions about their GPs’ performance during these consultations. Performances were compared with performances of the same GPs during consultations without support of the AC-service (usual care, earlier that year. Results Of consultations not initiated by an AC-service check-up, 91% focussed on complaints, the initial reason for the consultation. In AC-service supported follow-up consultations, GPs explored disease burden when the (BORG-score for complaints was high - as reported by the AC-service - even when patients themselves thought it was irrelevant. GPs put significantly less effort in exploring disease burden when the Borg-score was low (BORG 3–4: 69%; BORG1-2: 51%, p = 0,01. GPs mostly ignored MRC-dyspnoea scores: attention to dyspnoea was 18% for MRC-score p = 0,63. GPs encouraged physical fitness in 13% of patients. Smoking behaviour was discussed with 66% of the actual smokers but only 14% remembered a stop smoking advice. Furthermore, pharmacotherapeutic management education in AC-service supported consultations did not differ from performance in usual care according to patient evaluations. Conclusion

  16. Transitions of Care Consensus Policy Statement American College of Physicians-Society of General Internal Medicine-Society of Hospital Medicine-American Geriatrics Society-American College of Emergency Physicians-Society of Academic Emergency Medicine.

    Science.gov (United States)

    Snow, Vincenza; Beck, Dennis; Budnitz, Tina; Miller, Doriane C; Potter, Jane; Wears, Robert L; Weiss, Kevin B; Williams, Mark V

    2009-08-01

    The American College of Physicians (ACP), Society of Hospital Medicine (SHM), Society of General Internal Medicine (SGIM), American Geriatric Society (AGS), American College of Emergency Physicians (ACEP) and the Society for Academic Emergency Medicine (SAEM) developed consensus standards to address the quality gaps in the transitions between inpatient and outpatient settings. The following summarized principles were established: 1.) Accountability; 2) Communication; 3.) Timely interchange of information; 4.) Involvement of the patient and family member; 5.) Respect the hub of coordination of care; 6.) All patients and their family/caregivers should have a medical home or coordinating clinician; 7.) At every point of transitions the patient and/or their family/caregivers need to know who is responsible for their care at that point; 9.) National standards; and 10.) Standardized metrics related to these standards in order to lead to quality improvement and accountability. Based on these principles, standards describing necessary components for implementation were developed: coordinating clinicians, care plans/transition record, communication infrastructure, standard communication formats, transition responsibility, timeliness, community standards, and measurement.

  17. International Journal of Occupational Medicine and Environmental Health in world documentation services: the SCOPUS based analysis of citation.

    Science.gov (United States)

    Przyłuska, Jolanta

    2006-01-01

    A high classification of scientific journals in the ranking of international transfer of knowledge is reflected by other researchers' citations. The International Journal of Occupational Medicine and Environmental Health (IJOMEH) is an international professional quarterly focused on such areas as occupational medicine, toxicology and environmental health edited in Poland. IJOMEH, published in English, is indexed in numerous world information services (MEDLINE, EMBASE, EBSCO, SCOPUS). This paper presents the contribution of IJOMEH publications to the world circulation of scientific information based on the citation analysis. The analysis, grounded on the SCOPUS database, assessed the frequency of citations in the years 1996-2005. Journals in which they have been cited were retrieved and their list is also included.

  18. [Pharmaceutical Service after the Fukushima Disaster: A Case Report of Soma General Hospital].

    Science.gov (United States)

    Fukunaga, Hisanori; Momonoi, Toshiyuki; Kumakawa, Hiromi

    2016-01-01

      Despite being damaged by the 2011 Tohoku earthquake, tsunami, and nuclear disaster, Soma General Hospital, located approximately 40 km north of Fukushima Daiichi nuclear power plant, was able to fulfill its role as a key regional hospital in northeast Fukushima. To elucidate the pharmaceutical service in response to the disaster, we investigated the hospital's operations in 2011 according to the medical records and prescriptions. One of the difficulties that the department of pharmaceutical service faced at that time was the increase in emergency healthcare requests by evacuated patients from other hospitals and clinics. Herein, we propose the following countermeasures to be considered in future disaster preparations: (1) establishing a medical and pharmaceutical service coordinator for disaster relief; (2) sharing all local patients' medical information in emergencies (at least contraindicated drugs or allergy history); and (3) reviewing disaster stockpiles, especially pharmaceuticals (both at the hospital and in nearby locations).

  19. [Is computed interpretation of electrocardiograms suitable for a general medicine department?].

    Science.gov (United States)

    Besançon, F; Cousteau, J P; Bodiou, C; Bodiou, P

    1984-02-23

    Computed interpretation of electrocardiograms may be needed as French hospitals are divided into units in which physicians belonging to other specialities than cardiology may be in charge of internal medicine patients. We experimented two rival systems: SADE and CARDIONICS. Recordings were taken in the wards, on paper and magnetic tape. The computer, called by telephone, read the tape, interpreted the data, and printed conclusions and measurements. No useful information was provided in any of the 32 first patients studied (mean age: 71). The machine made our situation worse, as we were repeatedly prompted to call in a cardiologist without sufficient reason. A rejection reaction was observed. Telephone problems in French hospitals, losses of time, errors of manipulation, sometimes unintelligible language, and inappropriate material are discussed from the point of view of the internist. We did not consider the problems of cardiologists, screeners and archivists. In non-universitary hospitals, the needs may be greater, calling for improvements in software and hardware.

  20. Trends in study design and the statistical methods employed in a leading general medicine journal.

    Science.gov (United States)

    Gosho, M; Sato, Y; Nagashima, K; Takahashi, S

    2017-07-27

    Study design and statistical methods have become core components of medical research, and the methodology has become more multifaceted and complicated over time. The study of the comprehensive details and current trends of study design and statistical methods is required to support the future implementation of well-planned clinical studies providing information about evidence-based medicine. Our purpose was to illustrate study design and statistical methods employed in recent medical literature. This was an extension study of Sato et al. (N Engl J Med 2017; 376: 1086-1087), which reviewed 238 articles published in 2015 in the New England Journal of Medicine (NEJM) and briefly summarized the statistical methods employed in NEJM. Using the same database, we performed a new investigation of the detailed trends in study design and individual statistical methods that were not reported in the Sato study. Due to the CONSORT statement, prespecification and justification of sample size are obligatory in planning intervention studies. Although standard survival methods (eg Kaplan-Meier estimator and Cox regression model) were most frequently applied, the Gray test and Fine-Gray proportional hazard model for considering competing risks were sometimes used for a more valid statistical inference. With respect to handling missing data, model-based methods, which are valid for missing-at-random data, were more frequently used than single imputation methods. These methods are not recommended as a primary analysis, but they have been applied in many clinical trials. Group sequential design with interim analyses was one of the standard designs, and novel design, such as adaptive dose selection and sample size re-estimation, was sometimes employed in NEJM. Model-based approaches for handling missing data should replace single imputation methods for primary analysis in the light of the information found in some publications. Use of adaptive design with interim analyses is increasing

  1. [Cardiac deaths in hard coal-mining industry as an indicator of efficiency of occupational medicine services].

    Science.gov (United States)

    Skowronek, Rafał; Chowaniec, Czesław; Kowalska, Anna

    2011-01-01

    Deaths in hard-coal mining industry can be divided into: accidental (usually of a single character) and non-accidental-intentional (homicide, suicide) and natural (with a pathological background, 'without external factors'). The main cause of natural deaths is myocardial infarction (MI). Its risk is increased by environmental factors in working place, unhealthy life style, cigarette smoking and alcohol drinking, which is often an attempt at coping with chronic stress, so proper prevention, qualification and periodic examination of workers is indispensable. The aim of the study is to analyze cases of miners' cardiac deaths investigated in Department of Forensic Medicine in Katowice and the number of natural deaths in hard-coal mines in the years 1999-2010. There were 298 accidental and 122 natural deaths, the latter showing an increasing tendency in the years 2002-2004, 2006, 2008 and 2010. Natural deaths--in 95% sudden cardiac deaths--constituted 29% of all deaths in hard-coal mining industry. Autopsies supplemented by histopathological investigations often revealed advanced atherosclerosis and coronary heart disease, which should disqualify a candidate from working underground. A high number of natural deaths in hard-coal mining industry and morphological post mortem assessment of victims indicate insufficiency of occupational medicine services. We propose an improvement of its quality and a higher frequency of periodic examinations of workers (especially in groups with the highest risk of MI), as well as courses of Basic Life Support (BLS). Forensic medicine may be socially useful in assessing the efficiency of occupational medicine services in mining industry.

  2. Internal and External Perspectives on Quality of Healthcare Services at Sanglah General Hospital Denpasar

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    Made Nopy Diah Sundari

    2015-04-01

    Full Text Available Background and purpose: Customer satisfaction is a primary indicator of the quality of public healthcare services. This study investigated internal (hospital staff and external (hospital clients perspectives in order to gain insight into the quality of care at Sanglah General Hospital.Methods: The study used both qualitative and quantitative methodologies with 11 informants and 106 respondents. Qualitative data obtained through in-depth interviews with hospital staff were analyzed thematically. Quantitative data obtained through self-administered questionnaire were analyzed using univariate analysis.Results: Informants from the qualitative data collection stated that Sanglah General Hospital has a relatively high level of service and that existing structures to mitigate issues are in place, which act as reinforcing factors. Data from the quantitative survey indicated that clients were satisfied with the quality of service (ServQual, with an overall percentage of 83.82%.Conclusion: Further efforts could be made in order to improve healthcare provision at Sanglah Hospital, particularly from the perspective of hospital facilities, staff support and increased implementation of clinical governance.Keywords: quality of service, internal perspectives, external perspectives, Sanglah Hospital

  3. General practitioners' use and experiences of palliative care services: a survey in south east England

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    Higginson Irene J

    2008-11-01

    Full Text Available Abstract Background The role of the General Practitioner (GP is central to community palliative care. Good liaison between the different professionals involved in a patient's care is extremely important in palliative care patients. In cases where GPs have previously been dissatisfied with palliative services, this may be seen as a barrier to referral when caring for other patients. The aim of this survey is to investigate the use and previous experiences of GPs of two palliative care services, with particular emphasis on barriers to referral and to explore issues surrounding the GP's role in caring for palliative patients. Methods Design: Descriptive postal survey of use and experience of palliative care services with particular emphasis on barriers to referral. Setting: One Primary Care Trust (PCT, south London, England, population 298,500. Subjects: 180 GPs in the PCT, which is served by two hospice services (A&B. Results An overall questionnaire response rate of 77% (138 was obtained, with 69% (124 used in analysis. Over 90% of GPs were satisfied with the palliative care services over the preceding two years. Two areas of possible improvement emerged; communication and prescribing practices. GPs identified some patients that they had not referred, most commonly when patients or carers were reluctant to accept help, or when other support was deemed sufficient. Over half of the GPs felt there were areas where improvement could be made; with clarification of the rules and responsibilities of the multi disciplinary team being the most common. The majority of GPs were working, and want to work with, the specialist services as part of an extended team. However, a greater number of GPs want to hand over care to the specialist services than are currently doing so. Conclusion A large number of GPs were happy with the service provision of the palliative care services in this area. They suggested that 3 out of 4 terminally ill patients needed specialist

  4. VIEWPOINTS OF SUPERVISORS ABOUT THE PROCESS OF DISSERTATIONS FOR GENERAL MEDICINE PROGRAM SHAHID SADOUGHI UNIVERSITY OF MEDICAL SCIENCES

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    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.

  5. The role of family therapists in veterinary medicine: opportunities for clinical services, education, and research.

    Science.gov (United States)

    Hafen, McArthur; Rush, Bonnie R; Reisbig, Allison M J; McDaniel, Kara Z; White, Mark B

    2007-04-01

    Marriage and family therapists (MFTs) are applying their specific skill set in a variety of arenas. A new area for collaboration is veterinary medicine. The veterinary medical profession is emphasizing the importance of non-biomedical skills such as communication skills, acknowledging that human clientele are likely to view their pets as family members, and discussing veterinarian personal well-being. Each of these trends has clear application for intervention by MFTs. A discussion of how MFTs may be uniquely positioned to assist veterinary medicine is presented. An example of collaboration between MFT and veterinary medicine at Kansas State University is highlighted. Recommendations are made for development of effective educational relationships and possible private sector collaborations.

  6. Effect of a Community-Based Service Learning Experience in Geriatrics on Internal Medicine Residents and Community Participants.

    Science.gov (United States)

    Miller, Rachel K; Michener, Jennifer; Yang, Phyllis; Goldstein, Karen; Groce-Martin, Jennine; True, Gala; Johnson, Jerry

    2017-09-01

    Community-based service learning (CBSL) provides an opportunity to teach internal medicine residents the social context of aging and clinical concepts. The objectives of the current study were to demonstrate the feasibility of a CBSL program targeting internal medicine residents and to assess its effect on medical residents and community participants. internal medicine residents participated in a CBSL experience for half a day during ambulatory blocks from 2011 to 2014. Residents attended a senior housing unit or center, delivered a presentation about a geriatric health topic, toured the facility, and received information about local older adult resources. Residents evaluated the experience. Postgraduate Year 3 internal medicine residents (n = 71) delivered 64 sessions. Residents felt that the experience increased their ability to communicate effectively with older adults (mean 3.91 ± 0.73 on a Likert scale with 5 = strongly agree), increased their knowledge of resources (4.09 ± 1.01), expanded their knowledge of a health topic pertinent to aging (3.48 ± 1.09), and contributed to their capacity to evaluate and care for older adults (3.84 ± 0.67). Free-text responses demonstrated that residents thought that this program would change their practice. Of 815 older adults surveyed from 36 discrete teaching sessions, 461 (56%) thought that the medical residents delivered health information clearly (4.55 ± 0.88) and that the health topics were relevant (4.26 ± 0.92). Free-text responses showed that the program helped them understand their health concerns. This CBSL program is a feasible and effective tool for teaching internal medicine residents and older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  7. American College of Occupational and Environmental Medicine (ACOEM): a professional association in service to industry.

    Science.gov (United States)

    LaDou, Joseph; Teitelbaum, Daniel T; Egilman, David S; Frank, Arthur L; Kramer, Sharon N; Huff, James

    2007-01-01

    The American College of Occupational and Environmental Medicine (ACOEM) is a professional association that represents the interests of its company-employed physician members. Fifty years ago the ACOEM began to assert itself in the legislative arena as an advocate of limited regulation and enforcement of occupational health and safety standards and laws, and environmental protection. Today the ACOEM provides a legitimizing professional association for company doctors, and continues to provide a vehicle to advance the agendas of their corporate sponsors. Company doctors in ACOEM recently blocked attempts to have the organization take a stand on global warming. Company doctors employed by the petrochemical industry even blocked the ACOEM from taking a position on particulate air pollution. Industry money and influence pervade every aspect of occupational and environmental medicine. The controlling influence of industry over the ACOEM physicians should cease. The conflict of interests inherent in the practice of occupational and environmental medicine is not resolved by the ineffectual efforts of the ACOEM to establish a pretentious code of conduct. The conflicted interests within the ACOEM have become too deeply embedded to be resolved by merely a self-governing code of conduct. The specialty practice of occupational and environmental medicine has the opportunity and obligation to join the public health movement. If it does, the ACOEM will have no further purpose as it exists, and specialists in occupational and environmental medicine will meet with and be represented by public health associations. This paper chronicles the history of occupational medicine and industry physicians as influenced and even controlled by corporate leaders.

  8. A Proposal for a Mastology Post-Graduate Course for General Medicine Specialists Propuesta de diplomado en Mastología para especialistas en Medicina General Integral

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    Lidia Torres Ajá

    2011-08-01

    Full Text Available Background: Through a research conducted in the province of Cienfuegos the need for updating the general medicine specialists on early diagnosis of breast cancer as part of comprehensive care for women was confirmed. Objective: To design a post-graduate course on Mastology for general medicine specialists. Methods: Educational research conducted in the province of Cienfuegos, addressed to the methodological conception of a post-graduate course on mastology. Pertinence, relevance, characterization and objectives of this course are described, as well as the literature to be used. Results: A post-graduate course for general medicine specialists was designed. It was entitled "Updating of breast diseases” and consists of 3 classes (theoretical updating, breast imaginology tests, and practical training in mastology consultations and operation rooms lasting 284 hours and providing 23 academic credits. Conclusions: The design and implementation of a post-graduate course including content on breast diseases will enable an early diagnosis of breast cancer, thus improving the quality of comprehensive care for womenFundamentación: en investigación realizada en la provincia de Cienfuegos se confirmó la necesidad de actualización del especialista en Medicina General Integral sobre el diagnóstico precoz del cáncer de mama como parte de la atención integral a la mujer. Objetivo: diseñar un diplomado en Mastología dirigido a médicos generales integrales. Métodos: investigación pedagógica realizada en la provincia de Cienfuegos, dirigida a la concepción metodológica de un diplomado sobre mastología. Se describe la fundamentación, pertinencia, caracterización y objetivos del diplomado, así como la bibliografía a utilizar. Resultados: quedó diseñado un diplomado dirigido a médicos generales

  9. Methodological quality and reporting of generalized linear mixed models in clinical medicine (2000-2012: a systematic review.

    Directory of Open Access Journals (Sweden)

    Martí Casals

    Full Text Available BACKGROUND: Modeling count and binary data collected in hierarchical designs have increased the use of Generalized Linear Mixed Models (GLMMs in medicine. This article presents a systematic review of the application and quality of results and information reported from GLMMs in the field of clinical medicine. METHODS: A search using the Web of Science database was performed for published original articles in medical journals from 2000 to 2012. The search strategy included the topic "generalized linear mixed models","hierarchical generalized linear models", "multilevel generalized linear model" and as a research domain we refined by science technology. Papers reporting methodological considerations without application, and those that were not involved in clinical medicine or written in English were excluded. RESULTS: A total of 443 articles were detected, with an increase over time in the number of articles. In total, 108 articles fit the inclusion criteria. Of these, 54.6% were declared to be longitudinal studies, whereas 58.3% and 26.9% were defined as repeated measurements and multilevel design, respectively. Twenty-two articles belonged to environmental and occupational public health, 10 articles to clinical neurology, 8 to oncology, and 7 to infectious diseases and pediatrics. The distribution of the response variable was reported in 88% of the articles, predominantly Binomial (n = 64 or Poisson (n = 22. Most of the useful information about GLMMs was not reported in most cases. Variance estimates of random effects were described in only 8 articles (9.2%. The model validation, the method of covariate selection and the method of goodness of fit were only reported in 8.0%, 36.8% and 14.9% of the articles, respectively. CONCLUSIONS: During recent years, the use of GLMMs in medical literature has increased to take into account the correlation of data when modeling qualitative data or counts. According to the current recommendations, the

  10. Educational impact of using smartphones for clinical communication on general medicine: more global, less local.

    Science.gov (United States)

    Wu, Robert C; Tzanetos, Katina; Morra, Dante; Quan, Sherman; Lo, Vivian; Wong, Brian M

    2013-07-01

    Medical trainees increasingly use smartphones in their clinical work. Similar to other information technology implementations, smartphone use can result in unintended consequences. This study aimed to examine the impact of smartphone use for clinical communication on medical trainees' educational experiences. Qualitative research methodology using interview data, ethnographic data, and analysis of e-mail messages. We analyzed the interview transcripts, ethnographic data, and e-mails by applying a conceptual framework consisting of 5 educational domains. Smartphone use increased connectedness and resulted in a high level of interruptions. These 2 factors impacted 3 discrete educational domains: supervision, teaching, and professionalism. Smartphone use increased connectedness to supervisors and may improve supervision, making it easier for supervisors to take over but can limit autonomy by reducing learner decision making. Teaching activities may be easier to coordinate, but smartphone use interrupted learners and reduced teaching effectiveness during these sessions. Finally, there may be professionalism issues in relation to how residents use smartphones during encounters with patients and health professionals and in teaching sessions. We summarized the impact of a rapidly emerging information technology-smartphones-on the educational experience of medical trainees. Smartphone use increase connectedness and allow trainees to be more globally available for patient care but creates interruptions that cause trainees to be less present in their local interactions with staff during teaching sessions. Educators should be aware of these findings and need to develop curriculum to address the negative impacts of smartphone use in the clinical training environment. © 2013 Society of Hospital Medicine.

  11. Traditional Chinese medicine in the treatment of rheumatoid arthritis: a general review.

    Science.gov (United States)

    Zhang, Peng; Li, Jun; Han, Yong; Yu, Xiao Wei; Qin, Ling

    2010-04-01

    Rheumatoid arthritis (RA) is difficult to cure. Many methods have been used for its treatment, among which traditional Chinese medicine (TCM) has been considered as an important strategy. All of the three parts of TCM: Chinese herbs, acupuncture, and massage have been reported with varying degrees of therapeutic effects on RA. Also the mechanism exploration is under process. Many effective ingredients of anti-rheumatic Chinese herbs have been found to inhibit RA development and some of the effective ingredients have been verified. Furthermore, greatly enhanced life quality of RA patients was obtained using acupuncture and massage to relieve pain, expand joint motion and modulate emotion which mainly correlated with the possible modulation of immune system, nerve system, endocrine system, etc. Thus, a systemic review on the therapeutic effect of TCM on RA is necessary. In our paper, the current status of TCM application in the clinic for the therapy of RA was summarized accompanied with the related mechanism exploration using modern test facilities.

  12. Partnerships in Medical Education: An Exploration of Library Service Models for Postgraduate Medicine at Macquarie University

    Science.gov (United States)

    Simons, Mary

    2008-01-01

    Macquarie University's new medical school, The Australian School of Advanced Medicine (ASAM), is developing a postgraduate program that incorporates a partnership with Macquarie University Library. The curriculum encompasses contemporary models of competency-based assessment, teamwork and lifelong learning that are integrated with research and…

  13. [Unfavorable outcome of medical service: study of the problem in forensic medicine].

    Science.gov (United States)

    Erofeev, S V; Novoselov, V P

    2008-01-01

    The main tendencies in the development and study of the problem of unfavorable outcome and expert assessment of quality of medical aid were examined. Russian and foreign forensic medicine and juristic practice were compared. A combined approach to improve of forensic medical expertise and to prevent delinquencies of medical stuff was proposed.

  14. Monetary Value of a Prescription Assistance Program Service in a Rural Family Medicine Clinic

    Science.gov (United States)

    Whitley, Heather P.

    2011-01-01

    Purpose: To quantify the monetary value of medications provided to rural Alabamians through provision of pharmaceutical manufacturer-sponsored prescription assistance programs (PAPs) provided by a clinical pharmacist in a private Black Belt family medicine clinic during 2007 and 2008. Methods: Patients struggling to afford prescription medications…

  15. [Mental Health in General Family Medicine - obstacles and expectations perceived by Family Physicians].

    Science.gov (United States)

    Fernandes, Liliana; Basílio, Nuno; Figueira, Sofia; Nunes, José Mendes

    2017-03-01

    This study seeks to understand the difficulties experienced by family physicians (FP) in the management of mental disorders (MD) and their proposals to improve the quality of care. It is qualitative study with semi-structured interviews with ten family physicians. These were recorded, transcribed and their content analyzed. Eight thematic categories were identified: perceived working conditions and available resources; perceived level of training in mental health; therapies used for treatment of MD; mental health instruments used in consultation; MD addressed in Primary Health Care (PHC) and referral to hospitals; patient's reaction to referral; articulation of PHC with hospitals; proposals to improve mental health care in PHC. Articulation with the Mental Health Services suffers from lack of accessibility, one-way communication and delayed response. The FP propose creation of consultancies; multidisciplinary teams in the community; creating a two-way communication platform; continuous learning through discussion of cases. The FP have responsibilities in providing MHC. This requires working in a multidisciplinary team. Services should be organized to function as a learning system that allows the progressive improvement of the professionals and the improvement of the interfaces between them.

  16. A national comparison of burnout and work-life balance among internal medicine hospitalists and outpatient general internists.

    Science.gov (United States)

    Roberts, Daniel L; Shanafelt, Tait D; Dyrbye, Liselotte N; West, Colin P

    2014-03-01

    General internists suffer higher rates of burnout and lower satisfaction with work-life balance than most specialties, but the impact of inpatient vs outpatient practice location is unclear. Physicians in the American Medical Association Physician Masterfile were previously surveyed about burnout, depression, suicidal ideation, quality of life, fatigue, work-life balance, career plans, and health behaviors. We extracted and compared data for these variables for the 130 internal medicine hospitalists and 448 outpatient general internists who participated. Analyses were adjusted for age, sex, hours worked, and practice setting. There were 52.3% of the hospitalists and 54.5% of the outpatient internists affected by burnout (P = 0.86). High scores on the emotional exhaustion subscale (43.8% vs 48.1%, P = 0.71) and on the depersonalization subscale (42.3% vs 32.7%, P = 0.17) were common but similar in frequency in the 2 groups. Hospitalists were more likely to score low on the personal accomplishment subscale (20.3% vs 9.6%, P = 0.04). There were no differences in symptoms of depression (40.3% for hospitalists vs 40.0% for outpatient internists, P = 0.73) or recent suicidality (9.2% vs 5.8%, P = 0.15). Rates of reported recent work-home conflict were similar (48.4% vs 41.3%, P = 0.64), but hospitalists were more likely to agree that their work schedule leaves enough time for their personal life and family (50.0% vs 42.0%, P = 0.007). Burnout was common among both hospitalists and outpatient general internists, although hospitalists were more satisfied with work-life balance. A better understanding of the causes of distress and identification of solutions for all internists is needed. © 2014 Society of Hospital Medicine.

  17. Access to general health care services by a New Zealand population with serious mental illness.

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    Wheeler A

    2014-03-01

    Full Text Available INTRODUCTION: Literature suggests that good quality health care access can have a positive impact on the health of people with serious mental illness (SMI, but literature relating to patterns of access by this group is equivocal. AIM: This study was designed to explore health care access patterns in a group of people with SMI and to compare them with a general New Zealand population group, in order for health providers to understand how they might contribute to positive health outcomes for this group. METHODS: The study surveyed 404 mental health consumers aged 18-65 years receiving care from one district health board in Auckland about their patterns of health care access. Results were compared with those from the New Zealand Health Survey of the general population. RESULTS: Findings suggest that the SMI consumer respondents had poorer physical health than the general population respondents, accessed health care services in more complex ways and were more particular about who they accessed for their care than the general population respondents. There was some concern from SMI consumers around discrimination from health care providers. The study also suggested that some proactive management with SMI consumers for conditions such as metabolic syndrome was occurring within the health care community. DISCUSSION: The first point of access for SMI consumers with general health problems is not always the family general practitioner and so other health professionals may sometimes need to consider the mental and physical health of such consumers in a wider context than their own specialism.

  18. A Retrospective Analysis of 5,195 Patient Treatment Sessions in an Integrative Veterinary Medicine Service: Patient Characteristics, Presenting Complaints, and Therapeutic Interventions

    Directory of Open Access Journals (Sweden)

    Justin Shmalberg

    2015-01-01

    Full Text Available Integrative veterinary medicine, the combination of complementary and alternative therapies with conventional care, is increasingly prevalent in veterinary practice and a focus of clinical instruction in many academic teaching institutions. However, the presenting complaints, therapeutic modalities, and patient population in an integrative medicine service have not been described. A retrospective analysis of 5,195 integrative patient treatment sessions in a veterinary academic teaching hospital demonstrated that patients most commonly received a combination of therapeutic modalities (39% of all treatment sessions. The 274 patients receiving multiple modalities were most frequently treated for neurologic and orthopedic disease (50.7% versus 49.6% of all presenting complaints, resp.. Older neutered or spayed dogs (mean age = 9.0 years and Dachshunds were treated more often than expected based on general population statistics. Acupuncture, laser therapy, electroacupuncture, and hydrotherapy were frequently administered (>50% patients. Neurologic patients were more likely to receive acupuncture, electroacupuncture, and therapeutic exercises but less likely than orthopedic patients to receive laser, hydrotherapy, or therapeutic ultrasound treatments (P<0.05. The results suggest that the application of these specific modalities to orthopedic and neurologic diseases should be subjected to increased evidence-based investigations. A review of current knowledge in core areas is presented.

  19. Factors associated with nonattendance at clinical medicine scheduled outpatient appointments in a university general hospital

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    Giunta D

    2013-11-01

    Full Text Available Diego Giunta,1,2 Agustina Briatore,3 Analía Baum,3 Daniel Luna,3 Gabriel Waisman,2 Fernán Gonzalez Bernaldo de Quiros1–31Internal Medicine Research Unit, 2Internal Medicine Department, 3Health Informatics Department, Hospital Italiano de Buenos Aires, Buenos Aires, ArgentinaIntroduction: Nonattendance at scheduled outpatient appointments for primary care is a major health care problem worldwide. Our aim was to estimate the prevalence of nonattendance at scheduled appointments for outpatients seeking primary care, to identify associated factors and build a model that predicts nonattendance at scheduled appointments.Methods: A cohort study of adult patients, who had a scheduled outpatient appointment for primary care, was conducted between January 2010 and July 2011, at the Italian Hospital of Buenos Aires. We evaluated the history and characteristics of these patients, and their scheduling and attendance at appointments. Patients were divided into two groups: those who attended their scheduled appointments, and those who did not. We estimated the odds ratios (OR and corresponding 95% confidence intervals (95% CI, and generated a predictive model for nonattendance, with logistic regression, using factors associated with lack of attendance, and those considered clinically relevant. Alternative models were compared using Akaike's Information Criterion. A generation cohort and a validation cohort were assigned randomly.Results: Of 113,716 appointments included in the study, 25,687 were missed (22.7%; 95% CI: 22.34%–22.83%. We found a statistically significant association between nonattendance and age (OR: 0.99; 95% CI: 0.99–0.99, number of issues in the personal health record (OR: 0.98; 95% CI: 0.98–0.99, time between the request for and date of appointment (OR: 1; 95% CI: 1–1, history of nonattendance (OR: 1.07; 95% CI: 1.07–1.07, appointment scheduled later than 4 pm (OR: 1.30; 95% CI: 1.24–1.35, and specific days of the week (OR: 1

  20. Brigadier General Theodore C Lyster [correction of Lister], MD: father of American aviation medicine.

    Science.gov (United States)

    Barrios, J; O'Leary, J P

    2000-07-01

    Aviation medicine came into existence as a recognized entity when certain standards were established during and shortly after World War I. During this time, accident rates were high. In fact, a larger number of pilots were dying in accidents than in combat. Figures from Great Britain's casualty list at the close of the first year of World War I indicated that for every 100 aviators killed, 60 died as a result of some individual physical defect, 30 from some form of recklessness or careless behavior, 8 as a result of some mechanical defect in the airplane, and only 2 at the hands of the enemy. Aviators were found to be in poor physical condition. Because there were no established regulations with regard to workloads, aviators were frequently found to have been flying to a point beyond exhaustion. Because of workload, chronic fatigue, and emotional stress, aviators were constantly called upon to perform superhuman feats when not in peak physical condition. Errors in judgement were common. The majority of pilots lost weight as a somatic sign of stress. This was recognized by Theodore Lyster [corrected] who had recently been appointed as the Chief Surgeon, Aviation Section of the U.S. Army. Such problems were not diagnosed by medical officers because they were not trained to recognize them. Theodore Charles Lyster [corrected] was the son of Captain William J. and Martha Doughty Lyster [corrected]. He was an Army "brat" who entered the world on July 10, 1875. His childhood was spent in various posts around the country. At the age of 7, Lyster [corrected] contracted yellow fever while living in Fort Brown, TX. The boy was treated by William Gorgas, a young post surgeon. Gorgas was credited with the young boy's recovery. Later, Gorgas was to marry Lyster's [corrected] aunt making Lyster [corrected] his nephew by marriage. Having survived the yellow fever infection, young Lyster [corrected] had a lifelong immunity to the disease.

  1. [Multidimensional diagnosis in general medicine. Comparative study of the use of various instruments].

    Science.gov (United States)

    Becchi, M A; Franzelli, A; Moscardelli, S; De Pieri, P; Zeni, L; Paccagnella, B

    1994-10-01

    This study was performed to test three instruments for functional status assessment in General Practice: the Dartmouth Coop Charts (COOP Charts), the Functional Status Questionnaire (FSQ) and the Duke University Health Profile (DUHP). All the instruments covered a score of functional aspects in physical, mental and social areas, providing a multidimensional measure of health status. We used these three instruments, validated by international studies, to acquire information concerning their feasibility and acceptability among patients from rural communities needing primary care and to test their validity in differentiating between patient subgroups. The COOP Charts, the FSQ and the DUHP were administered by physicians respectively to 98, 100 and 97 patients, waiting for a visit in the ambulatories of their General Practitioner. Answers relating to each instrument were analyzed according to sex, age and education of patients. All the instruments seemed to be feasible and acceptable, but only the COOP Charts and the FSQ were able to discriminate between different sex, age and scolarity groups. Taking into account the need to elaborate answers according to a formula when using the FSQ, we concluded that the best instrument for General Practice to provide a multidimensional measure of health status seems to be the COOP Charts.

  2. The in-service examination score as a predictor of success on the American Board of Preventive Medicine certification examination.

    Science.gov (United States)

    Bedno, Sheryl A; Soltis, Michele A; Mancuso, James D; Burnett, Daniel G; Mallon, Timothy M

    2011-12-01

    To date, there has been no study correlating the American College of Preventive Medicine (ACPM) in-service exam (ISE) with the American Board of Preventive Medicine (ABPM) certification exam. To validate the ACPM ISE as a predictor of success on the ABPM certification exam. ISE and ABPM certification exam scores were standardized by year using z-scores. The correlation between practicum year ISE scores and certification exam scores for military preventive medicine residencies in the National Capital and Washington State areas (core component only) was analyzed. A multivariable linear regression model included adjustments for age, gender, Master of Public Health grade point average (GPA), prior specialty board certification, and board deferral ≥1 year after graduation. Data were collected in 2010 and analyzed in 2011. Performance on the ISE was correlated with performance on the ABPM certification core exam (r=0.61, pPerformance on the ISE was still significant after adjusting for relevant demographic and educational variables (pGPA (p=0.001) and board deferral (p=0.04) in the linear regression model. Performance on the ISE is moderately correlated with performance on the board certification core exam, and this correlation remained significant after adjustment in the linear regression model. These results serve to validate the ISE as a means for program directors to identify residents at academic risk and as encouragement for residents to take the certification exam as soon as possible after graduation. Published by Elsevier Inc.

  3. Integrating Traditional Chinese Medicine Services in Community Health Centers: Insights into Utilization Patterns in the Pearl River Region of China

    Directory of Open Access Journals (Sweden)

    Vincent C. H. Chung

    2013-01-01

    Full Text Available In China's healthcare reform, community health centers (CHCs are designed to take a pivotal role in providing primary care. Whilst about 20% of all outpatient care in China is delivered by the traditional Chinese medicine (TCM sector, hospitals, instead of CHCs, are major providers. Using current patterns of patient utilization this study aims to inform CHCs on how they may strengthen access to TCM services. Three thousand three hundred and sixty CHC patients from six cities within the urban Pearl Delta Region were enumerated using multistage cluster sampling. Fifty-two percent had visited herbalists within three months with a mean visit frequency of 1.50 times. Herbal treatments, which are cheaper than western medicines, were more popular amongst those who needed to pay out of pocket including the uninsured. Herbal medicines appeared to be an alternative for those who are underinsured. Acupuncturists and massage therapists were visited by smaller proportions, 6.58% and 5.98%, respectively, with a mean three-month visit of 0.27 and 0.26 times. Access was restricted by lack of social insurance coverage. Whilst increasing provision of TCM in CHCs might respond to patient demand, increasing insurance coverage for TCM needs to be evaluated using current evidence on safety and effectiveness.

  4. The paradox of non-evidence based, publicly funded complementary alternative medicine in the English National Health Service: An explanation.

    Science.gov (United States)

    Sheppard, Maria K

    2015-10-01

    Despite the unproven effectiveness of many practices that are under the umbrella term 'complementary alternative medicine' (CAM), there is provision of CAM within the English National Health Service (NHS). Moreover, although the National Institute for Health and Care Excellence was established to promote scientifically validated medicine in the NHS, the paradox of publicly funded, non-evidence based CAM can be explained as linked with government policy of patient choice and specifically patient treatment choice. Patient choice is useful in the political and policy discourse as it is open to different interpretations and can be justified by policy-makers who rely on the traditional NHS values of equity and universality. Treatment choice finds expression in the policy of personalised healthcare linked with patient responsibilisation which finds resonance in the emphasis CAM places on self-care and self-management. More importantly, however, policy-makers also use patient choice and treatment choice as a policy initiative with the objective of encouraging destabilisation of the entrenched healthcare institutions and practices considered resistant to change. This political strategy of system reform has the unintended, paradoxical consequence of allowing for the emergence of non-evidence based, publicly funded CAM in the NHS. The political and policy discourse of patient choice thus trumps evidence based medicine, with patients that demand access to CAM becoming the unwitting beneficiaries.

  5. Statistical identification of syndromes feature and structure of disease of western medicine based on general latent structure model.

    Science.gov (United States)

    Yang, Wei; Yi, Dan-Hui; Xie, Yan-Ming; Tian, Feng

    2012-11-01

    Syndrome differentiation is the character of Chinese medicine (CM). Disease differentiation is the principle of Western medicine (WM). Identifying basic syndromes feature and structure of disease of WM is an important avenue for prevention and treatment of integrated Chinese and Western medicine. The idea here is first to divide all patients suffering from a disease of WM into several groups in the light of the stage of the disease, and secondly to identify basic syndromes feature in a distinct stage, and finally to achieve the purpose of syndrome differentiation. Syndrome differentiation is simply taken as a classifier that classifies patients into distinct classes primarily based on overall observation of their symptoms. Previous clustering methods are unable to cope with the complexity of CM. We therefore show a new multi-dimensional clustering method in the form of general latent structure (GLS) model, which is a suitable statistical learning technique of latent class analysis. In this paper, we learn an optimal GLS model which reflects much better model quality compared with other latent class models from the osteoporosis patient of community women (OPCW) real data including 40-65 year-old women whose bone mineral density (BMD) is less than mean-2.0 standard deviation (M-2.0SD). Further, we illustrate a case analysis of statistical identification of CM syndromes feature and structure of OPCW from qualitative and quantitative contents through the GLS model. Our analysis has discovered natural clusters and structures that correspond well to CM basic syndrome and factors of osteoporosis patients (OP). The GLS model suggests the possibility of establishing objective and quantitative diagnosis standards for syndrome differentiation on OPCW. Hence, for the future it can provide a reference for the similar study from the perspective of a combination of disease differentiation and syndrome differentiation.

  6. Keep in a cool place: exposure of medicines to high temperatures in general practice during a British heatwave.

    Science.gov (United States)

    Crichton, Brian

    2004-07-01

    Exposure of medicines to high temperatures in storage or in transit could reduce their efficacy, and most licences specify storage at 25 degrees C or less. To assess whether this criterion was being met, maximum temperatures in a general practice drug cupboard and in drug bags placed in car boots were recorded for two weeks during a British heatwave (average peak daily ambient temperature 26 degrees C). Also, ten neighbouring dispensing pharmacies were questioned about their temperature-control policies. On every day of the study, maximum temperatures in the drug cupboard and in the car boots exceeded 25 degrees C. Mean daily maxima (range) were: drug cupboard 30.7 (27.5-37.0); silver car 37.5 (32.0-43.5); dark blue car 41.8 (35.0-49.5). None of the local dispensaries had air conditioning or kept a temperature log. In the course of a British summer, medicines were exposed to temperatures that might in theory have reduced their efficacy. This aspect of quality control deserves more attention.

  7. The Number Served in a Head Of The Line Priority Queue with General Service

    Directory of Open Access Journals (Sweden)

    K.N. Gaur

    1977-04-01

    Full Text Available In this paper, using the supplementary variable method, the head-of-the-line priority queueing system with general service time distributions have been studied to obtain an expression for the Laplace transform of the generating function of the joint probability distribution of the number of priority and non-priority units in the queue at time t, and the number of units served (including non-priority units in time t. In particular cases, explicit solution for the model with exponential service time distributions have been obtained; expression for the joint distribution of the queue length and the number served in time t, for an M/G/1 queue has also been derived.

  8. The effectiveness of cognitive behavioral therapy for generalized anxiety disorder in a frontline service setting.

    Science.gov (United States)

    Kehle, Shannon M

    2008-01-01

    The goal of the current study was to test the generalizability of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) in a frontline service setting. Twenty-nine patients who presented to treatment clinics with problematic worry were provided CBT for GAD. Among the intent-to-treat sample, there were no significant changes in worry or depression from pre- to posttreatment. Treatment completers showed significant pre- to posttreatment reductions on measures of worry and depression. The magnitude of change was smaller than has been reported in randomized control trials (RCTs). Although the frontline service setting differed from RCT settings in multiple ways, treatment completers nonetheless achieved moderate to large decreases in self-reported worry and depression.

  9. High quality care and ethical pay-for-performance: a Society of General Internal Medicine policy analysis.

    Science.gov (United States)

    Wharam, J Frank; Paasche-Orlow, Michael K; Farber, Neil J; Sinsky, Christine; Rucker, Lisa; Rask, Kimberly J; Figaro, M Kathleen; Braddock, Clarence; Barry, Michael J; Sulmasy, Daniel P

    2009-07-01

    Pay-for-performance is proliferating, yet its impact on key stakeholders remains uncertain. The Society of General Internal Medicine systematically evaluated ethical issues raised by performance-based physician compensation. We conclude that current arrangements are based on fundamentally acceptable ethical principles, but are guided by an incomplete understanding of health-care quality. Furthermore, their implementation without evidence of safety and efficacy is ethically precarious because of potential risks to stakeholders, especially vulnerable patients. We propose four major strategies to transition from risky pay-for-performance systems to ethical performance-based physician compensation and high quality care. These include implementing safeguards within current pay-for-performance systems, reaching consensus regarding the obligations of key stakeholders in improving health-care quality, developing valid and comprehensive measures of health-care quality, and utilizing a cautious evaluative approach in creating the next generation of compensation systems that reward genuine quality.

  10. The Effect of Learning Style Preferences on Pre-Service Teachers' Performance in General Chemistry Laboratory Course

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    Evrim Ural ALŞAN

    2009-06-01

    Full Text Available In the present study, the effect of learning style preferences on freshmen physics, chemistry and biology pre service teachers’ performances in general chemistry laboratory course was investigated. Grasha-Riechman Learning Style Inventory was administered to the pre-service teachers to determine their learning styles. Pre service teachers’ performances were determined by evaluating their experiment reports, midterm exams and final exam. One-Way ANOVA was conducted to determine whether pre-service teachers’ performances differ according to their learning styles in general chemistry laboratory course. The findings displayed that pre-service teachers’ learning styles affected their performances in general chemistry laboratory course. In this study, it was found that pre-service teachers who had “avoidant” learning style preference exhibited the lowest performances, while those who had “independent” and “independent/competitive” learning style preferences showed the highest performances.

  11. 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.

  12. Age, chronic non-communicable disease and choice of traditional Chinese and western medicine outpatient services in a Chinese population

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    Yeoh Eng

    2009-11-01

    Full Text Available Abstract Background In 1997 Hong Kong reunified with China and the development of traditional Chinese medicine (TCM started with this change in national identity. However, the two latest discussion papers on Hong Kong's healthcare reform have failed to mention the role of TCM in primary healthcare, despite TCM's public popularity and its potential in tackling the chronic non-communicable disease (NCD challenge in the ageing population. This study aims to describe the interrelationship between age, non-communicable disease (NCD status, and the choice of TCM and western medicine (WM services in the Hong Kong population. Methods This study is a secondary analysis of the Thematic Household Survey (THS 2005 dataset. The THS is a Hong Kong population representative face to face survey was conducted by the Hong Kong Administrative Region Government of China. A random sample of respondents aged >15 years were invited to report their use of TCM and WM in the past year, together with other health and demographic information. A total of 33,263 persons were interviewed (response rate 79.2%. Results Amongst those who received outpatient services in the past year (n = 18,087, 80.23% only visited WM doctors, 3.17% consulted TCM practitioners solely, and 16.60% used both type of services (double consulters. Compared to those who only consulted WM doctor, multinomial logistic regression showed that double consulters were more likely to be older, female, NCD patients, and have higher socioeconomic backgrounds. Further analysis showed that the association between age and double consulting was curvilinear (inverted U shaped regardless of NCD status. Middle aged (45-60 years NCD patients, and the NCD free "young old" group (60-75 years were most likely to double consult. On the other hand, the relationship between age and use of TCM as an alternative to WM was linear regardless of NCD status. The NCD free segment of the population was more inclined to use TCM alone

  13. 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.

  14. Burnout, empathy and their relationships: a qualitative study with residents in General Medicine.

    Science.gov (United States)

    Picard, Jeanne; Catu-Pinault, Annie; Boujut, Emilie; Botella, Marion; Jaury, Philippe; Zenasni, Franck

    2016-01-01

    Some studies have shown that burnout may have a negative impact on clinical empathy during internship. However, clinical empathy may also be a protective factor, preventing residents from experiencing burnout. Although several quantitative studies have been conducted to examine these relationships between burnout and empathy, no qualitative studies have been carried out. To examine how residents in general practice evaluate the link between burnout and empathy, 24 of them participated in a semi-structured interview. A thematic analysis was carried out to examine residents' discourses and answers to closed questions. The results indicated that residents thought that empathy and burnout were clearly related in different ways. They identified five types of relationship: regulation strategy, empathy as protection, psychological balance/imbalance, fatigue and moderating factors.

  15. Dendrimers: General Aspects, Applications and Structural Exploitations as Prodrug/ Drug-delivery Vehicles in Current Medicine.

    Science.gov (United States)

    Mariyam, Merina; Ghosal, Kajal; George, Anne; Thomas, Sabu; Kalarikkal, Nandakumar; S Latha, Mahima

    2017-05-11

    Dendrimers are hyper branched macro molecules with well-defined structure and high degree of functionality on the surface. The dendrimer architecture allows control over properties such as shape, size, density, polarity, reactivity, solubility etc. This can be manipulated to design molecules with desired properties in biomedical applications. Recent advancement in correlating structure to biodegradability and invivo performance opens up new avenue for these molecules in biological applications like drug delivery and tissue engineering. The unique structure of dendrimers provides enough attachment sites for drugs in drug delivery applications. It is possible to tune the molecule in such a way as to encapsulate drug molecule outside target area and release in the local environment of targets. This review presents the general aspects of dendrimers and how these properties are exploited for drug delivery applications. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  16. General consumer communication tools for improved image management and communication in medicine

    Science.gov (United States)

    Ratib, Osman M.; Rosset, Antoine; McCoy, J. Michael

    2005-04-01

    We elected to explore emerging consumer technologies that can be adopted to improve and facilitate image and data communication in medical and clinical environment. The wide adoption of new communication paradigm such as instant messaging, chatting and direct emailing can be integrated in specific applications. The increasing capacity of portable and hand held devices such as iPod music players offer an attractive alternative for data storage that exceeds the capabilities of traditional offline storage media such as CD or even DVD. We adapted medical image display and manipulation software called OSIRIX to integrate different innovative technologies facilitating the communication and data transfer between remote users. We integrated email and instant messaging features to the program allowing users to instantaneously email an image or a set of images that are displayed on the screen. Using iChat instant messaging application from Apple a user can share the content of his screen with a remote correspondent and communicate in real time using voice and video. To provide convenient mechanism for exchange of large data sets the program can store the data in DICOM format on CD or DVD, but was also extended to use the large storage capacity of iPod hard disks as well as Apple"s online storage service "dot Mac" that users can subscribe to benefit from scalable secure storage that accessible from anywhere on the internet. The adoption of these innovative technologies is likely to change the architecture of traditional picture archiving and communication systems and provide more flexible and efficient means of communication.

  17. The value of a multi-specialty service, including genitourinary medicine, dermatology and urology input, in the management of male genital dermatoses.

    Science.gov (United States)

    Pearce, J; Fernando, I

    2015-09-01

    We undertook a retrospective case note review of our monthly multi-specialty penile dermatoses clinic (which includes clinicians from Genitourinary medicine, Dermatology and Urology), to examine conditions presenting to the service, and compare clinical management and outcomes with other similar services in the UK. Over the 3-year study period, 226 patients were reviewed over 240 individual episodes. Lichenoid conditions were the most common category of genital pathologies seen (n = 60, 24%), but non-specific balanitis was the most common individual diagnosis (n = 55, 22%). Other common conditions seen included eczema and psoriasis (n = 28, 11%), Zoon/plasma cell balanitis (n = 26, 10%), malignancy/pre-malignant change (n = 25, 10%) and infective conditions (n = 24, 9%). The clinic had a biopsy rate of 10%; the most common indication was for confirmation of a clinical suspicion of malignancy/pre-malignancy. There was a high clinical-to-histological correlation in the biopsies of 79%. The most common treatment prescribed was topical corticosteroids and the clinic had a high discharge rate of 93%, the majority of patients discharged back to General Practice.

  18. [Effect of reproductive health services restructuring on antenatal care at Marcory General Hospital, Ivory Coast].

    Science.gov (United States)

    Benie Bi, Joseph Vroh; Tiembre, Issaka; Ahoussou, Éric Martial; Tchiny, Koutoua; Dagnan, N Cho Simplice; Tagliante-Saracino, Janine

    2015-01-01

    Improvement of the work environment and staff training are health promotion strategies that can contribute to improving the supply of health care. This study evaluated the effects of reorganization of health services on antenatal care (ANC) activities. A cross-sectional study was conducted over a period of 4 months in the ANC unit of Marcory General Hospital in Abidjan. The study population was health workers in charge of ANC and pregnant women attending the health facility. Self-administered questionnaires and observation sheets were used to collect data that were analysed with Epi Info 3.5.1 software. results: After reorganization, health workers said they were satisfied with the work environment and the care provided in 91% and 96.9% of cases, respectively. These results were confirmed by all pregnant respondents (100%) attending the centre, who said they were satisfied with the quality of care received. This could explain the ANC 4 coverage rate, which increased from 39.4% in 2010 to 56.7% in 2012 and tetanus vaccination coverage which increased from 59.4% to 87.5%, although the waiting time was still too long. This study showed an increase of ANC activity indicators, such as ANC 4 and tetanus vaccination coverage rate, after reorganization of health care services. This strategy could be an opportunity to strengthen ANC services.

  19. Doubly Exponential Solution for Randomized Load Balancing Models with General Service Times

    CERN Document Server

    Li, Quan-Lin

    2010-01-01

    In this paper, we provide a novel and simple approach to study the supermarket model with general service times. This approach is based on the supplementary variable method used in analyzing stochastic models extensively. We organize an infinite-size system of integral-differential equations by means of the density dependent jump Markov process, and obtain a close-form solution: doubly exponential structure, for the fixed point satisfying the system of nonlinear equations, which is always a key in the study of supermarket models. The fixed point is decomposited into two groups of information under a product form: the arrival information and the service information. based on this, we indicate two important observations: the fixed point for the supermarket model is different from the tail of stationary queue length distribution for the ordinary M/G/1 queue, and the doubly exponential solution to the fixed point can extensively exist even if the service time distribution is heavy-tailed. Furthermore, we analyze ...

  20. Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service

    Directory of Open Access Journals (Sweden)

    Savanheimo Nora

    2012-10-01

    Full Text Available Abstract Background Dental general anaesthesia (DGA is a very efficient treatment modality, but is considered only in the last resort because of the risks posed by general anaesthesia to patients’ overall health. Health services and their treatment policies regarding DGA vary from country to country. The aims of this work were to determine the reasons for DGA in the Helsinki Public Dental Service (PDS and to assess the role of patient characteristics in the variation in reasons and in the treatments given with special focus on preventive care. Methods The data covered all DGA patients treated in the PDS in Helsinki in 2010. The data were collected from patient documents and included personal background: age ( Results The DGA patients (n=349 were aged 2.3 to 67.2 years. Immigrants predominated in the youngest age group (p Conclusions Extreme non-cooperation, dental fear and an excessive need for treatment were the main reasons for the use of comprehensive, conservative DGA in the Helsinki PDS. The reasons for the use of DGA and the treatments provided varied according to personal and medical background, and immigration status with no gender-differences. Preventive measures formed only a minor part of the dental care given under DGA.

  1. Musculoskeletal (MSK) and Sport and Exercise Medicine (SEM) in General Practice (GP): A Novel GP-based MSK and SEM Clinic for Managing Musculoskeletal symptoms in a GP.

    Science.gov (United States)

    Heron, Neil

    2015-01-01

    Musculoskeletal (MSK) complaints are common within primary care (1) (2) (3) but some General Practitioners (GPs)/family physicians do not feel comfortable managing these symptoms (3), preferring to refer onto hospital specialists or Integrated Clinical Assessment and Treatment Services (ICATs). Long waiting times for hospital outpatient reviews are a major cause of patient inconvenience and complaints (4). We therefore aimed to establish a GP-ran MSK and sport and exercise medicine (SEM) clinic based within a Belfast GP surgery that would contribute to a sustainable improvement in managing these common conditions within primary care as well as reducing waiting times for patients with these conditions to see a specialist. This shift from hospital-based to community-based management is in-keeping with recent policy changes within the UK health-system, including Transforming Your Care within Northern Ireland (NI) (5). The GP-ran MSK and SEM clinic was held monthly within a Belfast GP practice, staffed by one GP with a specialist interest in MSK and SEM conditions and its performance was reviewed over a three month period. Parameters audited included cases seen, orthopaedic and x-ray referral rates and secondary care referrals comparing the GP practice's performance to the same time period in the previous year as well as patient satisfaction questionnaires.

  2. Patient empowerment and control: a psychological discourse in the service of medicine.

    Science.gov (United States)

    Salmon, Peter; Hall, George M

    2003-11-01

    The discourse of the patient as an active agent in managing illness and health care has become very important in medicine. It is seen in the significance attached to patient empowerment and participation, and in the burgeoning research into patients' coping with illness. The discourse cannot be fully understood from within conventional scientific frameworks because it is part of those frameworks. Instead, its current prominence can be understood by examining how it meets the needs of those who use it. Specifically, it has combined with earlier discourses of disease in a way that allows clinicians to withdraw from responsibility for areas of patient need that are problematic for medicine, such as unexplained symptoms, chronic disease and pain. This view is supported by evidence about how the discourse of patient as agent has been used in clinical consultation to constrain doctors' responsibility for patients' suffering. This discourse and other ways in which doctors and patients influence the boundaries of medical responsibility should be subjects for, rather than constraints on, empirical research.

  3. Diagnosis and treatment of acute pharyngitis/tonsillitis: a preliminary observational study in General Medicine.

    Science.gov (United States)

    Di Muzio, F; Barucco, M; Guerriero, F

    2016-12-01

    According to recent observations, the insufficiently targeted use of antibiotics is creating increasingly resistant bacterial strains. In this context, it seems increasingly clear the need to resort to extreme and prudent rationalization of antibiotic therapy, especially by the physicians working in primary care units. In clinical practice, actually the general practitioner often treats multiple diseases without having the proper equipment. In particular, the use of a dedicated, easy to use diagnostic test would be one more weapon for the correct diagnosis and treatment of acute pharyngo-tonsillitis. The disease is a condition frequently encountered in clinical practice but its optimal management remains a controversial topic. In this context, the observational study is intended to demonstrate the usefulness of the rapid test (RAD: Rapid antigen detection) against group A beta-hemolytic streptococcus (GABHS) in everyday clinical practice to identify individuals with acute streptococcal pharyngo-tonsillitis needing antibiotic therapy and to pursue the following objectives: (1) Getting the answer to an unmet medical need; (2) Promoting the appropriateness of the use of antibiotics; (3) Provide a means of containment in pharmaceutical spending. 50 patients presenting sore throat associated with erythema and/or pharyngeal tonsillar exudate with or without scarlatiniform rash, fever and malaise had been subjected to perform a rapid test (RAD: Rapid antigen detection) for the search of the beta-hemolytic Streptococcus Group A (GABHS). Pharyngeal-tonsillar swabs were tested using Immunospark (relative sensitivity 97.6%, relative specificity 97.5%) according to manufacturer's instructions (runtime/reading response < 10 min). Of the 50 tests, 45 provided a negative response while 5 were positive for the search of the beta-hemolytic Streptococcus group A. No test result has been invalid. Based on the results obtained, only patients with a positive rapid test were subjected

  4. Clinical Observation on General Anxiety Disorder Treated by Acupuncture plus Herbal Medicine

    Institute of Scientific and Technical Information of China (English)

    沈莉; 颜红; 冯辉

    2007-01-01

    To investigate the efficacy of the formula composed of the herbal drugs to soothe the liver, regulate qi, clarify the heart and eliminate vexation plus acupuncture for general anxiety disorder. Methods: Forty cases in the treatment group were treated with acupuncture plus herbal formula and 38 cases in the control group were treated with oral Doxepin. The assessment was conducted by Self-rating Anxiety Scale (SAS) and the Treatment Emergent Symptom Scale (TESS) before, during and after treatment. Results: The total effective rate was respectively 82.50% in the treatment group and 84.21% in the control group, with a significant difference in SAS assessment (P<0.01) between the two groups before and after the treatment.There were no significant differences in the curative and remarkable effective rate, total effective rate and SAS assessment between the two groups (P>0.05), but the side effect was higher in the control group than in the treatment group (P<0.01). Conclusion: Acupuncture plus herbal formula can have a precise effective effect for extensive anxiety neurosis with mild toxic side effects.%目的:观察疏肝理气、清心除烦中药结合针刺治疗广泛性焦虑症的疗效.方法:治疗组用针刺结合中药治疗40例,对照组采用口服多虑平治疗38例,治疗前、中、后均作焦虑自评量表(SAS)、副反应量表(TESS)评定.结果:治疗组与对照组总有效率分别为82.5%和84.2%,两组治疗前后SAS组内比较差异有统计学意义(P<0.01),两组间痊愈显效率、总有效率及SAS评分比较无差异(P>0.05),但副反应对照组显著高于治疗组(P<0.01).结论:针刺结合中药治疗广泛性焦虑症疗效确切,且毒副反应轻微.

  5. Measuring factors that influence the utilisation of preventive care services provided by general practitioners in Australia

    Directory of Open Access Journals (Sweden)

    Oldenburg Brian

    2009-12-01

    Full Text Available Abstract Background Relatively little research attention has been given to the development of standardised and psychometrically sound scales for measuring influences relevant to the utilisation of health services. This study aims to describe the development, validation and internal reliability of some existing and new scales to measure factors that are likely to influence utilisation of preventive care services provided by general practitioners in Australia. Methods Relevant domains of influence were first identified from a literature review and formative research. Items were then generated by using and adapting previously developed scales and published findings from these. The new items and scales were pre-tested and qualitative feedback was obtained from a convenience sample of citizens from the community and a panel of experts. Principal Components Analyses (PCA and internal reliability testing (Cronbach's alpha were then conducted for all of the newly adapted or developed scales utilising data collected from a self-administered mailed survey sent to a randomly selected population-based sample of 381 individuals (response rate 65.6 per cent. Results The PCA identified five scales with acceptable levels of internal consistency were: (1 social support (ten items, alpha 0.86; (2 perceived interpersonal care (five items, alpha 0.87, (3 concerns about availability of health care and accessibility to health care (eight items, alpha 0.80, (4 value of good health (five items, alpha 0.79, and (5 attitudes towards health care (three items, alpha 0.75. Conclusion The five scales are suitable for further development and more widespread use in research aimed at understanding the determinants of preventive health services utilisation among adults in the general population.

  6. [Issues in oncologic radiation physics and the establishing of a nuclear medicine service in Russia].

    Science.gov (United States)

    Kostylev, V A

    1997-01-01

    The creation of a framework of federal and regional medico-physical agencies at key medical, research and educational establishments will help solve many problems of development of oncological radiation physics. The setting-up of a medico-physical service in Russia will be instrumental in providing effective radiation treatment to cancer patients and will prevent huge losses in resources.

  7. 31 CFR 595.513 - In-kind donations of medicine, medical devices, and medical services.

    Science.gov (United States)

    2010-07-01

    ... Health must apply for a specific license from the Office of Foreign Assets Control. ... Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY..., medical devices, and medical services to the Palestinian Authority Ministry of Health, provided that...

  8. 31 CFR 594.515 - In-kind donations of medicine, medical devices, and medical services.

    Science.gov (United States)

    2010-07-01

    ... Health must apply for a specific license from the Office of Foreign Assets Control. ... Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY..., medical devices, and medical services to the Palestinian Authority Ministry of Health, provided that...

  9. Role of general practice in the utilisation of the NSW Get Healthy Information and Coaching Service.

    Science.gov (United States)

    O'Hara, Blythe J; Phongsavan, Philayrath; Rissel, Chris; Hardy, Louise L; Zander, Alexis; Greenaway, Mark; Bauman, Adrian E

    2015-01-01

    A lifestyle-modification telephone-based service is delivered in New South Wales (NSW; the Get Healthy Information and Coaching Service (GHS)) as an important obesity-prevention, population-wide program. The present study examined referrals from general practitioners (GP) versus self-referral to the GHS in terms of risk profile and effectiveness of outcomes. The study used a pre-post test design to assess changes in outcomes within the setting of a telephone-based lifestyle-support service available to NSW adults (18+ years) who self-referred or were referred by their health practitioner and/or GP, and registered for the GHS between February 2009 and August 2013 (n = 22 183). The GHS has two service components: (1) the provision of an information kit (one off contact) on healthy eating, being physically active and achieving and/or maintaining a healthy weight; and (2) a 6-month coaching program that includes 10 telephone calls aimed at achieving and maintaining lifestyle-related goals. Sociodemographic characteristics, referral source and self-reported anthropometric (height, waist and waist circumference (WC)) and behavioural risk factor (physical activity and nutrition-related behaviours) data were collected at baseline and at 6 months. Analysis revealed that GPs effectively recruited hard-to-reach subtargets, as well as adults who are obese and have an increased WC risk. Participants in the GHS coaching program, irrespective of GHS referral source, reported a mean weight loss of -3.8 kg, a decrease in WC of -5.0 cm and increases in both fruit and vegetable consumption and physical activity. In conclusion, GPs have an important role in GHS uptake (through proactive referral or as an adjunct to practice-based interventions) because they can recruit those most at need and facilitate improvements in their patients' risk factor profiles.

  10. Assessment of general public satisfaction with public healthcare services in Kedah, Malaysia.

    Science.gov (United States)

    Hassali, Mohammed Azmi; Alrasheedy, Alian A; Ab Razak, Basyirah Afifah; Al-Tamimi, Saleh Karamah; Saleem, Fahad; Ul Haq, Noman; Aljadhey, Hisham

    2014-01-01

    Patient satisfaction is considered an essential component of healthcare services evaluation and an additional indicator of the quality of healthcare. Moreover, patient satisfaction may also predict health-related behaviours of patients such as adherence to treatment and recommendations. The study aimed to assess patients' level of satisfaction with public healthcare services and to explore the association between socio-demographic and other study variables and patient satisfaction level. A cross-sectional study was conducted using selfadministered questionnaires distributed to a convenience sample of the general public in Kedah, Malaysia. A total of 435 out of 500 people invited to participate in the study agreed to take part, giving a response rate of 87 per cent. In this study, only approximately half of the participants (n=198, 45.5 per cent) were fully satisfied with the current healthcare services. The majority of the participants agreed that doctors had given enough information about their state of health (n=222, 51 per cent) and were competent and sympathetic (n=231, 53.1 per cent). Almost half of the participants (n=215, 49.5 per cent) agreed that the doctors took their problems seriously. Only 174 (40 per cent) participants agreed that doctors had spent enough time on their consultation session. Some respondents (n=266, 61.2 per cent) agreed that healthcare professionals in the public health sector were highly skilled. The majority of the respondents described amenities, accessibility and facilities available in the public healthcare sector as good or better. In this study, waiting time was significantly associated with patient satisfaction as the results showed that those who waited longer than two hours were less satisfied with the services than those who waited under two hours. The study findings showed that approximately half of the respondents were fully satisfied with current healthcare services. In this study, waiting time was the main factor that

  11. Blurring the boundaries between public and private health care services as an alternative explanation for the emergence of black medicine: the Israeli case.

    Science.gov (United States)

    Filc, Dani; Cohen, Nissim

    2015-07-01

    Black medicine represents the most problematic configuration of informal payments for health care. According to the accepted economic explanations, we would not expect to find black medicine in a system with a developed private service. Using Israel as a case study, we suggest an alternative yet a complimentary explanation for the emergence of black medicine in public health care systems - even though citizens do have the formal option to use private channels. We claim that when regulation is weak and political culture is based on 'do it yourself' strategies, which meant to solve immediate problems, blurring the boundaries between public and private health care services may only reduce public trust and in turn, contribute to the emergence of black medicine. We used a combined quantitative and qualitative methodology to support our claim. Statistical analysis of the results suggested that the only variable significantly associated with the use of black medicine was trust in the health care system. The higher the respondents' level of trust in the health care system, the lower the rate of the use of black medicine. Qualitatively, interviewee emphasized the relation between the blurred boundaries between public and private health care and the use of black medicine.

  12. The role of the internal medicine specialist in the management of infective complications in general surgical wards

    Directory of Open Access Journals (Sweden)

    Patrizia Zoboli

    2013-05-01

    Full Text Available BACKGROUND Internal medicine specialists are often asked to evaluate a patient before surgery. Perioperative risk evaluation for elderly patients is important, because complications increase with age. The increasing age of the general population increases the probabilities of surgery in the older patients. The manifestation of a surgical problem, is more likely to be severe and complicated in the elderly patients. In fact, emergency surgery treatment occurs more frequently in the elderly (e.g., it is much more common to see intestinal obstruction complicating colorectal cancer in the elderly compared with a younger population. Old age is an independent factor for long hospital stay after surgery. The role of the preoperative medical consultant is to identify and evaluate a patient’s current medical status and provide a clinical risk profile, in order to decide whether further tests are indicated prior to surgery, and to optimise the patient’s medical condition in the attempt of reducing the risk of complications. The medical consultant must know which medical condition could eventually influence the surgery, achieve a good contact and communication between the medical and surgical team, in order to obtain the best management planning. AIM OF THE STUDY This paper focuses on the rational use of antibiotic prophylaxis and on the treatment of the complications of post-surgery infections (e.g., pulmonary complication, peritonitis, intra-abdominal infection. Specific aspects of pre-operative risk evaluation and peri and post-operative management are discussed. CONCLUSIONS The internal medicin specialist in collaboration with the surgical team is necessary in the peri and post-surgery management.

  13. 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.

  14. Implementation of a novel occupational and environmental medicine specialty teleconsultation service: the VHA experience.

    Science.gov (United States)

    Eaton, Jennifer L; Mohr, David C; Mohammad, Amir; Kirkhorn, Steven; Gerstel-Santucci, Christina; McPhaul, Kathleen; Hodgson, Michael J

    2015-02-01

    Occupational and environmental medicine (OEM) physician specialty practices continue to grow in scope and intensity across the Veterans Health Administration. This study characterizes the implementation of a novel, nationwide telemedicine program that provides OEM specialty consultation to providers across the Veterans Health Administration. We examined provider requests and specialist responses for a 6-month pilot from May to October 2013. Characteristics of consult users, determinants of case complexity, and specific applications of OEM specialty expertise were identified. Over a 6-month period, employee occupational health providers consulted the OEM telemedicine pilot a total of 65 times. Employee occupational health providers without formal training repeatedly identified complex cases related to work and disability. The program has created a new system management solution to deliver expert, in-depth consultation and real-time provider education in OEM.

  15. Quality of Interhospital Transfer Communication Practices and Association With Adverse Events on an Internal Medicine Hospitalist Service.

    Science.gov (United States)

    Borofsky, Jennifer S; Bartsch, Jason C; Howard, Alan B; Repp, Allen B

    2015-03-25

    Communication practices around interhospital transfer have not been rigorously assessed in adult medicine patients. Furthermore, the clinical implications of such practices have not been reported. This case-control study was designed to assess the quality of communication between clinicians during interhospital transfer and to determine if posttransfer adverse events (PTAEs) are associated with suboptimal communication. Cases included patients transferred to a Medicine Hospitalist Service from an outside hospital who subsequently experienced a PTAE, defined as unplanned transfer to an intensive care unit or death within 24 hours of transfer. Control patients also underwent interhospital transfer but did not experience a PTAE. A blinded investigator retrospectively reviewed the recorded pretransfer phone conversations between sending and receiving clinicians for adherence to a set of 13 empiric best practice communication elements. The primary outcome was the mean communication score, on a scale of 0-13. Mean scores between PTAE (8.3; 95% confidence interval [CI], 7.6-8.9) and control groups (7.9; 95% CI, 7.1-8.8) did not differ significantly (p = .50), although suboptimal communication on a subset of these elements was associated with increased PTAEs. Communication around interhospital transfer appears suboptimal compared with an empiric set of standard communication elements. Posttransfer adverse events were not associated with aggregate adherence to these standards.

  16. Evaluation of diagnostic procedures in nuclear medicine services of Pernambuco and Alagoas states - Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Ricardo Braz F. da; Hazin, Clovis A., E-mail: chazin@cnen.gov.br [Centro Regional de Ciencias Nucleares (CRCN-NE/CNEN-PE), Recife, PE (Brazil); Universidade Federal de Pernambuco (DEN/UFPE), Recife, PE (Brazil). Dept. de Energia Nuclear; Lima, Fabiana F., E-mail: fflima@cnen.gov.br [Centro Regional de Ciencias Nucleares (CRCN-NE/CNEN-PE), Recife, PE (Brazil)

    2011-07-01

    The medical use of ionizing radiation contributes significantly to population exposure to radiation. This study aimed to evaluate the diagnostic procedures carried out in nuclear medicine (SMN) in Pernambuco and Alagoas in order to gather data to subsidize the proposal of reference levels for nuclear medicine in Brazil. Data were collected of the SMN in Pernambuco and Alagoas in the period of 2005 to 2009, according by UNSCEAR. The study used data from IBGE. The results showed that the total number of examinations in the period 2005 to 2009 was 34.828 in Pernambuco and 27.700 in Alagoas, corresponding to 6.966 and 5.540 average annual examinations in Pernambuco and Alagoas, respectively. The total number of examinations performed in both states in 2009 was twice the number carried out in 2005. Scintigraphy is the cardiovascular examination most performed in both states, followed by bone scintigraphy. Tc-99m is the radionuclide used most often, followed by I-131. The number of tests using Tc-99m in 2009 doubled when compared with the examinations performed in 2005. The results indicate that there has been a significant increase in the number of examinations in MN, and that females outnumber males, as far as the use of this diagnostic resource is concerned. The study of the activities of the radionuclides administered to patients in the states of Pernambuco and Alagoas showed that they are high when compared to the values recommended by the IAEA in its Safety Report Series Document No. 40. (author)

  17. [Agreements Between Syracuse University and Syracuse University Employees' Union, Local 200 of the General Service Employees' International Union.

    Science.gov (United States)

    Syracuse Univ., NY.

    Contained in this document are three labor contracts made by and between Syracuse University and Local 200 General Services Employees' Union, Service Employees' International Union, AFL-CIO. The purpose of the agreements is to promote and maintain good relations between the university, the union, and the employees represented by the union and to…

  18. A survey exploring knowledge and perceptions of general practitioners towards the use of generic medicines in the northern state of Malaysia.

    Science.gov (United States)

    Chua, Gin Nie; Hassali, Mohamed Azmi; Shafie, Asrul Akmal; Awaisu, Ahmed

    2010-05-01

    The objective of this study was to evaluate the general practitioners' (GPs') knowledge and perceptions towards generic medicines in a northern state of Malaysia. A postal cross-sectional survey involving registered GPs in Penang, Malaysia was undertaken. A 23-item questionnaire was developed, validated and administered on the GPs. Eighty-seven GPs responded to the survey (response rate 26.8%). The majority of the respondents (85.1%) claimed that they actively prescribed generic medicines in their practice. On the other hand, only 4.6% of the respondents correctly identified the Malaysia's National Pharmaceutical Control Bureau's bioequivalence standard for generic products. There were misconceptions among the respondents about the concepts of "bioequivalence", "efficacy", "safety", and "manufacturing standards" of generic medicines. GPs in this survey believed that a standard guideline on brand substitution process, collaboration with pharmacists, patient education and information on safety and efficacy of generic medicines were necessary to ensure quality use of generics. Furthermore, advertisements and product bonuses offered by pharmaceutical companies, patient's socio-economic factors as well as credibility of manufacturers were factors reported to influence their choice of medicine. Although it appeared that GPs have largely accepted the use of generic medicines, they still have concerns regarding the reliability and quality of such products. GPs need to be educated and reassured about generic products approval system in Malaysia concerning bioequivalence, quality, and safety. The current findings have important implications in establishing generic medicines policy in Malaysia. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

  19. The Hazard Evaluation System and Information Service: A Physician's Resource in Toxicology and Occupational Medicine

    OpenAIRE

    Hooper, Kim

    1982-01-01

    Hazard evaluation is an emerging science. The Hazard Evaluation System and Information Service (HESIS), part of California's program in preventive occupational health, is a resource for clinicians who wish to stay abreast of the relationship between toxicology and occupational health. For example, advances in assays for cancer or reproductive effects in test animals enable us to identify with greater confidence significant cancer or reproductive hazards among the increasing variety of workpla...

  20. Assessment of weight gain during pregnancy in general prenatal care services in Brazil

    Directory of Open Access Journals (Sweden)

    Nucci Luciana Bertoldi

    2001-01-01

    Full Text Available Obesity is an emerging major health risk for women around the world. In this regard, little attention has been given to pregnancy, a moment of risk not only for major weight gain in these women, but also for macrosomia in their offspring. The objective of this study is to evaluate weight gain during pregnancy. Data pertains to a cohort of pregnant women attending general prenatal care clinics in six state capitals in Brazil, from 1991 to 1995. We studied women aged 20 years and over with singleton pregnancies and no diagnosis of diabetes outside pregnancy, enrolled at approximately 20 - 28 weeks of gestation. According to the Institute of Medicine criteria, 38% (95%CI: 36-40% of the women studied gained less and 29% (95%CI: 28-31% had more than the recommended total weight gain. These proportions vary according to pre-pregnancy nutritional status. Given the increasing epidemic of obesity, the high prevalence of overweight and obesity in Brazilian women prior to pregnancy, and the lack of achievement of recommended weight gain during pregnancy, more effective means of managing weight gain during pregnancy are necessary.

  1. Joint medicine-information and pharmacovigilance services could improve detection and communication about drug-safety problems

    Directory of Open Access Journals (Sweden)

    Schjøtt J

    2014-07-01

    Full Text Available Jan Schjøtt,1–3 Jenny Bergman3 1Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, 2Institute of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, 3Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest, Haukeland University Hospital, Bergen, Norway Background: RELIS is a Norwegian network of four regional medicine-information and pharmacovigilance centers where pharmacists and clinical pharmacologists provide feedback to health care professionals in spontaneous drug-related questions and adverse drug-reaction (ADR reports published in a question–answer pair (QAP database (the RELIS database and the Norwegian ADR database, respectively. Objective: To describe the potential of RELIS's dual service to improve detection and communication of drug-safety problems. Materials and methods: We searched the RELIS database for QAPs about ADRs with use of the Norwegian ADR database as a reference. We also searched the Norwegian ADR database for reports that used the RELIS database as a reference. Both searches were limited to the years 2003–2012. We then selected the example of pregabalin and drug abuse after the marketing of Lyrica in Norway in September 2004 to illustrate RELIS's potential to detect new drug-safety information through a limited number of QAPs and ADR reports. Results: A total of 5,427 (26% of 21,071 QAPs in the RELIS database concerned ADRs. QAPs from this database were used as references in 791 (4% of a total of 22,090 reports in the Norwegian ADR database. The Norwegian ADR database was used as a reference in 363 (7% of 5,427 QAPs that concerned ADRs. Between September 2004 and September 2008, RELIS received eleven questions and 13 ADR reports about suspicion of Lyrica (pregabalin and different aspects of abuse. Conclusion: RELIS processes data through two databases that facilitate communication about ADRs. Our service also has the

  2. Proceedings of the Sixth General Meeting of the International VLBI Service for Geodesy and Astrometry

    Science.gov (United States)

    Behrend, Dirk (Editor); Baver, Karen D. (Editor)

    2010-01-01

    This volume is the proceedings of the sixth General Meeting of the International VLBI Service for Geodesy and Astrometry (IVS), held in Hobart, Tasmania, Australia, February 7-13, 2010. The contents of this volume also appear on the IVS Web site at http://ivscc.gsfc.nasa.gov/publications/gm2010. The keynote of the sixth GM was the new perspectives of the next generation VLBI system under the theme "VLBI2010: From Vision to Reality". The goal of the meeting was to provide an interesting and informative program for a wide cross-section of IVS members, including station operators, program managers, and analysts. This volume contains 88 papers. All papers were edited by the editors for usage of the English language, form, and minor content-related issues.

  3. Evaluation of Police General Hospital's Fracture Liaison Service (PGH's FLS: The first study of a Fracture Liaison Service in Thailand

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    Tanawat Amphansap

    2016-12-01

    Conclusions: Patients with recent hip fractures participating in the Fracture Liaison service had a significantly higher post-injury BMD follow up and osteoporotic medication administration rates. This resulted in a lower risk of secondary fracture than those who did not participate in the Fracture Liaison service at a follow up time of one year.

  4. Psychiatric services in primary care settings: a survey of general practitioners in Thailand

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    Saipanish Ratana

    2006-07-01

    Full Text Available Abstract Background General Practitioners (GPs in Thailand play an important role in treating psychiatric disorders since there is a shortage of psychiatrists in the country. Our aim was to examine GP's perception of psychiatric problems, drug treatment and service problems encountered in primary care settings. Methods We distributed 1,193 postal questionnaires inquiring about psychiatric practices and service problems to doctors in primary care settings throughout Thailand. Results Four hundred and thirty-four questionnaires (36.4% were returned. Sixty-seven of the respondents (15.4% who had taken further special training in various fields were excluded from the analysis, giving a total of 367 GPs in this study. Fifty-six per cent of respondents were males and they had worked for 4.6 years on average (median = 3 years. 65.6% (SD = 19.3 of the total patients examined had physical problems, 10.7% (SD = 7.9 had psychiatric problems and 23.9% (SD = 16.0 had both problems. The most common psychiatric diagnoses were anxiety disorders (37.5%, alcohol and drugs abuse (28.1%, and depressive disorders (29.2%. Commonly prescribed psychotropic drugs were anxiolytics and antidepressants. The psychotropic drugs most frequently prescribed were diazepam among anti-anxiety drugs, amitriptyline among antidepressant drugs, and haloperidol among antipsychotic drugs. Conclusion Most drugs available through primary care were the same as what existed 3 decades ago. There should be adequate supply of new and appropriate psychotropic drugs in primary care. Case-finding instruments for common mental disorders might be helpful for GPs whose quality of practice was limited by large numbers of patients. However, the service delivery system should be modified in order to maintain successful care for a large number of psychiatric patients.

  5. General Nuclear Medicine

    Science.gov (United States)

    ... the gallbladder identify bleeding into the bowel assess post-operative complications of gallbladder surgery evaluate lymphedema evaluate fever of unknown origin locate the presence of infection measure thyroid function to detect an overactive or underactive ...

  6. PROMOTE THE DEVELOPMENT OF ACUPUNCTURE MEDICINE AND ENHANCE LEVEL OF GLOBAL ACUPUNCTURE RESEARCHThe Fifth General Assembly of WFAS and the Fifth Academic Conference was rounded off in Seoul

    Institute of Scientific and Technical Information of China (English)

    范玲玲

    2001-01-01

    The Fifth General Assembly of WFAS was held in Seoul, Republic of Korea, on November 12, 2 000. She Jing, Vice Health Minister and concurrent Director-General of State Administration of Traditional Chinese Medicine from the People's Republic of China and Hong-Bin Kang, Vice Mayor of Seoul, Republic of Korea, attended the opening ceremony and adressed at the assembly. They spoke highly of the contributions that WFAS has made to the development and application of acupuncture medicine. They pointed out that in the past 13 years since the establishement of WFAS, fruitful efforts have been made for the dissemination and development of acupuncture medicine in the world. The organizational structure of WFAS is becoming more mature in the process of promoting the development of acupuncture science and accelerating the mutual understanding and cooperation among acupuncture groups in the world. The development of WFAS has entered a new stage since WFA$ was admitted into official relations with WHO.

  7. Patient perception and knowledge of acetaminophen in a large family medicine service.

    Science.gov (United States)

    Herndon, Christopher M; Dankenbring, Dawn M

    2014-06-01

    The use of acetaminophen is currently under increased scrutiny by the US Food and Drug Administration (FDA) due to the risk of intentional and more concerning, unintentional overdose-related hepatotoxicity. Acetaminophen is responsible for an estimated 48% of all acute liver failure diagnoses. The purpose of this study is to evaluate patient perception and knowledge of the safe use and potential toxicity of acetaminophen-containing products. The authors conducted a descriptive, 2-week study using a convenience sample from a large family medicine clinic waiting room. Survey questions assessed ability to identify acetaminophen, knowledge of the current recommended maximum daily dose, respondent acetaminophen use patterns, common adverse effects associated with acetaminophen, and respondent self-reported alcohol consumption. Acetaminophen safety information was provided to all persons regardless of participation in the study. Of the 102 patients who chose to participate, 79% recognized acetaminophen as a synonym of Tylenol, whereas only 9% identified APAP as a frequently used abbreviation. One third of respondents thought acetaminophen was synonymous with ibuprofen and naproxen. Approximately one fourth of patients correctly identified the then maximum recommended daily acetaminophen dose of 4 g. Seventy-eight percent of patients correctly identified hepatotoxicity as the most common serious adverse effect. We conclude that patient deficiencies in knowledge of acetaminophen recognition, dosing, and toxicity warrant public education by health professionals at all levels of interaction. Current initiatives are promising; however, further efforts are required.

  8. Necesidades de aprendizaje del especialista en Medicina General Integral sobre síndrome demencial Needs of learning of specialist of Integral General Medicine on dementia syndrome

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    Víctor T. Pérez Martínez

    2010-03-01

    Full Text Available Introducción: las necesidades de aprendizaje o capacitación son la resultante de un proceso de comparación entre un patrón de conocimientos o habilidades y la realidad. Siempre resulta de contrastar un desempeño ideal o propuesto con el real, bien sea para un individuo o un grupo determinado. Objetivos: identificar las necesidades de aprendizaje que, sobre el síndrome demencial, tienen los médicos que laboran en los equipos de atención primaria de salud del municipio Playa. Métodos: se realizó la identificación de necesidades de aprendizaje mediante un cuestionario escrito, que se aplicó de forma colectiva y anónima a 20 especialistas de Medicina General Integral seleccionados al azar y que laboran en tres policlínicos del extremo este del municipio Playa. Resultados: se puntualizaron las deficiencias e insuficiencias de los conocimientos y habilidades profesionales sobre el síndrome demencial, fundamentalmente en lo referente al diagnóstico, y su terapéutica desactualizada. Conclusiones: a pesar de que la demencia senil constituye una entidad mayor en el orden geriátrico, psiquiátrico, epidemiológico y socioeconómico, la gran mayoría de los especialistas no la identifican debidamente, por lo que persiste como una entidad infradiagnosticada e infravalorada.Introduction: needs of learning or training are the result of a comparison process between the knowledges or abilities and the reality. Always it comes of to verify an ideal performance or the proposed compared to the real one, for a subject or a determined group. Objectives: to identify the needs of learning that on the dementia syndrome, have the physicians working in health primary care teams from Playa municipality. Methods: authors identified the needs of learning by a written questionnaire, applied in a collective or anonymous way in 20 specialists of Integral General Medicine working in three polyclinics from eastern extreme of Playa municipality. It was a random

  9. Modelo de dirección estratégica para el departamento de Medicina General Integral Model of strategical management for the Department of General Comprehensive Medicine

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    Alcides Abad Ochoa Alonso

    2005-12-01

    Full Text Available La creciente complejidad del proceso organizacional del Departamento de Medicina General Integral, de la Facultad de Ciencias Médicas “Mariana Grajales Coello” de Holguín, evidenció la necesidad de una intervención de carácter estratégico, capaz de guiar la gestión del cambio y de facilitar la sostenibilidad de las estrategias en curso en el departamento. Valiéndose de métodos de investigación científica, como son, el dialéctico, la modelación y la triangulación, y otros propios de las ciencias de la administración, se construyó un modelo de dirección estratégica específico para este departamento. El proyecto de intervención concebido es producto del análisis crítico de los modelos de dirección estratégica estudiados, y de la introducción de momentos, procedimientos y técnicas adecuados a las condiciones del departamento. Los enfoques rectores del proceso, aplicados en el modelo construido, permiten una mayor integración entre los niveles estratégico, táctico y operativo, con el consiguiente impacto esperado sobre la eficacia y la eficiencia en el alcance de los objetivos.The increasing complexity of the organizational process of the Department of General Comprehensive Medicine of “Mariana Grajales Coello” Faculty of Medical Sciences, in Holguin , evidenced the need of an intervention of strategical character capable of guiding the change management and of facilitating the sustainability of the strategies under way in the department. By using methods of scientific research, such as the dialectic methods, modeling, triangulation and others characteristic of the management science, it was constructed a specific model of strategical management for this department.The intervention project created is the result of the critical analysis of studied strategic management models, and of the introduction of moments, procedures and techniques adjusted to the conditions of the department. The ruling approaches of the

  10. Defining scholarship at the Uniformed Services University of the Health Sciences School of Medicine: A study in cultures.

    Science.gov (United States)

    Marks, E S

    2000-09-01

    Medical schools' long-awaited recognition of the varied contributions of their faculty has caused active dialogue and debate. The discourse centers on the best approach for incorporating a broader definition of scholarship, including professional service, into the traditional promotion and tenure processes. At the School of Medicine of the Uniformed Services University of the Health Sciences (USUHS), the majority of the clinical faculty also serve as active-duty uniformed medical officers, and the subject of how to appropriately recognize their varied contributions has long been contended. Concerns have been raised from all constituent groups that broadening the definition of scholarship at the USUHS has the potential to lower the standards of the academy and thus devalue faculty positions. The USUHS has viewed this challenge as a study in the integration of cultures. Institutional cultures include those of the academy, the military, government, basic science, and clinical science, and all the resulting permutations. A nine-year review of scholarship, promotion, and tenure at the USUHS has resulted in a document that supports the diverse missions of the university and appropriately rewards the accomplishments of its faculty. The dialogue continues, as the new document is subject to continuing review and ongoing critical analysis.

  11. Physiotherapists' perceptions of and experiences with the discharge planning process in acute-care general internal medicine units in ontario.

    Science.gov (United States)

    Matmari, Lakshmi; Uyeno, Jennifer; Heck, Carol S

    2014-01-01

    To examine discharge planning of patients in general internal medicine units in Ontario acute-care hospitals from the perspective of physiotherapists. A cross-sectional study using an online questionnaire was sent to participants in November 2011. Respondents' demographic characteristics and ranking of factors were analyzed using descriptive statistics; t-tests were performed to determine between-group differences (based on demographic characteristics). Responses to open-ended questions were coded to identify themes. Mobility status was identified as the key factor in determining discharge readiness; other factors included the availability of social support and community resources. While inter-professional communication was identified as important, processes were often informal. Discharge policies, timely availability of other discharge options, and pressure for early discharge were identified as affecting discharge planning. Respondents also noted a lack of training in discharge planning; accounts of ethical dilemmas experienced by respondents supported these themes. Physiotherapists consider many factors beyond the patient's physical function during the discharge planning process. The improvement of team communication and resource allocation should be considered to deal with the realities of discharge planning.

  12. Specificity and sensitivity of SPECT myocardial perfusion studies at the Nuclear Medicine Department of the Limassol General Hospital in Cyprus

    Science.gov (United States)

    Koumna, S.; Yiannakkaras, Ch; Avraamides, P.; Demetriadou, O.

    2011-09-01

    The aim is to determine the sensitivity and specificity of Myocardial Perfusion Imaging (MPI) performed at the Nuclear Medicine Department of the Limassol General Hospital in Cyprus. Through a retrospective analysis, patient results obtained by MPI were compared to results obtained by Invasive Angiography. We analyzed data from 96 patients that underwent both MPI and Angiography during the years 2009-2010, with a maximum time interval of ± 9 months between the two types of medical exams. For 51 patients, the indication was the detection of CAD. For 45 patients, the indication was to assess viability and/or ischemia after MI, PCI or CABG. Out of 84 patients with CAD confirmed by angiography, 80 patients resulted in abnormal MPI (sensitivity of 95% and positive predictive value of 98%). Out of 12 patients with normal coronaries, 10 patients resulted in normal MPI (specificity of 83% and negative predictive value of 71%).In conclusion, for the patients with abnormal MPI and confirmed CAD, MPI was a useful aid for further therapy management.

  13. Functional recovery of elderly patients hospitalized in geriatric and general medicine units. The PROgetto DImissioni in GEriatria Study.

    Science.gov (United States)

    Palleschi, Lorenzo; De Alfieri, Walter; Salani, Bernardo; Fimognari, Filippo Luca; Marsilii, Alberto; Pierantozzi, Andrea; Di Cioccio, Luigi; Zuccaro, Stefano Maria

    2011-02-01

    To investigate the characteristics of patients who regain function during hospitalization and the differences in terms of functional outcomes between patients admitted to geriatric and general medicine units. Multicenter, prospective cohort study. Acute care geriatric and medical wards of five Italian hospitals. One thousand forty-eight elderly patients hospitalized for acute medical diseases. Functional status 2 weeks before hospital admission (baseline), at admission, and at discharge, as measured using the Barthel Index (BI). Geriatric patients were older (P<.001) and had lower preadmission functional levels (P<.001) than medical patients. Between baseline and discharge, 43.2% of geriatric and 18.9% of medical patients declined in physical function. In the subpopulation of 464 patients who had declined before hospitalization (between baseline and admission), 59% improved during hospitalization (45% of geriatric and 75% of medical patients), whereas only approximately 1% declined further. High baseline function (odds ratio (OR)=1.03, 95% confidence interval (CI)=1.02-1.04, per point of BI) and greater functional decline before hospitalization (OR 0.95, 95% CI 0.94-0.97, per % point of BI decline) were significant predictors of in-hospital functional improvement; type of hospital ward and age were not. Although geriatric patients have overall worse functional outcomes, in-hospital functional recovery may be frequent even in geriatric units, particularly in patients with greater preadmission functional loss and high baseline level of function. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

  14. A 9-year analysis of bibliographical trends for journals in the subject category of general and internal medicine.

    Science.gov (United States)

    Foo, Jong Yong Abdiel

    2009-05-01

    For academic research outcomes, an important bibliometric scoring termed as the journal impact factor (JIF) is used when assessment of the quality of research is required. No known study has been conducted to explore the bibliographical trends of 'Medicine, General & Internal' journals indexed by the annual Journal Citation Reports. Data from the Journal Citation Reports and Web of Science database were extracted to formulate a comprehensive analysis. In this study, the trends of 15 journals (5 top ranked and 10 low ranked; 5 English and 5 non-English based) were selected and analysed over a 9-year period (starting from year 1999 to 2007). Using the year 1999 as the base year, the results showed that the JIF rose significantly for the selected top ranked journals (up to 180.9%) while the low ranked ones slipped in their JIF value (down to -44.4%). The observed upward or downward trend was caused by a combination of other bibliographical measures like citations, number of citable, and total items published. It is postulated that changes in bibliographical trends can be classified as editorial and non-editorial influences. The impacts of these influences on the 15 selected journals over the 9-year period were also discussed retrospectively.

  15. Specificity and sensitivity of SPECT myocardial perfusion studies at the Nuclear Medicine Department of the Limassol General Hospital in Cyprus

    Energy Technology Data Exchange (ETDEWEB)

    Koumna, S [Athens Anticancer - Oncology Hospital ' AgiosSavvas' , Athens (Greece); Yiannakkaras, Ch [Medical Physics Department, Nicosia General Hospital, Nicosia (Cyprus); Avraamides, P [Cardiology Clinic, Limassol General Hospital, Limassol (Cyprus); Demetriadou, O, E-mail: stelkoum@gmail.com [Nuclear Medicine Department, Limassol General Hospital, Limassol (Cyprus)

    2011-09-23

    The aim is to determine the sensitivity and specificity of Myocardial Perfusion Imaging (MPI) performed at the Nuclear Medicine Department of the Limassol General Hospital in Cyprus. Through a retrospective analysis, patient results obtained by MPI were compared to results obtained by Invasive Angiography. We analyzed data from 96 patients that underwent both MPI and Angiography during the years 2009-2010, with a maximum time interval of {+-} 9 months between the two types of medical exams. For 51 patients, the indication was the detection of CAD. For 45 patients, the indication was to assess viability and/or ischemia after MI, PCI or CABG. Out of 84 patients with CAD confirmed by angiography, 80 patients resulted in abnormal MPI (sensitivity of 95% and positive predictive value of 98%). Out of 12 patients with normal coronaries, 10 patients resulted in normal MPI (specificity of 83% and negative predictive value of 71%).In conclusion, for the patients with abnormal MPI and confirmed CAD, MPI was a useful aid for further therapy management.

  16. The hazard evaluation system and information service: a physician's resource in toxicology and occupational medicine.

    Science.gov (United States)

    Hooper, K

    1982-12-01

    Hazard evaluation is an emerging science. The Hazard Evaluation System and Information Service (HESIS), part of California's program in preventive occupational health, is a resource for clinicians who wish to stay abreast of the relationship between toxicology and occupational health. For example, advances in assays for cancer or reproductive effects in test animals enable us to identify with greater confidence significant cancer or reproductive hazards among the increasing variety of workplace exposures. Occupational experiences with dibromochloropropane (DBCP), Kepone, bis(chloromethyl) ether, benzidine and vinyl chloride demonstrate the shortcomings of relying on human data. The latency period of cancer, limited sensitivity of epidemiologic studies and severity of effects require us to use animal test data to evaluate the potential cancer and reproductive risks of workplace substances. HESIS gives appropriate weight to experimental data in hazard evaluations of chemicals such as ethylene oxide, ethylene dibromide, polychlorinated biphenyls and the glycol ethers. A similar approach is apparent in the California Department of Health Services' recently released Carcinogen Identification Policy.

  17. Relation between safe use of medicines and Clinical Pharmacy Services at Pediatric Intensive Care Units

    Science.gov (United States)

    Okumura, Lucas Miyake; da Silva, Daniella Matsubara; Comarella, Larissa

    2016-01-01

    Abstract Objective: Clinical Pharmacy Services (CPS) are considered standard of care and is endorsed by the Joint Commission International, the American Academy of Pediatrics, and the American College of Clinical Pharmacy. In Brazil, single experiences have been discreetly arising and the importance of these services to children and adolescents care has led to interesting results, but certainly are under reported. This short report aims to discuss the effect of implementing a bedside CPS at a Brazilian Pediatric Intensive Care Unit (PICU). Methods: This is a cross-sectional study conducted in a 12 bed PICU community hospital, from Campo Largo/Brazil. Subjects with<18 years old admitted to PICU were included for descriptive analysis if received a CPS intervention. Results: Of 53 patients accompanied, we detected 141 preventable drug-related problems (DRPs) which were solved within clinicians (89% acceptance of all interventions). The most common interventions performed to improve drug therapy included: preventing incompatible intravenous solutions (21%) and a composite of inadequate doses (17% due to low, high and non-optimized doses). Among the top ten medications associated with DRPs, five were antimicrobials. By analyzing the correlation between DRPs and PICU length of stay, we found that 74% of all variations on length of stay were associated with the number of DRPs. Conclusions: Adverse drug reactions due to avoidable DRPs can be prevented by CPS in a multifaceted collaboration with other health care professionals, who should attempt to use active and evidence-based strategies to reduce morbidity related to medications. PMID:27578187

  18. 41 CFR 105-68.635 - May the General Services Administration settle a debarment or suspension action?

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false May the General Services Administration settle a debarment or suspension action? 105-68.635 Section 105-68.635 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL...

  19. 41 CFR 105-68.630 - May the General Services Administration impute conduct of one person to another?

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false May the General Services Administration impute conduct of one person to another? 105-68.630 Section 105-68.630 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL...

  20. 41 CFR 102-71.5 - What is the scope and philosophy of the General Services Administration's (GSA) real property...

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What is the scope and philosophy of the General Services Administration's (GSA) real property policies? 102-71.5 Section 102-71.5...) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 71-GENERAL § 102-71.5 What is the scope and philosophy of...

  1. Regional Development Disparities and the Provision of Services of General Interest. A Case Study on the Health Care Services Availability in the North-East Region of Romania

    Directory of Open Access Journals (Sweden)

    Daniela-Luminita Constantin

    2013-04-01

    Full Text Available This paper proposes an inquiry into the issue of availability of services of general interest, offering as case study the health care services in the North-East region of Romania. The interregional and intraregional (within North-East region disparities in terms of health care services provision are examined in relation to the overall regional development disparities, confirming that the concern with providing a minimum level of social SGI to all citizens has conducted to health care service disparities lower than those in terms of GDP per inhabitant. The paper also provides relevant evidence on the impact of demography, especially in terms of population density on the availability of health care services.

  2. Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice? A cluster randomised controlled trial

    NARCIS (Netherlands)

    Kortekaas, M.F.; Bartelink, M.E.L.; Zuithoff, N.P.A.; van der Heijden, G.J.M.G.; de Wit, N.J.; Hoes, A.W.

    2016-01-01

    Objectives Evidence-based medicine (EBM) is an important element in the general practice (GP) specialty training. Studies show that integrating EBM training into clinical practice brings larger benefits than stand-alone modules. However, these studies have neither been performed in GP nor assessed E

  3. Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice? : A cluster randomised controlled trial

    NARCIS (Netherlands)

    Kortekaas, M F; Bartelink, M E L|info:eu-repo/dai/nl/100449069; Zuithoff, N P A|info:eu-repo/dai/nl/313995494; van der Heijden, G J M G; de Wit, N J|info:eu-repo/dai/nl/100525393; Hoes, A W|info:eu-repo/dai/nl/101111762

    2016-01-01

    OBJECTIVES: Evidence-based medicine (EBM) is an important element in the general practice (GP) specialty training. Studies show that integrating EBM training into clinical practice brings larger benefits than stand-alone modules. However, these studies have neither been performed in GP nor assessed

  4. [The prevalence of nasal carriage of Staphylococcus aureus aureus and methicillin-resistant S. aureus (MRSA) among general medicine students of the Palacky University Olomouc].

    Science.gov (United States)

    Holý, O; Vlčková, J; Matoušková, I; Kolář, M

    2015-06-01

    Staphylococcus aureus is one of the major agents of both healthcare- and community-associated infections. Nasal carriage of S. aureus has been reported in approximately 37% of healthy persons. 1. To investigate the prevalence of nasal carriage of S. aureus and MRSA in healthy persons of the age group 18-26 years (general medicine students of the Palacký University Olomouc). This type of information is not available in the Czech Republic. 2. To find whether the prevalence of nasal carriage strains of S. aureus and MRSA varies over the years of studies. 3. To compare the Year 1 (baseline) and Year 5 (after a long, close contact with the indoor environment of health-care facilities) general medicine students for nasal carriage of S. aureus and MRSA strains. The prevalence study was conducted for over 12 months in 2012 and 2013. Nasal swabs were taken from the general medicine students participating in the study. Each subject was sampled once. In total, 307 samples were collected: 206 samples from the Year 1 students and 101 from the Year 5 students. Sixty-one (about 32%) Year 1 students and 32 (30%) Year 5 students were positive for S. aureus. Of them, 94 (30.6%) were males and 213 (69.4%) were females. The observed prevalence of nasal S. aureus carriage is consistent with the literature data. No statistically significant difference in the prevalence of nasal carriage of S. aureus was found between the Year 1 and Year 5 general medicine students.

  5. The Willingness-to-Pay for General Practitioners in Contractual Service and Influencing Factors among Empty Nesters in Chongqing, China

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    Fei Chen

    2015-08-01

    Full Text Available Background: In 2012, a pilot health policy of contractual service relations between general practitioners and patients was implemented in China. Due to the decline in body and cognitive function, as well as the lack of family care and narrow social support networks, the demand of health services among the elderly is much higher than that among the general population. This study aims to probe into the empty nesters’ willingness-to-pay for general practitioners using a contractual service policy, investigating empty nesters’ payment levels for the service, and analyze the main factors affecting the willingness of empty-nesters’ general practitioners using contractual service supply cost. Methods: This cross-sectional study adopted a multistage stratified sampling method to survey 865, city empty nesters (six communities in three districts of one city aged 60–85 years. A condition value method was used to infer the distribution of the willingness-to-pay; Cox’s proportional hazards regression model was used to analyze the influencing factors of willingness-to-pay. Results: More than seventy percent (76.6% of the empty nesters in this city were willing to pay general practitioners using contract service in Chongqing. The level of willingness-to-pay for the surveyed empty nesters was 34.1 yuan per year. The median value was 22.1 yuan per year, which was below the Chongqing urban and rural cooperative medical insurance individual funding level (60 yuan per year in 2013. Cox’s proportional hazards regression model analysis showed that the higher the education level was, the worse the self-reported health status would be, accompanied by higher family per capita income, higher satisfaction of community health service, and higher willingness-to-pay empty nesters using a contract service. Women had a higher willingness-to-pay than men. Conclusions: The willingness-to-pay for general practitioners by contractual service is high among city empty

  6. Evaluation of PM emissions from two in-service gas turbine general aviation aircraft engines

    Science.gov (United States)

    Yu, Zhenhong; Liscinsky, David S.; Fortner, Edward C.; Yacovitch, Tara I.; Croteau, Philip; Herndon, Scott C.; Miake-Lye, Richard C.

    2017-07-01

    We determined particulate matter (PM) emissions in the exhaust plumes from two gas turbine aircraft engines: a CF34-3A1 turbofan engine and a TPE331-6-252B turboprop engine in a dedicated study on in-service general aviation aircraft. The engine power states were from 16% to 100% engine thrust. Both nucleation and soot mode particles were observed from the emission exhausts of the CF34-3A1 engine but only soot particle mode was detected from the TPE331-6-252B engine. For the CF34-3A1 engine, the contribution of soot mode to total PM emissions was dominant at high power, while at decreased engine power states nucleation mode organic PM became important. PM emissions indices of the TPE331-6-252B engine were found to be generally larger than those of the CF34-3A1 engine. For both engines, medium power conditions (40-60% of thrust) yielded the lowest PM emissions. For the TPE331-6-252B engine, volatile PM components including organic and sulfate were more than 50% in mass at low power, while non-volatile black carbon became dominant at high power conditions such as takeoff.

  7. Relation between safe use of medicines and Clinical Pharmacy Services at Pediatric Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Lucas Miyake Okumura

    Full Text Available Abstract Objective: Clinical Pharmacy Services (CPS are considered standard of care and is endorsed by the Joint Commission International, the American Academy of Pediatrics, and the American College of Clinical Pharmacy. In Brazil, single experiences have been discreetly arising and the importance of these services to children and adolescents care has led to interesting results, but certainly are under reported. This short report aims to discuss the effect of implementing a bedside CPS at a Brazilian Pediatric Intensive Care Unit (PICU. Methods: This is a cross-sectional study conducted in a 12 bed PICU community hospital, from Campo Largo/Brazil. Subjects with<18 years old admitted to PICU were included for descriptive analysis if received a CPS intervention. Results: Of 53 patients accompanied, we detected 141 preventable drug-related problems (DRPs which were solved within clinicians (89% acceptance of all interventions. The most common interventions performed to improve drug therapy included: preventing incompatible intravenous solutions (21% and a composite of inadequate doses (17% due to low, high and non-optimized doses. Among the top ten medications associated with DRPs, five were antimicrobials. By analyzing the correlation between DRPs and PICU length of stay, we found that 74% of all variations on length of stay were associated with the number of DRPs. Conclusions: Adverse drug reactions due to avoidable DRPs can be prevented by CPS in a multifaceted collaboration with other health care professionals, who should attempt to use active and evidence-based strategies to reduce morbidity related to medications.

  8. General practitioners' satisfaction with and attitudes to out-of-hours services

    Directory of Open Access Journals (Sweden)

    Wesseling Geertjan

    2005-03-01

    Full Text Available Abstract Background In recent years, Dutch general practitioner (GP out-of-hours service has been reorganised into large-scale GP cooperatives. Until now little is known about GPs' experiences with working at these cooperatives for out-of-hours care. The purpose of this study is to gain insight into GPs' satisfaction with working at GP cooperatives for out-of-hours care in separated and integrated cooperatives. Methods A GP cooperative separate from the hospital Accident and Emergency (A&E department, and a GP cooperative integrated within the A&E department of another hospital. Both cooperatives are situated in adjacent geographic regions in the South of the Netherlands. One hundred GPs were interviewed by telephone; fifty GPs working at the separated GP cooperative and fifty GPs from the integrated GP cooperative. Opinions on different aspects of GP cooperatives for out-of-hours care were measured, and regression analysis was performed to investigate if these could be related to GP satisfaction with out-of-hours care organisation. Results GPs from the separated model were more satisfied with the organisation of out-of-hours care than GPs from the integrated model (70 vs. 60 on a scale score from 0 to 100; P = 0.020. Satisfaction about out-of-hours care organisation was related to opinions on workload, guarantee of gatekeeper function, and attitude towards out-of-hours care as being an essential part of general practice. Cooperation with medical specialists was much more appreciated at the integrated model (77 vs. 48; P Conclusion GPs in this study appear to be generally satisfied with the organisation of GP cooperatives for out-of-hours care. Furthermore, GPs working at the separated cooperative seem to be more satisfied compared to GPs working at the integrated cooperative.

  9. Quality of medical service, patient satisfaction and loyalty with a focus on interpersonal-based medical service encounters and treatment effectiveness: a cross-sectional multicenter study of complementary and alternative medicine (CAM) hospitals.

    Science.gov (United States)

    Kim, Chang Eun; Shin, Joon-Shik; Lee, Jinho; Lee, Yoon Jae; Kim, Me-Riong; Choi, Areum; Park, Ki Byung; Lee, Ho-Joo; Ha, In-Hyuk

    2017-03-28

    Treatment effectiveness holds considerable importance in the association between service quality and satisfaction in medical service studies. While complementary and alternative medicine (CAM) use grows more prominent, comprehensive evaluations of the quality of medical service at CAM-oriented hospitals are scarce. This study assesses the quality of medical services provided at a CAM-oriented hospital of Korean medicine using the service encounter system approach and analyzes the influence of treatment effectiveness on patient loyalty. A survey study using one-on-one interviews was conducted using a cross-sectional design in outpatients visiting one of fifteen Korean medicine facilities located throughout Korea. A total of 880 surveys were completed from June to July, 2014, and 728 surveys were included in the final analysis after excluding incomplete or incorrect questionnaires. The reliability and validity of the surveys was confirmed using Cronbach's alpha coefficient and confirmatory factor analysis, and a structural equation modeling analysis was performed to verify causality and association between factors (quality of medical service, treatment effectiveness, patient satisfaction, and intent to revisit). The measured factors of physician performance and quality of service procedures had a positive effect on treatment effectiveness. The impression of the facilities and environment directly impacted satisfaction rates for interpersonal-based medical service encounters, while treatment effectiveness positively affected satisfaction regarding quality of medical service. However, treatment effectiveness had a more significant effect on satisfaction compared to facilities and environment, and it indirectly affected satisfaction and directly influenced intent to revisit. Treatment effectiveness and satisfaction both positively influenced intent to revisit. The importance of treatment effectiveness should be recognized when examining quality of medical services, and

  10. 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.

  11. Improving hospital care and collaborative communications for the 21st century: key recommendations for general internal medicine.

    Science.gov (United States)

    Wu, Robert C; Lo, Vivian; Rossos, Peter; Kuziemsky, Craig; O'Leary, Kevin J; Cafazzo, Joseph A; Reeves, Scott; Wong, Brian M; Morra, Dante

    2012-09-24

    Communication and collaboration failures can have negative impacts on the efficiency of both individual clinicians and health care system delivery as well as on the quality of patient care. Recognizing the problems associated with clinical and collaboration communication, health care professionals and organizations alike have begun to look at alternative communication technologies to address some of these inefficiencies and to improve interprofessional collaboration. To develop recommendations that assist health care organizations in improving communication and collaboration in order to develop effective methods for evaluation. An interprofessional meeting was held in a large urban city in Canada with 19 nationally and internationally renowned experts to discuss suitable recommendations for an ideal communication and collaboration system as well as a research framework for general internal medicine (GIM) environments. In designing an ideal GIM communication and collaboration system, attendees believed that the new system should possess attributes that aim to: a) improve workflow through prioritization of information and detection of individuals' contextual situations; b) promote stronger interprofessional relationships with adequate exchange of information; c) enhance patient-centered care by allowing greater patient autonomy over their health care information; d) enable interoperability and scalability between and within institutions; and e) function across different platforms. In terms of evaluating the effects of technology in GIM settings, participants championed the use of rigorous scientific methods that span multiple perspectives and disciplines. Specifically, participants recommended that consistent measures and definitions need to be established so that these impacts can be examined across individual, group, and organizational levels. Discussions from our meeting demonstrated the complexities of technological implementations in GIM settings

  12. New graduates’ perceptions of preparedness to provide speech-language therapy services in general and dysphagia services in particular

    Directory of Open Access Journals (Sweden)

    Shajila Singh

    2015-02-01

    Full Text Available Background: Upon graduation, newly qualified speech-language therapists are expected to provide services independently. This study describes new graduates’ perceptions of their preparedness to provide services across the scope of the profession and explores associations between perceptions of dysphagia theory and clinical learning curricula with preparedness for adult and paediatric dysphagia service delivery.Methods: New graduates of six South African universities were recruited to participate in a survey by completing an electronic questionnaire exploring their perceptions of the dysphagia curricula and their preparedness to practise across the scope of the profession of speechlanguage therapy. Results: Eighty graduates participated in the study yielding a response rate of 63.49%. Participants perceived themselves to be well prepared in some areas (e.g. child language: 100%; articulation and phonology: 97.26%, but less prepared in other areas (e.g. adult dysphagia: 50.70%; paediatric dysarthria: 46.58%; paediatric dysphagia: 38.36% and most unprepared to provide services requiring sign language (23.61% and African languages (20.55%. There was a significant relationship between perceptions of adequate theory and clinical learning opportunities with assessment and management of dysphagia and perceptions of preparedness to provide dysphagia services. Conclusion: There is a need for review of existing curricula and consideration of developing a standard speech-language therapy curriculum across universities, particularly in service provision to a multilingual population, and in both the theory and clinical learning of the assessment and management of adult and paediatric dysphagia, to better equip graduates for practice.

  13. [EBM Service: evidence-based answers provided by general practitioners to questions asked by general practitioners--a project from South Tyrol/Italy].

    Science.gov (United States)

    Piccoliori, Giuliano; Kostner, Simon; Abholz, Heinz-Harald

    2010-01-01

    General practices also require more and more evidence-based decision-making. But knowledge is increasing rapidly and guidelines produced to help doctors to find answers to their problems seem to exclude a number of problems that are important in general practices. Here we report on the introduction and activities of an EbM Service provided by general practitioners to answer questions of their colleagues. The aim is to give EBM answers, but also, in doing so, to teach the application of EBM and--in the long run--to enable the users themselves to find EBM answers. The provision of EBM answers is fairly pragmatic: after using the service the inquiring physician should be better informed, i.e., have more evidence-based information, but sometimes this need not be the "ultimate truth" that experts might deliver. EBM answers are published both on the homepage of the College of General Practitioners and in their journal. It took quite a while to implement this service, and the number of those using it has increased slowly but constantly.

  14. USDA forest service global change research program highlights: 1991-1995. Forest Service general technical report (Final)

    Energy Technology Data Exchange (ETDEWEB)

    Birdsey, R.; Mickler, R.; Sandberg, D.; Tinus, R.; Zerbe, J.

    1997-12-29

    The report summarizes research findings of the USDA Forest Service`s Global Change Research Program. Research highlights are presented at national and regional scales within the following topic areas: atmosphere/biosphere gas and energy exchange; ecosystem dynamics; disturbance ecology; and human activities and natural resource interactions. Selected topics are reviewed in depth with individual papers covering the global carbon cycle, climate scenarios, multiple stress studies, changes in vegetation distribution, the United States carbon budget, and the human dimensions of global change. Also included is a progress report on development of an integrated national model of the effects of global change on forests and people.

  15. Herbal Medicine

    Science.gov (United States)

    ... resources Diseases and Conditions Acupuncture Art, Dance, and Music Ayurveda Biofeedback Body Movement Chinese Medicine Electromagnetic Therapy ... conditions associated with aging, including poor circulation and memory loss. Ginseng Used as a general tonic to ...

  16. [The physician manager--building a clinical leadership in community medicine--the Maccabi Healthcare Services (MHS) model].

    Science.gov (United States)

    Kokia, Ehud; Siegal, Neomi; Shemer, Joshua

    2008-05-01

    Community medicine around the world is facing constant trends of changes. The need to overcome the huge burden of chronic diseases, the need to prioritize and adapt new technologies, and above all, the fact that all these must be done within a given, restricted budget, calls for advanced medical management. In this review we focused on the development of the role of the physician manager in Maccabi Healthcare Services (MHS) over the last 60 years. From what was once a reactive, utilization control-oriented administrative physician role, there has emerged a proactive, formally educated, health quality leader who is expected to lead his clinical colleagues towards achieving the organization's goals. Every organization should answer 4 basic questions in order to encourage/develop the new generation of physician managers. 1. Who am I?--What is the profile and what are the tasks of the physician manager's role? 2. What is the time allocation allotted to the physician manager by the organization to enable him to do his job? 3. What are the educational and managerial tools provided for the 'new" physician manager? 4. What are the rewards that the organization grants to its best people? By addressing the above questions MHS has successfully developed new generations of young clinical leaders who can help MHS management conduct a real dialogue with its clinical physicians in order to maximize the services that our beneficiaries are receiving from the HMO. Our conclusion is that choosing the right people, providing them with the right tools and positioning the physician manager appropriately in the organization's hierarchy will enable the medical care delivery system in Israel to achieve the level of clinical leadership that can lead us towards a better future.

  17. Differences in pediatric dental services under general anesthesia for Medicaid and military dependent children.

    Science.gov (United States)

    Johnson, M B; Cappelli, D P; Bradshaw, B S; Mabry, J C

    2010-01-01

    This study's purpose was to compare pediatric dental services provided for Medicaid and military dependent children to determine if differences in dental treatment choices exist based on site and payment method. Subjects included 120 Medicaid patients at the University of Texas Health Science Center at San Antonio and 120 military dependents at Lackland Air Force Base, Texas. Demographic data and treatment information were abstracted for children younger than 6 years old receiving dental treatment under general anesthesia between 2002 and 2006. Data was analyzed using Wilcoxon rank sum, Kruskal-Wallis, and Fisher's exact tests. The Medicaid recipients were younger (40.2 vs 49.8 months, P<.001) and more likely to be Hispanic (78% vs 30%, P<.001). The means of decayed teeth, fillings, and stainless steel crowns did not differ between sites. Medicaid children received more composite fillings (P<.001), fewer amalgam fillings (P<.001), fewer pulp therapies (P<.001), more extractions (P=.01), and fewer sealants (P<.001). Age and gender did not affect decay rates, but those of Hispanic ethnicity did experience more decay than non-Hispanics (9.5 vs 8.6, P=.02). This study found no difference in the number of less conservative, albeit more costly, procedures performed with Medicaid children at a university compared to military dependents at a military base.

  18. Mobile task management tool that improves workflow of an acute general surgical service.

    Science.gov (United States)

    Foo, Elizabeth; McDonald, Rod; Savage, Earle; Floyd, Richard; Butler, Anthony; Rumball-Smith, Alistair; Connor, Saxon

    2015-10-01

    Understanding and being able to measure constraints within a health system is crucial if outcomes are to be improved. Current systems lack the ability to capture decision making with regard to tasks performed within a patient journey. The aim of this study was to assess the impact of a mobile task management tool on clinical workflow within an acute general surgical service by analysing data capture and usability of the application tool. The Cortex iOS application was developed to digitize patient flow and provide real-time visibility over clinical decision making and task performance. Study outcomes measured were workflow data capture for patient and staff events. Usability was assessed using an electronic survey. There were 449 unique patient journeys tracked with a total of 3072 patient events recorded. The results repository was accessed 7792 times. The participants reported that the application sped up decision making, reduced redundancy of work and improved team communication. The mode of the estimated time the application saved participants was 5-9 min/h of work. Of the 14 respondents, nine discarded their analogue methods of tracking tasks by the end of the study period. The introduction of a mobile task management system improved the working efficiency of junior clinical staff. The application allowed capture of data not previously available to hospital systems. In the future, such data will contribute to the accurate mapping of patient journeys through the health system. © 2015 Royal Australasian College of Surgeons.

  19. [Abdominal unplanned reoperations in the Service of General Surgery, University Hospital of Puebla].

    Science.gov (United States)

    León-Asdrúbal, Samuel Báez; Juárez-de la Torre, Juan Carlos; Navarro-Tovar, Fernando; Heredia-Montaño, Mónica; Quintero-Cabrera, José Eduardo

    2016-01-01

    The reoperation is considered as the access to the abdominal cavity before complete healing of the surgical wound from a previous operation within the first 60 days after the first procedure. It occurs in 0.5 to 15% of patients undergoing abdominal surgery and generates significant increase in morbidity and mortality in patients undergoing abdominal surgery. Identify the number of unplanned abdominal surgical reoperations and identify the causes of these unplanned reoperations were performed in our department. This is a retrospective study conducted at the University Hospital of Puebla in the period between April 2009 to February 2012, a total of 1,709 abdominal surgeries performed by the Service of General Surgery were included. Ninety-seven cases of reoperation of which 50 cases were not planned surgery cases were identified; 72% (36 cases) from emergency operations, and 28% of elective surgery. The incidence found in our study is low compared to similar studies. Prospective studies and focus on risk factors and causes of unplanned reoperations are required, in order to know them in detail and, consequently, reduce its incidence and morbidity and mortality they add.

  20. 38 CFR 61.80 - General operation requirements for supportive housing and service centers.

    Science.gov (United States)

    2010-07-01

    ... recipient if VA determines that such services are of unacceptable quality. Further, VA will not pay per diem...) Space in a service center shall be made available as mutually agreeable for use by VA staff and other..., job training and job placement services (including job readiness, job counseling, and literacy and...

  1. Impact of inpatient caseload, emergency department duties, and online learning resource on General Medicine In-Training Examination scores in Japan

    Directory of Open Access Journals (Sweden)

    Kinoshita K

    2015-10-01

    Full Text Available Kensuke Kinoshita,1 Yusuke Tsugawa,2 Taro Shimizu,3 Yusuke Tanoue,4 Ryota Konishi,5 Yuji Nishizaki,6 Toshiaki Shiojiri,7 Yasuharu Tokuda8 1Department of Medicine, Mito Kyodo General Hospital, University of Tsukuba, Mito City, Ibaraki, Japan; 2Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; 3Tokyo Joto Hospital, Koto-ku, Tokyo, 4Good Medicine Japan, Miyagi, 5Department of General Internal Medicine, Kanto Rosai Hospital, Kawasaki, Kanagawa, 6Department of Cardiology, Juntendo University Graduate School of Medicine, Tokyo, 7Department of General Internal Medicine, Asahi General Hospital, Asahi, Chiba, 8Japan Community Healthcare Organization, Minato-ku, Tokyo, Japan Background: Both clinical workload and access to learning resource are important components of educational environment and may have effects on clinical knowledge of residents. Methods: We conducted a survey with a clinical knowledge evaluation involving postgraduate year (PGY-1 and -2 resident physicians at teaching hospitals offering 2-year postgraduate training programs required for residents in Japan, using the General Medicine In-Training Examination (GM-ITE. An individual-level analysis was conducted to examine the impact of the number of assigned patients and emergency department (ED duty on the residents' GM-ITE scores by fitting a multivariable generalized estimating equations. In hospital-level analysis, we evaluated the relationship between for the number of UpToDate reviews for each hospital and for the hospitals' mean GM-ITE score. Results: A total of 431 PGY-1 and 618 PGY-2 residents participated. Residents with four or five times per month of the ED duties exhibited the highest mean scores compared to those with greater or fewer ED duties. Those with largest number of inpatients in charge exhibited the highest mean scores compared to the residents with fewer inpatients in charge. Hospitals with the greater Up

  2. Seeking to understand: using generic qualitative research to explore access to medicines and pharmacy services among resettled refugees.

    Science.gov (United States)

    Bellamy, Kim; Ostini, Remo; Martini, Nataly; Kairuz, Therese

    2016-06-01

    Introduction There are challenges associated with selecting a qualitative research approach. In a field abundant with terminology and theories, it may be difficult for a pharmacist to know where and how to begin a qualitative research journey. The purpose of this paper is to provide insight into generic qualitative research and to describe the journey of data collection of a novice qualitative researcher in the quest to answer her research question: 'What are the barriers to accessing medicines and pharmacy services for resettled refugees in Queensland, Australia?' Methodology Generic qualitative research draws on the strengths of one or more qualitative approaches. The aim is to draw out participants' ideas about things that are 'outside themselves'; rather than focussing on their inner feelings the research seeks to understand a phenomenon, a process, or the perspectives of participants. Sampling is designed to obtain a broad range of opinions about events and experiences and data collection includes interviews, questionnaires or surveys; thematic analysis is often used to analyse data. When to use Generic qualitative research provides an opportunity to develop research designs that fit researchers' epistemological stance and discipline, with research choices, including methodology and methods, being informed by the research question. Limitations Generic qualitative research is one of many methodologies that may be used to answer a research question and there is a paucity of literature about how to do it well. There is also debate about its validity as a qualitative methodology.

  3. 75 FR 4576 - Veterinary Medicine Advisory Committee; Notice of Meeting

    Science.gov (United States)

    2010-01-28

    ... HUMAN SERVICES Food and Drug Administration Veterinary Medicine Advisory Committee; Notice of Meeting... the public. Name of Committee: Veterinary Medicine Advisory Committee. General Function of the... Rockville Pike, Rockville MD 20852, 301-468-1100. Contact Person: Aleta Sindelar, Center for...

  4. Data-as-a-Service Platform for Delivering Healthy Lifestyle and Preventive Medicine: Concept and Structure of the DAPHNE Project.

    Science.gov (United States)

    Gibbons, Catherine; Bailador Del Pozo, Gonzalo; Andrés, Javier; Lobstein, Tim; Manco, Melania; Lewy, Hadas; Bergman, Einat; O'Callaghan, David; Doherty, Gavin; Kudrautseva, Olga; Palomares, Angel; Ram, Roni; Olmo, Alberto

    2016-12-09

    Overweight and obesity is related to many health problems and diseases. The current obesity epidemic, which is a major health problem, is closely related to a lack of physical activity, high levels of sedentary behavior, and increased energy intake; with evidence to show increasing incidence of these issues in the younger population. Tackling obesity and its comorbid conditions requires a holistic approach encompassing attention on physical activity, healthy diet, and behavioral activation in order to enable and maintain meaningful and long-term weight loss and weight maintenance. The objective of the Data-as-a-Service Platform for Healthy Lifestyle and Preventive Medicine (DAPHNE) project is to develop a breakthrough information communications technology (ICT) platform for tracking health, weight, physical activity, diet, lifestyle, and psychological components within health care systems, whereby the platform and clinical support is linked. The DAPHNE platform aims to deliver personalized guidance services for lifestyle management to the citizen/patient by means of (1) advanced sensors and mobile phone apps to acquire and store continuous/real-time data on lifestyle aspects, behavior, and surrounding environment; (2) individual models to monitor their health and fitness status; (3) intelligent data processing for the recognition of behavioral trends; and (4) specific services for personalized guidance on healthy lifestyle and disease prevention. It is well known that weight loss and maintenance of weight loss are particularly difficult. This tool will address some of the issues found with conventional treatment/advice in that it will collect data in real time, thereby reducing reliability issues known with recalling events once they have passed and will also allow adjustment of behavior through timely support and recommendations sent through the platform without the necessity of formal one-to-one visits between patient and clinician. Patient motivation

  5. Scaling up family medicine training in Gezira, Sudan – a 2-year in-service master programme using modern information and communication technology: a survey study

    Science.gov (United States)

    2014-01-01

    Background In 2010 the Gezira Family Medicine Project (GFMP) was initiated in Gezira state, Sudan, designed as an in-service training model. The project is a collaboration project between the University of Gezira, which aims to provide a 2-year master’s programme in family medicine for practicing doctors, and the Ministry of Health, which facilitates service provision and funds the training programme. This paper presents the programme, the teaching environment, and the first batch of candidates enrolled. Methods In this study a self-administered questionnaire was used to collect baseline data at the start of the project from doctors who joined the programme. A checklist was also used to assess the health centres where they work. A total of 188 out of 207 doctors responded (91%), while data were gathered from all 158 health centres (100%) staffed by the programme candidates. Results The Gezira model of in-service family medicine training has succeeded in recruiting 207 candidates in its first batch, providing health services in 158 centres, of which 84 had never been served by a doctor before. The curriculum is community oriented. The mean age of doctors was 32.5 years, 57% were males, and 32% were graduates from the University of Gezira. Respondents stated high confidence in practicing some skills such as asthma management and post-abortion uterine evacuation. They were least confident in other skills such as managing depression or inserting an intrauterine device. The majority of health centres was poorly equipped for management of noncommunicable diseases, as only 10% had an electrocardiography machine (ECG), 5% had spirometer, and 1% had a defibrillator. Conclusions The Gezira model has responded to local health system needs. Use of modern information and communication technology is used to facilitate both health service provision and training. The GFMP represents an example of a large-volume scaling-up programme of family medicine in Africa. PMID:24443978

  6. [Pain medicine as a cross-sectional subject in German medical schools. An opportunity for general pain management].

    Science.gov (United States)

    Kopf, A; Dusch, M; Alt-Epping, B; Petzke, F; Treede, R-D

    2014-08-01

    Unrelieved pain is a substantial public health concern owing in part to deficits in clinical expertise among physicians. In most medical faculties worldwide, teaching on pain and pain management is either nonexistent or limited to a small number of students attending voluntary courses. In light of the fact that pain is the most frequent reason to seek medical advice, the lack of formal training of pain medicine is considered the leading reason for inadequate pain management. Therefore, the patients' unmet needs for adequate diagnosis and therapy call for action. Pain assessment and effective pain management should be a priority in the health care system. The limited number of pain specialists available in hospitals and primary care and CME (continuous medical education) activities focusing on pain are not sufficient to solve the problem. Every practicing physician should, therefore, have basic knowledge of the most prominent painful conditions and management strategies. To achieve this goal, pain medicine should become an integral part of the undergraduate curriculum for medical students. In Germany, pain medicine became a mandatory subject in undergraduate medical studies in 2012. The introduction of pain medicine into the undergraduate curriculum in Germany is a major challenge regarding the development and implementation processes. This article describes current instruments and implementation strategies for pain medicine as a new cross-sectional subject in Germany.

  7. The hospital educational environment and performance of residents in the General Medicine In-Training Examination: a multicenter study in Japan

    Directory of Open Access Journals (Sweden)

    Shimizu T

    2013-07-01

    Full Text Available Taro Shimizu,1 Yusuke Tsugawa,2,3 Yusuke Tanoue,4 Ryota Konishi,5 Yuji Nishizaki,6 Mitsumasa Kishimoto,7 Toshiaki Shiojiri,8 Yasuharu Tokuda9 1Hospitalist Division, Department of Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan; 2Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; 3Center for Clinical Epidemiology, St Luke's Life Science Institute, 4Department of Vascular and Oncological Surgery, Hospital of Tokyo University, 5Department of General Internal Medicine, Kanto Rousai Hospital, 6Department of Cardiology, Juntendo University School of Medicine, 7Division of Rheumatology, St Luke's International Hospital, Tokyo, Japan; 8Asahi Chuo Hospital, Chiba, Japan; 9Department of Medicine, Tsukuba University Mito Kyodo General Hospital, Mito City, Ibaraki, Japan Background: It is believed that the type of educational environment in teaching hospitals may affect the performance of medical knowledge base among residents, but this has not yet been proven. Objective: We aimed to investigate the association between the hospital educational environment and the performance of the medical knowledge base among resident physicians in Japanese teaching hospitals. Methods: To assess the knowledge base of medicine, we conducted the General Medicine In-Training Examination (GM-ITE for second-year residents in the last month of their residency. The items of the exam were developed based on the outcomes designated by the Japanese Ministry of Health, Labor, and Welfare. The educational environment was evaluated using the Postgraduate Hospital Educational Environment Measure (PHEEM score, which was assessed by a mailed survey 2 years prior to the exam. A mixed-effects linear regression model was employed for the analysis of variables associated with a higher score. Results: Twenty-one teaching hospitals participated in the study and a total of 206 residents (67 women participated and

  8. Impacts of the EISA 2007 Energy Efficiency Standard on General Service Lamps

    Energy Technology Data Exchange (ETDEWEB)

    Kantner, Colleen L. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Alstone, Andrea L. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Ganeshalingam, Mohan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Gerke, Brian F. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Hosbach, Robert [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2017-01-20

    The Energy Policy and Conservation Act of 1975, as amended by the Energy Independence and Security Act of 2007 (EISA 2007), requires that, effective beginning January 1, 2020, the Secretary of Energy shall prohibit the sale of any general service lamp (GSL) that does not meet a minimum efficacy standard of 45 lumens per watt. This is referred to as the EISA 2007 backstop. The U.S. Department of Energy recently revised the definition of the term GSL to include certain lamps that were either previously excluded or not explicitly mentioned in the EISA 2007 definition. For this subset of GSLs, we assess the impacts of the EISA 2007 backstop on national energy consumption, carbon dioxide emissions, and consumer expenditures. To estimate these impacts, we projected the energy use, purchase price, and operating cost of representative lamps purchased during a 30-year analysis period, 2020-2049, for cases in which the EISA 2007 backstop does and does not take effect; the impacts of the backstop are then given by the difference between the two cases. In developing the projection model, we also performed the most comprehensive assessment to date of usage patterns and lifetime distributions for the analyzed lamp types in the United States. There is substantial uncertainty in the estimated impacts, which arises from uncertainty in the speed and extent of the market conversion to solid state lighting technology that would occur in the absence of the EISA 2007 backstop. In our central estimate we find that the EISA 2007 backstop results in significant energy savings of 27 quads and consumer net present value of $120 billion (at a seven percent discount rate) for lamps shipped between 2020 and 2049, and carbon dioxide emissions reduction of 540 million metric tons by 2030 for those GSLs not explicitly included in the EISA 2007 definition of a GSL.

  9. Impact of the EISA 2007 Energy Efficiency Standard on General Service Lamps

    Energy Technology Data Exchange (ETDEWEB)

    Kantner, Colleen L.S. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Alstone, Andrea L. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Ganeshalingam, Mohan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Gerke, Brian F. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Hosbach, Robert [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2017-06-20

    The Energy Policy and Conservation Act of 1975, as amended by the Energy Independence and Security Act of 2007 (EISA 2007), requires that, effective beginning January 1, 2020, the Secretary of Energy shall prohibit the sale of any general service lamp (GSL) that does not meet a minimum efficacy standard of 45 lumens per watt. This is referred to as the EISA 2007 backstop. The U.S. Department of Energy recently revised the definition of the term GSL to include certain lamps that were either previously excluded or not explicitly mentioned in the EISA 2007 definition. For this subset of GSLs, we assess the impacts of the EISA 2007 backstop on national energy consumption, carbon dioxide emissions, and consumer expenditures. To estimate these impacts, we projected the energy use, purchase price, and operating cost of representative lamps purchased during a 30-year analysis period, 2020-2049, for cases in which the EISA 2007 backstop does and does not take effect; the impacts of the backstop are then given by the difference between the two cases. In developing the projection model, we also performed the most comprehensive assessment to date of usage patterns and lifetime distributions for the analyzed lamp types in the United States. There is substantial uncertainty in the estimated impacts, which arises from uncertainty in the speed and extent of the market conversion to solid state lighting technology that would occur in the absence of the EISA 2007 backstop. In our central estimate we find that the EISA 2007 backstop results in significant energy savings of 27 quads and consumer net present value of $120 billion (at a seven percent discount rate) for lamps shipped between 2020 and 2049, and carbon dioxide emissions reduction of 540 million metric tons by 2030 for those GSLs not explicitly included in the EISA 2007 definition of a GSL.

  10. Evaluation of the effectiveness of postgraduate general medicine training by objective structured clinical examination---pilot study and reflection on the experiences of Kaohsiung Medical University Hospital.

    Science.gov (United States)

    Tsai, Jer-Chia; Liu, Keh-Min; Lee, Kun-Tai; Yen, Jo-Chu; Yen, Jeng-Hsien; Liu, Ching-Kuan; Lai, Chung-Sheng

    2008-12-01

    Objective structured clinical examination (OSCE) is an effective assessment method to evaluate medical students' clinical competencies performance. Postgraduate year 1 (PGY1) residents have been initiated in a general medicine training program in Taiwan since 2003. However, little is known about the learning effectiveness of trainees from this program. This pilot study aimed to evaluate the clinical core competencies of PGY1 residents using OSCE, and to reflect on the strengths and weaknesses of this pilot assessment project. OSCE was conducted for five PGY1 examinees (4 men, 1 woman) with five stations covering core themes, including history taking, physical examination, clinical procedure of airway intubation, clinical reasoning, and communication skills for informing bad news. Itemized checklists and five-point Likert scale global ratings were used for evaluating performance. The results showed that the performance of our PGY1 residents on history taking was significantly better after about 2 months of postgraduate training on general internal medicine. Self-evaluation on performance by examinees revealed significantly lower global ratings on post-course OSCE (4.14 +/- 0.80 vs. 3.68 +/- 0.66; p OSCEs showed consistently favorable responses on the purposes, content, process, and environment of this assessment (4.0 +/- 0.17 vs. 4.0 +/- 0.12, nonsignificant). However, a survey of the examinees completed at pre- and post-course OSCEs showed relatively unfavorable responses to the same aspects, and to tutors and SPs (4.1 +/- 0.09 vs. 3.7 +/- 0.18; p clinical reasoning performance, communication skills (giving bad news) and self-confidence were unsatisfactory. In conclusion, this pilot study has demonstrated that OSCE is a rational and feasible assessment method for evaluating the effectiveness of our PGY general medicine training program. The quantitative data and qualitative information provide a foundation to improve the quality of the program design and evaluation

  11. Tongrentang,A Pearl of Chinese Traditional Medicine Interview with Mei Qun, General Manager of China Beijing Tongrentang(Group) Co., Ltd.

    Institute of Scientific and Technical Information of China (English)

    Sun Yongjian; Bai Yifeng

    2006-01-01

    @@ On June 10, China Beijing Tongrentang (Group) Co., Ltd. celebrated its first Day of Cultural Heritage because its brand Tongrentang had been registered in the Directory of Chinese Intangible Cultural Heritages. Tongrentang is welknown in China for its effective Chinese traditional medicine, but what is the core value of the brand? Mei Qun, General Manager of China Beijing Tongrentang(Group) Co., Ltd. let the secret out when interviewed by China's Foreign Trade.

  12. 知识服务及其在中医药领域的应用%Knowledge Services and Applications in Traditional Chinese Medicine

    Institute of Scientific and Technical Information of China (English)

    于彤; 于琦; 李敬华; 杨硕; 张竹绿

    2015-01-01

    目的:通过发展中医药知识服务,促进中医药知识与经验的保护与传承。方法:根据服务计算理论,阐述知识服务的概念和性质,设计并实现中医药知识服务平台。结果:中医药知识服务平台整合中医药知识资源,实现了百科知识服务、知识搜索服务、知识发现服务、决策支持服务等中医药知识服务模式。结论:中医药知识服务平台面向中医专家和社会大众提供知识服务,为中医药科学研究、临床实践和新药研发提供了有力支持。%Objective: To develop knowledge services for the preservation and inheritance of knowledge and experience in Traditional Chinese Medicine (TCM) domain. Methods: Explains the concept and characteristics of knowledge services according to service computing theory, and design and implement the knowledge services platform for TCM domain. Results:The knowledge services platform integrates TCM knowledge resources, implements various types of knowledge services, such as encyclopedia services, knowledge search services, knowledge discovery services, decision support services, in order to provide reference for the development of knowledge services in TCM domain. Conclusion: The knowledge services platform provides services for TCM experts and the public, and facilitates TCM research, clinical practices, and drug discovery.

  13. Giving information on medicinal products to the general public--in search of a definition to safeguard the patient.

    Science.gov (United States)

    Faeh, Andrea

    2014-04-01

    Information on medicinal products is vital for enabling patients to give informed consent to the use of a specific product. Within the European Union (EU) the debate about how much information about prescription-only medicinal products should be made available to patients has gone on for the past five years with no definite conclusion yet. This contribution assesses the current legislation and the ongoing debate in order to identify the challenges and the prospect of new legislation, and consider its potential implications for the scope for advertising and for patient safety.

  14. Development and evaluation of Standard Operating Procedures (SOPs) for quality control tests and radiological protection activities in a Nuclear Medicine Service

    Energy Technology Data Exchange (ETDEWEB)

    Krempser, Alexandre R., E-mail: krempser@peb.ufrj.br [Universidade Federal do Rio de Janeiro (PEB/COPPE/UFRJ), RJ (Brazil). Programa de Engenharia Biomedica; Soares, Alexandre B. [Universidade Federal do Rio de Janeiro (IF/UFRJ), Rio de Janeiro, RJ (Brazil). Inst. de Fisica; Corbo, Rossana [Universidade Federal do Rio de Janeiro (FM/UFRJ), Rio de Janeiro, RJ (Brazil). Dept. de Radiologia

    2011-07-01

    The quality management in Nuclear Medicine Services is a requirement of national and international standards. The Brazilian regulatory agency in health surveillance, the Agencia Nacional de Vigilancia Sanitaria (ANVISA), in its Resolucao de Diretoria Colegiada (Collegiate Directory Resolution) no. 38, requires the elaboration of documents describing the technical and clinical routine activities. This study aimed to elaborate, implement and evaluate Standard Operating Procedures (SOPs) for quality control tests and radiological protection activities in the Nuclear Medicine Service of a university hospital. Eighteen SOPs were developed, involving tasks related to dose calibrator, gamma camera, Geiger-Muller detectors and radiological protection activities. The performance of its application was evaluated for a period of six months. It was observed a reduction in 75% of reported operational errors and 42% of the number of reported incidents with contamination by radioactive material. The SOPs were adequate and successful in its application. New procedures involving clinical activities will also be developed and evaluated. (author)

  15. [The information on a sanitary-and-epidemiologic condition of general educational establishments and catering services of schoolboys].

    Science.gov (United States)

    Onishchenko, G G

    2008-01-01

    The federal service on supervision in sphere of protection of the rights of consumers and well-being of the person develops normative and methodical documents, including sanitary rules and the norms defining hygienic parameters of food value of food raw material and foodstuff, children used in a feed and teenagers; requirements to catering services of pupils of various types of teaching and educational establishments. Decisions of the Main state health officer of the Russian Federation, the conditions directed on improvement and catering services in educational establishments are published. At participation of Rospotrebnadzor's experts on subjects of the Russian Federation the regional programs directed on improvement of catering services of pupils are developed. The information on a condition of general educational establishments with offers on improvement of a sanitary-engineering condition, goes to address of enforcement authorities.

  16. A General Investigation of the In-Service Training of English Language Teachers at Elementary Schools in Turkey

    Directory of Open Access Journals (Sweden)

    Ebru Melek KOÇ

    2016-03-01

    Full Text Available This study presents a critical diagnosis of in-service teacher-training activities offered to English-language teachers in Turkey and aims to investigate whether those teachers are satisfied with the activities. Thirty-two English-language teachers participated in this study. Data were collected from 32 elementary-school teachers of English as a foreign language, using a general evaluation form prepared by the researcher. The results indicate that the teachers are not satisfied with their in-service teacher-training activities and that in-service training does not fulfil their needs. The study also proposes an in-service teacher training model in distance format.

  17. 以能力为本全科医学住院医师培训方案的初步评价研究%Preliminary Evaluation of the General Medicine Residency Training Program Based on Competency

    Institute of Scientific and Technical Information of China (English)

    杜改燕; 王爽; 苏婷婷; 许龙龙; 齐殿君; 于晓松

    2012-01-01

    目的 以能力为本的全科医学住院医师培训方案实施过程中开展了形成性评价研究,以进一步完善培训方案,提高培训质量.方法 采用问卷调查、个别访谈、理论考试、客观结构化临床考试、360°评估等方法对全科医学住院医师培训实施方案进行中期评价研究.结果 本研究对由9个培训模块构成的、以能力为本的全科医学住院医师培训方案进行了中期评价研究,结果表明,该方案实施后,住院医师的道德素质、人际交往与沟通能力、医疗、教学能力均有不同程度的提高,同时强化了全科医师的核心能力.结论 以能力为本的全科医学住院医师培训方案有助于更好地为社区培养适宜的高素质全科医师.%Objective A formative evaluation study was conducted in the implementation process of the competency -based general medicine residency training program, in order to further improve training programs and increase effectiveness of training. Methods The questionnaire surveys, interviews, theoretical examinations, objective structured clinical tests, andgram. Results The study contained nine training modules, dealing with mid - term evaluation of competency - based general medicine residency training program. The results showed that, after the implementation of the program, the general practitioners' moral integrity, interpersonal and communication skills, and medical service and teaching competencies had to different degrees improved. Meanwhile, the core competencies of general practitioners were also enhanced. Conclusion The competency - based general medicine residency training program is conducive to training appropriate and qualified general practitioners for community.

  18. 75 FR 41093 - General Services Administration Acquisition Regulation; Rewrite of GSAR Part 516, Types of Contracts

    Science.gov (United States)

    2010-07-15

    ... contracts for architect-engineer (A-E) services and the addition of the verbiage ``under the PBS Design... GSAR 516.603-70, Limitations on the use of letter contracts for architect-engineer (A-E) services. This... prohibition placed on contracting officers to ``not authorize the A-E to begin the design effort before...

  19. 26 CFR 31.3121(b)-4 - Employment; excepted services in general.

    Science.gov (United States)

    2010-04-01

    ... employer. If not otherwise provided in the regulations relating to the numbered paragraphs of section 3121(b), such regulations apply to services performed after 1954. (b) The exception attaches to the... constitute employment. While no tax liability is incurred with respect to A's remuneration for services...

  20. Effect of comanagement with internal medicine on hospital stay of patients admitted to the Service of Otolaryngology.

    Science.gov (United States)

    Montero Ruiz, Eduardo; Rebollar Merino, Ángela; Rivera Rodríguez, Teresa; García Sánchez, Marta; Agudo Alonso, Rosa; Barbero Allende, José Maria

    2015-01-01

    Patients admitted to the Department of Otolaryngology (ENT) are increasing in age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. We studied the effect of co-management on length of stay (LoS) in hospital for patients admitted to ENT. This was a retrospective observational study including patients ≥14 years old discharged from ENT between 1/1/2009 and 30/06/2013, with co-management from May/2011. We analysed age, sex, type of admission, whether the patient was operated, administrative weight associated with DRG, total number of discharge diagnoses, Charlson comorbidity index (CCI), deaths, readmissions and LoS. There were statistically significant differences between both groups in age (4.5 years; 95% confidence interval [95% CI] 2.8-6.3), emergency admissions (odds ratio [OR] 1.4; 95% CI 1.1-1.8), administrative weight (0.3637; 95% CI 0.0710-0.6564), number of diagnoses (1.3; 95% CI 1-1.6), CCI (0.4; 95% CI 0.2-0.6) and deaths (OR 4.1; 95% CI 1.1-15.7). On adjustment, co-management reduced ENT LoS in hospital by 28.6%, 0.8 days (95% CI 0.1-1.6%; P=.038). This reduction represents an ENT savings of at least €165,893. Co-management patients admitted to ENT are increasing in age, comorbidity and complexity. Co-management is associated with reduced LoS and costs in ENT, similar to those observed in other surgical services. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  1. 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.

  2. The impact of clinical pharmacy services in China on the quality use of medicines: a systematic review in context of China's current healthcare reform.

    Science.gov (United States)

    Penm, Jonathan; Li, Yan; Zhai, Suodi; Hu, Yongfang; Chaar, Betty; Moles, Rebekah

    2014-10-01

    Recently, China initiated an ambitious healthcare reform aiming to provide affordable and equitable basic health care to all by 2020. To meet these goals, new policies issued by China's Ministry of Health mandate clinical pharmacy services be integrated into China's hospitals. This review aims to highlight the impact of clinical pharmacy services on the quality use of medicines in hospitals in China. Both English and Chinese databases were used. For the English databases, Web of Science, Medline, International Pharmaceutical Abstracts and Embase were searched using the following keywords ('pharmacists' OR 'pharmacy' OR 'pharmaceutical services/pharmaceutical care') AND ('China'). For the Chinese database, Chinese Biomedical Literature Database on disc was searched using the following keywords ('clinical pharmacist' OR 'clinical pharmacy' OR 'pharmaceutical care' OR 'pharmaceutical services'). Articles were then retrieved from WanFang database and China Knowledge Resource Integrated Database. A total of 75 published papers were included in this review. The majority of studies were conducted in the inpatient setting (68%), which included clinical pharmacy interventions such as educating doctors and patients, evaluating and monitoring the implementation of hospital policies and/or reviewing medications on the ward. In the outpatient setting, the majority of studies conducted involved educating patients. Clinical pharmacy services frequently focused on antimicrobials (44%). More than half of these studies employed an administrative intervention alongside the clinical pharmacy service. Clinical pharmacy services in China, with its unique healthcare system and cultural nuances, appear to positively influence patient care and the appropriate use of medications. From the published literature, it is expected that clinical pharmacy services can make a strong contribution to China's healthcare reform with further governmental and educational support. Published by Oxford

  3. Car travel time and accessibility by bus to general practitioner services: a study using patient registers and GIS.

    Science.gov (United States)

    Lovett, Andrew; Haynes, Robin; Sünnenberg, Gisela; Gale, Susan

    2002-07-01

    Accessibility to general practitioner (GP) surgeries was investigated in a population study of East Anglia (Cambridgeshire, Norfolk and Suffolk) in the United Kingdom. Information from patient registers was combined with details of general practitioner surgery locations, road network characteristics, bus routes and community transport services, and a geographical information system (GIS) was used to calculate measures of accessibility to surgeries by public and private transport. Outcome measures included car travel times and indicators of the extent to which bus services could be used to visit GP surgeries. These variables were aggregated for wards or parishes and then compared with socio-economic characteristics of the populations living in those areas. The results indicated that only 10% of residents faced a car journey of more than 10 min to a GP. Some 13% of the population could not reach general medical services by daily bus. For 5% of the population, the car journey to the nearest surgery was longer than 10 min and there was no suitable bus service each weekday. In the remoter rural parishes, the lowest levels of personal mobility and the highest health needs indicators were found in the places with no daytime bus service each weekday and no community transport. The overall extent of accessibility problems and the existence of inverse care law effects in some rural localities have implications for the NHS, which aims to provide an equitable service to people wherever they live. The research also demonstrates the potential of patient registers and GIS as research and planning tools, though the practical difficulties of using these data sources and techniques should not be underestimated.

  4. 中医药知识服务平台构建的研究%Research on the Construction of Knowledge Services Platforms for Traditional Chinese Medicine

    Institute of Scientific and Technical Information of China (English)

    于彤; 苏大明; 尹仁芳; 张竹绿; 田野

    2014-01-01

    近年来,在互联网上已出现了UpToDate、MD Consult和DynaMed等一系列医学知识服务平台,面向广大医师提供综合性的知识服务和现有的最佳证据,推动了循证医学的发展。这些国外的知识服务平台已得到广泛使用,而我国目前类似的知识服务平台尚不成熟,有关中医药循证临床综述数据库和知识服务平台的研发也属空白。在本文中,介绍了TCMKS这一实验性的中医药知识服务平台,阐述了TCMKS的体系结构、数据模型、主要功能和技术特点,并讨论该平台在乙型肝炎中的适用性与使用情况,以期为中医药工作者在该领域中推广使用循证知识服务提供参考。%In recent years,a series of knowledge services platforms,such as UpToDate,MD Consult, DynaMed were established to provide synthesized knowledge services and the best evidence for clinical physicians,which accelerated the progress of evidence-based medicine.The knowledge service platform has been widely used abroad.But similar knowledge service platform in our country at present is not yet mature.About evidence-based clinical review of traditional Chinese medicine database and development of knowledge service platform is also a blank.This paper introduces TCMKS,an experimental knowledge services platform for Traditional Chinese Medicine,articulates the architecture, data model,functions and technical characteristics of this platform,and discusses the applicability of this platform with a use case in Hepatitis B,in order to provide useful information for those who want to apply knowledge services platforms in Traditional Chinese Medicine.

  5. 一种支持广义服务组合的遗传算法%A Genetic Algorithm for Generalized Real-Life Service Composition

    Institute of Scientific and Technical Information of China (English)

    王显志; 王忠杰; 徐晓飞; 莫同

    2009-01-01

    In the last decade,selection and composition of Web services have drawn increasing attentions.However,real-life services are not only web services but complicated eco-systems composed of various service elements like human,resources,environment,ete,and existing service composition methods cannot be directly applied to such real-life service composition scenarios.In this paper,we propose a conceptual model for generalized real-life service composition.In this model,service behaviors are abstracted as service components and uniformly described by XML.Various service requirements raised by customers are completely listed and classified.Based on these works,a genetic algorithm for real-life service composition is presented to select the best matching service components and compose them together.The algorithm's effectiveness of obtaining optimal solution is proved by a prototype system.

  6. Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice? A cluster randomised controlled trial.

    Science.gov (United States)

    Kortekaas, M F; Bartelink, M E L; Zuithoff, N P A; van der Heijden, G J M G; de Wit, N J; Hoes, A W

    2016-09-13

    Evidence-based medicine (EBM) is an important element in the general practice (GP) specialty training. Studies show that integrating EBM training into clinical practice brings larger benefits than stand-alone modules. However, these studies have neither been performed in GP nor assessed EBM behaviour of former trainees in daily clinical practice. GP specialty training in the Netherlands. All 82 third year GP trainees who started their final third year in 2011 were approached for inclusion, of whom 79 (96%) participated: 39 in the intervention group and 40 in the control group. Integrated EBM training, in which EBM is embedded closely within the clinical context by joint assignments for the trainee and supervisor in daily practice, and teaching sessions based on dilemmas from actual patient consultations. Stand-alone EBM training at the institute only. Our primary outcome was EBM behaviour, assessed by measuring guideline adherence (incorporating rational, motivated deviation) and information-seeking behaviour. Our secondary outcomes were EBM attitude and EBM knowledge. Data were acquired using logbooks and questionnaires, respectively. Analyses were performed using mixed models. Logbook data were available from 76 (96%) of the participating trainees at baseline (7614 consultations), 60 (76%) at the end of the third year (T1, 4973 consultations) and 53 (67%) 1 year after graduation (T2, 3307 consultations). We found no significant differences in outcomes between the 2 groups, with relative risks for guideline adherence varying between 0.96 and 0.99 (95% CI 0.86 to 1.11) at T1, and 0.99 and 1.10 (95% CI 0.92 to 1.25) at T2, and for information-seeking behaviour between 0.97 and 1.16 (95% CI 0.70 to 1.91) and 0.90 and 1.10 (95% CI 0.70 to 1.32), respectively. Integrated EBM training compared with stand-alone EBM training does not improve EBM behaviour, attitude or knowledge of (future) GPs. Published by the BMJ Publishing Group Limited. For permission to use (where

  7. U.S. Department of Health and Human Services Office of Inspector General Advisory Opinion List

    Data.gov (United States)

    U.S. Department of Health & Human Services — This OIG website contains a list of recently issued advisory opinions and a link to archives of previously issued advisory opinions. In accordance with section...

  8. From vision to reality--managing change in the provision of library and information services to nurses, midwives, health visitors and PAMs: (professions allied to medicine) a case study of the North Thames experience with the Inner London Consortium.

    Science.gov (United States)

    Godbolt, S; Williamson, J; Wilson, A

    1997-06-01

    One of the North Thames' pioneering consortia, the Inner London Consortium (ILC) is a complex body which includes NHS Trusts with teaching hospital university connections, community-based Trusts and general hospital acute Trusts. Within the consortium there are 12,000 trained nurses, midwives, health visitors and other professional staff working in the professions allied to medicine (PAMs), all of whom require access to and provision of appropriate library information services. In 1994, taking into account experiences elsewhere in the Region and nationally, it became clear that library issues were complex and would become acute with the move of nursing libraries from ILC Trust sites over a very short timescale. A report on the issues commissioned by the Consortium recommended that a library project, which built on existing NHS Trust PGMDE funded library resources and moved these to a multidisciplinary base to serve the consortium membership, be implemented. The objective of providing access to library information services for nurses and PAMs was achieved. Successes that emerged from the implementation included: The registration in Trust libraries of almost 12 000 new members within the initial 6-month monitoring period. The development of service level agreements and standards for the delivery of services to these new user groups. This paper describes the processes behind these significant and complex changes.

  9. [What Must the (Abdominal) Surgeon Know about Experimental Medicine (?) - Translational Research in General (Abdominal) Surgery(Viszeral-)Chirurg & experimentelle Medizin].

    Science.gov (United States)

    Wex, T; Kuester, D; Meyer, F

    2015-08-01

    Experimental medicine has evolved tremendously in the last few years. In particular, the introduction of novel techniques, in-vitro models, knock-out/transgenic animals and high-through put analytical methodologies have resulted in a deeper understanding of cellular pathophysiology and diseases. The daily clinical management has benefited by the introduction of biomarkers and targeted therapies. This development has been accompanied by increasing specialisation across all fields of research and medicine. Therefore, clinical-translational research requires a team of competent partners nowadays. The visceral surgeon can contribute significantly to these projects. The present review highlights several aspects of translational research and put chances and potential pitfalls into perspective in context with the work of the visceral surgeon.

  10. Personal stigma and use of mental health services among people with depression in a general population in Finland

    Directory of Open Access Journals (Sweden)

    Tuulari Jyrki

    2011-03-01

    Full Text Available Abstract Background A minority of people suffering from depression seek professional help for themselves. Stigmatizing attitudes are assumed to be one of the major barriers to help seeking but there is only limited evidence of this in large general population data sets. The aim of this study was to analyze the associations between mental health attitude statements and depression and their links to actual use of mental health services among those with depression. Methods We used a large cross-sectional data set from a Finnish population survey (N = 5160. Attitudes were measured by scales which measured the belief that people with depression are responsible for their illness and their recovery and attitudes towards antidepressants. Desire for social distance was measured by a scale and depression with the Composite International Diagnostic Interview Short Form (CIDI-SF instrument. Use of mental health services was measured by self-report. Results On the social discrimination scale, people with depression showed more social tolerance towards people with mental problems. They also carried more positive views about antidepressants. Among those with depression, users of mental health services, as compared to non-users, carried less desire for social distance to people with mental health problems and more positive views about the effects of antidepressants. More severe depression predicted more active use of services. Conclusions Although stronger discriminative intentions can reduce the use of mental health services, this does not necessarily prevent professional service use if depression is serious and views about antidepressant medication are realistic.

  11. Defensive medicine in general practice: recent trends and the impact of the Civil Liability Act 2002 (NSW).

    Science.gov (United States)

    Salem, Omar; Forster, Christine

    2009-10-01

    This article presents the results of a survey conducted among New South Wales medical practitioners to assess the extent to which the enactment of the Civil Liability Act 2002 (NSW) has reduced the practice of defensive medicine. The new legislation was intended in part to reduce the practice of defensive medicine, both "assurance-type" measures, such as performing additional tests to assure patients they have received all possible care, and "avoidance-type" measures, such as avoiding the treatment of patients who may be at a higher risk for adverse outcomes and therefore at higher risk for filing lawsuits. However, the results of the survey reveal that many medical practitioners in New South Wales remain unaware of the legal reforms and the consequent reduction in their legal liability and continue to practise defensive medicine. This article argues therefore that while the ultimate aim of reducing litigation has been achieved in New South Wales through the introduction of the Civil Liability Act, the underlying and arguably more important aim of providing medical practitioners with a more secure environment in which to practise their profession effectively has not been achieved. The apparent failure to disseminate the legal changes to the medical profession illustrates the limitations of law reform to effectively engender social change without the active use of educative and other implementation initiatives.

  12. Critical evaluation of the external occupational exposure in nuclear medicine services in Brazil; Avaliacao critica da exposicao ocupacional externa nos servicos de medicina nuclear no Brasil

    Energy Technology Data Exchange (ETDEWEB)

    Kubo, Ana Luiza Silva Lima

    2016-07-01

    Currently in Brazil (2016), there are 421 Nuclear Medicine Services (NMS). In nuclear medicine, the possibility of occupational internal contamination and external exposure is unavoidable. The chest individual monitoring, to estimate the effective dose, is mandatory, but the extremity monitoring is not always made. The aim of this study was to conduct a survey of data for external exposure of NMS professionals in Brazil from 1987 to 2010, analysing them in terms of trends and comparing them with measurements carried out in this work and in other countries. Although most of the NMS is still located in large urban centres (54% in the Southeast region), there is no state without any NMS. The increasing number of NMS has generated the need for more professionals. In the year 1987, they were 755 workers and, in 2010, 4134, with the following distribution of specialties: 29% of Nuclear Medicine Technicians (NMT), 23% of Nursing professionals, 29% of Physicians and 3% of Physicists. The average annual effective dose reached more than 3.0 mSv in some regions of the country, from 1987 to 2010, but tends to 1.0 mSv in 2010. The highest doses, as expected, are received by NMT and Nursing. The professionals who handle radiopharmaceuticals have their hands much more exposed than the chest. During 2010, only 31% of NMT and 16% of Nursing used extremity dosimeters as compared to chest dosimeters. The data from the measurements indicate that not all individual dosimeters are used properly. Generally, both in the measurements as in national registries, the hand doses were higher for professionals who prepared the radiopharmaceutical (NMT) than those who injected (Nursing). The value measured by chest dosimeters can be used to estimate the equivalent dose to the eye lenses, except for NMT at preparation practices at conventional NMS, where the equivalent dose of the lens is about 2 times higher than the dose at the chest. The most exposed areas of the hands are the tips of the index

  13. Calculation of dose due to exposure internal in the services of nuclear medicine of Peru; Calculo de dosis debida a la exposicion interna en los servicios de medicina nuclear del Peru

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez, S.; Zapata, L.; Cardenas, A.; Velasquez, M.

    2013-07-01

    The objective of this work is to improve the radiation protection of workers occupationally exposed to open source of nuclear medicine services and train those responsible for radiation protection of such installations to carry a comprehensive record of doses. (Author)

  14. Quantitative Analysis of Contributing Factors Affecting Patient Satisfaction in Family Medicine Service Clinics at Brooke Army Medical Center

    Science.gov (United States)

    2008-06-06

    physicians, Doctors of Medicine (M.D.) or Doctors of Osteopathy (D.O.); physician assistants; or clinical nurse practitioners. Physicians, physician...treatment methods including spinal manipulation and the whole body concept and confer the Doctor of Osteopathy (D.O.) degree. After completion of...medical school, both Doctors of Medicine and Doctors of Osteopathy are licensed by their state boards and may become board certified in any medical

  15. 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

  16. 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.

  17. [Feasibility of consultation - liaison psychiatry in a large general hospital: quantitative description of services and personnel expenditure].

    Science.gov (United States)

    Windhager, Elmar; Thaler, Katharina; Selberis-Vahl, Wilia Vasiliki; Friedl-Wörgetter, Petra; Windhager, Isabella; Zauner, Katharina

    2015-01-01

    The integration of psychiatric departments in general hospitals lead to an increasing demand of psychiatric consultation, which often overstrains personnel resources of short staffed psychiatric services. To provide consulting service, as it is demanded by guidelines, a multidisciplinary consulting team could be a possible solution. A retrospective descriptive analysis of all consultations made by the psychosocial consultation and liaison service at the general hospital Wels-Grieskirchen in the years 2012 and 2013. There was an increase in referrals overall of 22 % from 2012 to 2013. The largest increase was observed in the group of psychiatrists, who carried out 33.1 % of all consultations. Most consultations, 39.5 %, were done by the group of clinical psychologists, partly substituting medical attendance. Taking together both occupational groups, the expected number of consultations of at least 3 % of all admissions could be achieved. A multidisciplinary consulting team consisting of psychiatrists, psychologists, psychosomatic physicians and social workers staffed with 5.11-6.79 full-time personnel is able to provide psychosocial consultation service at a quantitative level required by international guidelines.

  18. Shared care between specialised psychiatric services and primary care: The experiences and expectations of General Practitioners in Ireland.

    LENUS (Irish Health Repository)

    Agyapong, Vincent Israel Opoku

    2012-04-17

    Objective. The study aims to explore the views of General Practitioners in Ireland on shared care between specialised psychiatric services and primary care. Method. A self-administered questionnaire was designed and posted to 400 randomly selected General Practitioners working in Ireland. Results. Of the respondents, 189 (94%) reported that they would support a general policy on shared care between primary care and specialised psychiatric services for patients who are stable on their treatment. However, 124 (61.4%) reported that they foresaw difficulties for patients in implementing such a policy including: a concern that primary care is not adequately resourced with allied health professionals to support provision of psychiatric care (113, 53.2%); a concern this would result in increased financial burden on some patients (89, 48.8%); a lack of adequate cooperation between primary care and specialised mental health services (84, 41.8%); a concern that some patients may lack confidence in GP care (55, 27.4%); and that primary care providers are not adequately trained to provide psychiatric care (29, 14.4% ). Conclusion. The majority of GPs in Ireland would support a policy of shared care of psychiatric patients; however they raise significant concerns regarding practical implications of such a policy in Ireland.

  19. Interprofessional collaboration between residents and nurses in general internal medicine: a qualitative study on behaviours enhancing teamwork quality.

    Science.gov (United States)

    Muller-Juge, Virginie; Cullati, Stéphane; Blondon, Katherine S; Hudelson, Patricia; Maître, Fabienne; Vu, Nu V; Savoldelli, Georges L; Nendaz, Mathieu R

    2014-01-01

    Effective teamwork is necessary for optimal patient care. There is insufficient understanding of interactions between physicians and nurses on internal medicine wards. To describe resident physicians' and nurses' actual behaviours contributing to teamwork quality in the setting of a simulated internal medicine ward. A volunteer sample of 14 pairs of residents and nurses in internal medicine was asked to manage one non-urgent and one urgent clinical case in a simulated ward, using a high-fidelity manikin. After the simulation, participants attended a stimulated-recall session during which they viewed the videotape of the simulation and explained their actions and perceptions. All simulations were transcribed, coded, and analyzed, using a qualitative method (template analysis). Quality of teamwork was assessed, based on patient management efficiency and presence of shared management goals and of team spirit. Most resident-nurse pairs tended to interact in a traditional way, with residents taking the leadership and nurses executing medical prescriptions and assuming their own specific role. They also demonstrated different types of interactions involving shared responsibilities and decision making, constructive suggestions, active communication and listening, and manifestations of positive team building. The presence of a leader in the pair or a truly shared leadership between resident and nurse contributed to teamwork quality only if both members of the pair demonstrated sufficient autonomy. In case of a lack of autonomy of one member, the other member could compensate for it, if his/her own autonomy was sufficiently strong and if there were demonstrations of mutual listening, information sharing, and positive team building. Although they often relied on traditional types of interaction, residents and nurses also demonstrated readiness for increased sharing of responsibilities. Interprofessional education should insist on better redefinition of respective roles and

  20. Interprofessional collaboration between residents and nurses in general internal medicine: a qualitative study on behaviours enhancing teamwork quality.

    Directory of Open Access Journals (Sweden)

    Virginie Muller-Juge

    Full Text Available BACKGROUND: Effective teamwork is necessary for optimal patient care. There is insufficient understanding of interactions between physicians and nurses on internal medicine wards. OBJECTIVE: To describe resident physicians' and nurses' actual behaviours contributing to teamwork quality in the setting of a simulated internal medicine ward. METHODS: A volunteer sample of 14 pairs of residents and nurses in internal medicine was asked to manage one non-urgent and one urgent clinical case in a simulated ward, using a high-fidelity manikin. After the simulation, participants attended a stimulated-recall session during which they viewed the videotape of the simulation and explained their actions and perceptions. All simulations were transcribed, coded, and analyzed, using a qualitative method (template analysis. Quality of teamwork was assessed, based on patient management efficiency and presence of shared management goals and of team spirit. RESULTS: Most resident-nurse pairs tended to interact in a traditional way, with residents taking the leadership and nurses executing medical prescriptions and assuming their own specific role. They also demonstrated different types of interactions involving shared responsibilities and decision making, constructive suggestions, active communication and listening, and manifestations of positive team building. The presence of a leader in the pair or a truly shared leadership between resident and nurse contributed to teamwork quality only if both members of the pair demonstrated sufficient autonomy. In case of a lack of autonomy of one member, the other member could compensate for it, if his/her own autonomy was sufficiently strong and if there were demonstrations of mutual listening, information sharing, and positive team building. CONCLUSIONS: Although they often relied on traditional types of interaction, residents and nurses also demonstrated readiness for increased sharing of responsibilities. Interprofessional

  1. GENERAL INFORMATION AND MAIN CHARACTERISTICS REGARDING WEB SERVICES. PROTOCOL SOAP AND REST

    Directory of Open Access Journals (Sweden)

    MIRONELA PIRNAU

    2009-05-01

    Full Text Available A web service represents a communication interface offered by the server, through that the clients (programs on other systems may require different information. The customer may vary, may be present on the same computer server, may be in the same local n

  2. 49 CFR 192.367 - Service lines: General requirements for connections to main piping.

    Science.gov (United States)

    2010-10-01

    ... connections to main piping. 192.367 Section 192.367 Transportation Other Regulations Relating to... (CONTINUED) PIPELINE SAFETY TRANSPORTATION OF NATURAL AND OTHER GAS BY PIPELINE: MINIMUM FEDERAL SAFETY... requirements for connections to main piping. (a) Location. Each service line connection to a main must...

  3. Speech-Language Pathologist and General Educator Collaboration: A Model for Tier 2 Service Delivery

    Science.gov (United States)

    Watson, Gina D.; Bellon-Harn, Monica L.

    2014-01-01

    Tier 2 supplemental instruction within a response to intervention framework provides a unique opportunity for developing partnerships between speech-language pathologists and classroom teachers. Speech-language pathologists may participate in Tier 2 instruction via a consultative or collaborative service delivery model depending on district needs.…

  4. General Economic and Demographic Background and Projections for Indiana Library Services.

    Science.gov (United States)

    Foust, James D.; Tower, Carl B.

    Before future library needs can be estimated, economic and demographic variables that influence the demand for library services must be projected and estimating equations relating library needs to economic and demographic parameters developed. This study considers the size, location and age-sex characteristics of Indiana's current population and…

  5. A General Evaluation for Recycling Process of Impregnated Wood Removed From the Service

    Directory of Open Access Journals (Sweden)

    Cihat Taşçıoğlu

    2011-03-01

    Full Text Available Wood presevatives such as creosote, pentaclorophenol (PCP and chromated copper arsenate (CCA have been widely used over the years in order to extend wood products’ service life. CCA was known as most widely used wood preservative chemical in residendial and commercial applications world wide until 2004 volanteered phase out of the chemical from residential use bye the major manufacturers. Over the years CCA treated wood acuumulated in service reaching millions of cubic meters. But there is growing concern about the environmental impacts and increasing difficulty in disposing of treated wood products in many countries. Since disposal of CCA treated wood material poses greater problems than the other treated wood products due to heavy and toxic metal componets of CCA such as chromium and arsenic Traditional disposal methods like landfillig or incineration, both have negative environmental consequences. For that reason the increasing volume of CCA-treated wood products coming out of service requires alternative disposal methods and recycling techniques never tried before. The main purpose of this study, except for traditional methods like landfilling and incineration, is to evaluate the current alternative disposal and recycling methods for CCA treated wood removed from service.

  6. Integrative Medicine in Preventive Medicine Education: Competency and Curriculum Development for Preventive Medicine and Other Specialty Residency Programs.

    Science.gov (United States)

    Jani, Asim A; Trask, Jennifer; Ali, Ather

    2015-11-01

    During 2012, the USDHHS's Health Resources and Services Administration funded 12 accredited preventive medicine residencies to incorporate an evidence-based integrative medicine curriculum into their training programs. It also funded a national coordinating center at the American College of Preventive Medicine, known as the Integrative Medicine in Preventive Medicine Education (IMPriME) Center, to provide technical assistance to the 12 grantees. To help with this task, the IMPriME Center established a multidisciplinary steering committee, versed in integrative medicine, whose primary aim was to develop integrative medicine core competencies for incorporation into preventive medicine graduate medical education training. The competency development process was informed by central integrative medicine definitions and principles, preventive medicine's dual role in clinical and population-based prevention, and the burgeoning evidence base of integrative medicine. The steering committee considered an interdisciplinary integrative medicine contextual framework guided by several themes related to workforce development and population health. A list of nine competencies, mapped to the six general domains of competence approved by the Accreditation Council of Graduate Medical Education, was operationalized through an iterative exercise with the 12 grantees in a process that included mapping each site's competency and curriculum products to the core competencies. The competencies, along with central curricular components informed by grantees' work presented elsewhere in this supplement, are outlined as a roadmap for residency programs aiming to incorporate integrative medicine content into their curricula. This set of competencies adds to the larger efforts of the IMPriME initiative to facilitate and enhance further curriculum development and implementation by not only the current grantees but other stakeholders in graduate medical education around integrative medicine training.

  7. A real-world approach to Evidence-Based Medicine in general practice: a competency framework derived from a systematic review and Delphi process.

    Science.gov (United States)

    Galbraith, Kevin; Ward, Alison; Heneghan, Carl

    2017-05-03

    Evidence-Based Medicine (EBM) skills have been included in general practice curricula and competency frameworks. However, GPs experience numerous barriers to developing and maintaining EBM skills, and some GPs feel the EBM movement misunderstands, and threatens their traditional role. We therefore need a new approach that acknowledges the constraints encountered in real-world general practice. The aim of this study was to synthesise from empirical research a real-world EBM competency framework for general practice, which could be applied in training, in the individual pursuit of continuing professional development, and in routine care. We sought to integrate evidence from the literature with evidence derived from the opinions of experts in the fields of general practice and EBM. We synthesised two sets of themes describing the meaning of EBM in general practice. One set of themes was derived from a mixed-methods systematic review of the literature; the other set was derived from the further development of those themes using a Delphi process among a panel of EBM and general practice experts. From these two sets of themes we constructed a real-world EBM competency framework for general practice. A simple competency framework was constructed, that acknowledges the constraints of real-world general practice: (1) mindfulness - in one's approach towards EBM itself, and to the influences on decision-making; (2) pragmatism - in one's approach to finding and evaluating evidence; and (3) knowledge of the patient - as the most useful resource in effective communication of evidence. We present a clinical scenario to illustrate how a GP might demonstrate these competencies in their routine daily work. We have proposed a real-world EBM competency framework for general practice, derived from empirical research, which acknowledges the constraints encountered in modern general practice. Further validation of these competencies is required, both as an educational resource and as a

  8. Use of complementary and alternative medicine for physical performance, energy, immune function, and general health among older women and men in the United States.

    Science.gov (United States)

    Tait, Elizabeth M; Laditka, Sarah B; Laditka, James N; Nies, Mary A; Racine, Elizabeth F

    2012-01-01

    We examined use of complementary and alternative medicine (CAM) for health and well-being by older women and men. Data were from the 2007 National Health Interview Survey, representing 89.5 million Americans ages 50+. Multivariate logistic regression accounted for the survey design. For general health, 52 million people used CAM. The numbers for immune function, physical performance, and energy were 21.6, 15.9, and 10.1 million respectively. In adjusted results, women were much more likely than men to use CAM for all four reasons, especially energy. Older adults, particularly women, could benefit from research on CAM benefits and risks.

  9. Maintaining connections: some thoughts on the value of intensive care unit rounding for general medicine ward teams.

    Science.gov (United States)

    Howell, Joel D

    2011-09-06

    When established ward patients are unexpectedly transferred to an intensive care unit (ICU), the ward team should continue to follow them. Although there may be reasons not to do so, the advantages outweigh the obstacles. Great pedagogic value can be gained from following patients after acute decompensation, but a more important reason is that by following patients into the ICU, the ward team can enact for both patients and their families the twin virtues of caring and continuity. Doing so also demonstrates the highest ideals of medicine-that we are focused not on defined areas of turf, but on our patient's well-being. It shows that we are not merely doing narrowly defined "shift work," but that we truly care about our patients. Rounding on established patients who have been transferred into the ICU is the sort of behavior that undergirds the fundamental bases of professionalism. It takes a few minutes from a busy day, but it can be incredibly beneficial for families, patients, and the ideals of medicine.

  10. Selfless Service: The Cavalry Career of Brigadier General Samuel M. Whitside from 1858 to 1902

    Science.gov (United States)

    2002-05-31

    McClellan. Following that campaign, he was assigned in September 1862 as an aide-de-camp to General Nathaniel Banks. Later he would serve as an aide on...throughout the Civil War, he would not serve with the regiment again until after the war in 1865.23 Aide to General Banks Nathaniel Banks had...section of Artillery under Lt. Hawthorn , to this point and try to intercept the Sitting Bull 140 Indians who escaped from Col. Sumner, who

  11. Assistant Inspector General for Investigations Defense Criminal Investigative Service Annual Report for Calendar Year 2001

    Science.gov (United States)

    2001-01-01

    Inspection Service. • On March 16, 2001, Vencor, Incorporated (Vencor), and Ventas , Incorporated ( Ventas ), both in Louisville, KY, entered... Ventas , a real estate investment trust that owns and manages all of the real estate assets. The settlement agreement requires Vencor and Ventas to pay...the False Claims Act. The whistleblowers alleged that Vencor, Ventas and/or their subsidiaries submitted false and fraudulent claims to Medicare

  12. Meeting the needs of vulnerable patients: The need for team working across general practice and community nursing services.

    Science.gov (United States)

    Bliss, Julie; While, Alison E

    2014-01-01

    General practitioners and district nurses have a long history of providing care outside the hospital setting. With health care increasingly moving out of the hospital setting, there are more opportunities for general practitioners and district nurses to work together to meet the health needs of the local population. However, the reduction in qualified specialist practitioner district nurses over the last decade is concerning. The need for an effective district nursing service has been recognised by the Department of Health in their own model - the nature of district nursing work, often over a long period, enables relationships to develop with the patient, family and informal carers as a basis for anticipatory care to manage long-term conditions. Communication and understanding of the role are central to enhance effective working between general practitioners and district nurses, which can be fostered by engagement in community-oriented integrated care and case management.

  13. Doing the right thing without being told: joint effects of initiative climate and general self-efficacy on employee proactive customer service performance.

    Science.gov (United States)

    Raub, Steffen; Liao, Hui

    2012-05-01

    We developed and tested a cross-level model of the antecedents and outcomes of proactive customer service performance. Results from a field study of 900 frontline service employees and their supervisors in 74 establishments of a multinational hotel chain located in Europe, the Middle East, Africa, and Asia demonstrated measurement equivalence and suggested that, after controlling for service climate, initiative climate at the establishment level and general self-efficacy at the individual level predicted employee proactive customer service performance and interacted in a synergistic way. Results also showed that at the establishment level, controlling for service climate and collective general service performance, initiative climate was positively and indirectly associated with customer service satisfaction through the mediation of aggregated proactive customer service performance. We discuss important theoretical and practical implications of these findings. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

  14. 预防医学在社区卫生服务中的运用探讨%On the Preventive Medicine in the Community Health Services

    Institute of Scientific and Technical Information of China (English)

    吐尔洪•尼牙孜

    2013-01-01

      目的:探讨预防医学在社区卫生服务中的运用效果。方法:将该地区的社区卫生服务工作分成两个阶段,对两个阶段居民对环境卫生、食品卫生、劳动卫生、心理卫生等相关知识的掌握、年家庭食物中毒发生例数以及对社区卫生服务工作的满意度情况进行比较。结果:第二阶段的居民相关知识掌握、年家庭食物中毒发生例数、社区卫生服务工作满意度明显优于第一阶段,均具有显著性差异,P<0.05,有统计学意义。结论:预防医学在社区卫生服务中具有重要地位,可显著提高社区居民的健康水平,应继续扩大预防医学在卫生服务中的应用范围,提高人民预防疾病发生的意识。%  Objective] Study on preventive medicine in the community health service. [Method] the community health services of the region can be divided into two phase, it compared the number of food poisoning cases in the family, the satisfaction of community health service work, and the related knowledge of residents in two phase from the following aspacts:sanitation,food hygiene,labor health and mental health etc.[Result] Knowledge of the second phase of the residents, the annual household food poisoning number, and the community health service job satisfaction was significantly better than the first phase, has significant difference, P<0.05, and has statistical significance. [Conclusion] Preventive Medicine has an important position in the community health service,can significantly improve the level of health of the community, we should continue expand the scope of application of preventive medicine in health services, and improve the awareness of the people's prevention of disease.

  15. [Medical Service of the Estonian Defense Forces].

    Science.gov (United States)

    Anisimov, A S; Golota, A S; Krassii, A B; Soldatov, E A; Shalakin, R A

    2015-06-01

    The article is a brief description of the current state of the Estonian Defense Forces medical service and is based on the study of the open access foreign sources. At the beginning, the general information about Estonia, its Defense Forces, and their medical service is presented. Then the medical service particular features are described with more detail, namely, the organization of the inpatient and outpatient treatment, medical supply, scientific research, combat medicine, medical staff education and training, medical service personnel income.

  16. [The practice guideline 'Smoking cessation' from the Dutch College of General Practitioners; a response from the perspective of pulmonary medicine].

    Science.gov (United States)

    van Spiegel, P I

    2008-06-28

    The practice guideline 'Smoking cessation' from the Dutch College of General Practitioners has been published. If general practitioners are going to use the standard, this can have a great impact on smoking in the Dutch population. A decrease in smokers among the population will also have an impact on several smoking-related chronic diseases from a preventive point of view. The guideline emphasizes that smoking cessation is not a one-stop shop but that it requires a long-term effort.

  17. Savannah River Plant engineering and design history. Volume 4: 300/700 Areas & general services and facilities

    Energy Technology Data Exchange (ETDEWEB)

    1957-01-01

    The primary function of the 300 Area is the production and preparation of the fuel and target elements required for the 100 Area production reactors. Uranium slugs and lithium-aluminium alloy control and blanket rods are prepared in separate structures. Other facilities include a test pile, a physics assembly laboratory, an office and change house, an electrical substation, and various service facilities such as rail lines, roads, sewers, steam and water distribution lines, etc. The 700 Area contains housing and facilities for plant management, general plant services, and certain technical activities. The technical buildings include the Main Technical Laboratory, the Waste Concentration Building, the Health Physics Headquarters, and the Health Physics Calibration building. Sections of this report describe the following: development of the 300-M Area; selection and description of process; design of main facilities of the 300 Area; development of the 700-A Area; design of the main facilities of the 700 Area; and general services and facilities, including transportation, plant protection, waste disposal and drainage, site work, pilot plants, storage, and furniture and fixtures.

  18. The Impact of the Hospital Volume on the Performance of Residents on the General Medicine In-Training Examination: A Multicenter Study in Japan.

    Science.gov (United States)

    Mizuno, Atsushi; Tsugawa, Yusuke; Shimizu, Taro; Nishizaki, Yuji; Okubo, Tomoya; Tanoue, Yusuke; Konishi, Ryota; Shiojiri, Toshiaki; Tokuda, Yasuharu

    2016-01-01

    Objective Although several studies have been conducted worldwide on factors that might improve residents' knowledge, the relationship between the hospital volume and the internal medicine residents' knowledge has not been fully understood. We conducted a cross-sectional study to compare the relationships of the hospital volume and hospital resources with the residents' knowledge assessed by the In-training Examination. Methods We conducted a retrospective survey and a clinical knowledge evaluation of postgraduate year 1 and 2 (PGY-1 and -2) resident physicians in Japan by using the General Medicine In-training Examination (GM-ITE) in 2014. We compared the ITE score and the hospital volume. Results A total of 2,015 participants (70.6% men; age, 27.3±2.9 years old) from 208 hospitals were retrospectively analyzed. Generalized estimating equations were used, and the results revealed that an increasing number of hospitalizations, decreasing staff number, decreasing age and PGY-2 were significantly associated with higher GM-ITE scores. Conclusion The hospital volume, such as the number of hospitalizations, is thus considered to have a positive impact on the GM-ITE scores.

  19. Barriers to integration of behavioral and social sciences in the general medicine curriculum and recommended strategies to overcome them: A systematic review

    Science.gov (United States)

    TABATABAEI, ZAHRA; YAZDANI, SHAHRAM; SADEGHI, RAMIN

    2016-01-01

    Introduction The integration of behavioral and social sciences (BSS) into the curriculum of medical students in order to equip them with the necessary knowledge, skills and attitudes is an essential issue, emphasized in many researches. Our aim is to investigate the barriers to integrate BSS into the general medicine curriculum as well as the recommended strategies to overcome such barriers through a systematic review of literature. Methods PubMed, ERIC, Scopus, CINAHL, Google Scholar, and OPENGREY were searched for studies on the barriers to integration of BSS into the general medicine curriculum as well as the strategies employed to overcome them until August 28, 2015. Results Sixteen relevant studies were included and the related domains were categorized as barriers and some strategies were recommended to overcome them. In addition, the quality of the included studies was assessed. Conclusion Despite the prominent role of BSS in the effectiveness of health care, these sciences have not been included in the curriculum of medical students effectively. The identified barriers and the strategies used to overcome them should be considered for all integration programs. Future studies should focus on the process of BSS integration in the medical curricula and should evaluate the efficacy of this integration in more detail. PMID:27382578

  20. Multiple barriers against successful care provision for depressed patients in general internal medicine in a Japanese rural hospital: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Saitoh Akiyoshi

    2010-04-01

    Full Text Available Abstract Background A general internist has an important role in primary care, especially for the elderly in rural areas of Japan. Although effective intervention models for depressed patients in general practice and primary care settings have been developed in the US and UK medical systems, there is little information regarding even the recognition rate and prescription rate of psychotropic medication by general internists in Japan. The present study surveyed these data cross-sectionally in a general internal medicine outpatient clinic of a Japanese rural hospital. Methods Patients were consecutively recruited and evaluated for major depressive disorder or any mood disorder using the Patient Health Questionnaire (PHQ. Physicians who were blinded to the results of the PHQ were asked to diagnose whether the patients had any mental disorders, and if so, whether they had mood disorders or not. Data regarding prescription of psychotropic medicines were collected from medical records. Results Among 312 patients, 27 (8.7% and 52 (16.7% were identified with major depressive disorder and any mood disorder using the PHQ, respectively. Among those with major depressive disorder, 21 (77.8% were recognized by physicians as having a mental disorder, but only three (11.1% were diagnosed as having a mood disorder. Only two patients with major depressive disorder (7.4% had been prescribed antidepressants. Even among those (n = 15 whom physicians diagnosed with a mood disorder irrespective of the PHQ results, only four (26.7% were prescribed an antidepressant. Conclusions Despite a high prevalence of depression, physicians did not often recognize depression in patients. In addition, most patients who were diagnosed by physicians as having a mood disorder were not prescribed antidepressants. Multiple barriers to providing appropriate care for depressed patients exist, such as recognizing depression, prescribing appropriate medications, and appropriately referring

  1. General practitioners and carers: a questionnaire survey of attitudes, awareness of issues, barriers and enablers to provision of services

    Directory of Open Access Journals (Sweden)

    Atkins Christine

    2010-12-01

    Full Text Available Abstract Background Approximately one in ten of the UK population are unpaid carers supporting a family member or friend who could not manage without their help, saving the UK economy an estimated £87 billion. This role is known to sometimes have a negative impact on carers and to require support both informally and from statutory services. General practice is a first point of contact for carers but research investigating general practitioners' (GPs' attitudes towards carers and awareness of issues facing carers is rare. This study therefore aimed to identify GPs' attitudes, awareness of issues, and perceptions of the barriers and enablers to provision of services. Methods Using a self-completion questionnaire distributed at a series of workshops, this study investigates GPs' attitudes to carers; awareness and knowledge of carers' issues; services offered in general practice and barriers to supporting carers. Results Seventy eight out of a total of 95 GPs (82% response rate from a variety of areas in England completed the questionnaires. The GPs identified time, resources and lack of knowledge as barriers, but only 9% agreed with the statement that there is little support they can offer carers. However, nine in ten GPs (89% feel they have insufficient training here and approximately half of them (47% lack confidence that they are meeting carers' needs. Confidence in identifying carers is also low (45%. Issues that GPs would look out for amongst carers include emotional and physical health problems and financial and isolation difficulties. GPs specifically highlighted educational and isolation issues for young carers. Few services were described that targeted carers. Conclusions GPs recognise that they have an important role to play in supporting carers but would like training and support. Further investigation is needed both to determine how best to train and facilitate GPs and general practice teams in their role in supporting carers and to

  2. From General English to EST: A Proposal to Reform China's Service English Teaching.

    Science.gov (United States)

    Zhijian, Zhou

    1988-01-01

    Describes English teaching in China, covering course materials, teaching activities, and students' reactions, and noting an upsurge of interest in English for science and technology (EST). A proposed reform argues for a shift from General English to EST and offers suggestions for preparing course materials, teacher training, and learner testing.…

  3. 78 FR 21952 - Submission for OMB Review; Proposed Collection; Comment Request; General Services Administration...

    Science.gov (United States)

    2013-04-12

    ..., company name (if any), and ``Information Collection 3090-0297'' on your attached document. Mail: General... feedback we mean information that provides useful insights on perceptions and opinions, but are not... feedback will provide insights into customer or stakeholder perceptions, experiences and expectations...

  4. Febrile Children at a General Practice Out-of-hours Service

    NARCIS (Netherlands)

    M. Kool (Marijke)

    2015-01-01

    markdownabstractChildhood fever occurs frequently in young children and is a common reason for parents to contact a general practitioner (GP). On average children have suffered from 8 infective episodes at the age of 18 months. In an English birth cohort of 13,617 young children, parents have report

  5. Examining the Effects of Reflective Journals on Pre-Service Science Teachers' General Chemistry Laboratory Achievement

    Science.gov (United States)

    Cengiz, Canan; Karatas, Faik Özgür

    2015-01-01

    The general chemistry laboratory is an appropriate place for learning chemistry well. It is also effective for stimulating higher-order thinking skills, including reflective thinking, a skill that is crucial for science teaching as well as learning. This study aims to examine the effects of feedback-supported reflective journal-keeping activities…

  6. Inclusion Assistants in General Education Settings--A Model for In-Service Training

    Science.gov (United States)

    Moshe, Anat

    2017-01-01

    The inclusion assistant (IA) is a fairly new position in the education system and is the outcome of current ideological and legislative steps to include students with special needs into the general educational system. The IA's function is to personally accompany students with severe disabilities--autism, developmental disabilities, physical…

  7. Acceptance of online audio-visual cultural heritage archive services: a study of the general public

    NARCIS (Netherlands)

    Ongena, G.; Wijngaert, van de L.A.L.; Huizer, E.

    2013-01-01

    Introduction. This study examines the antecedents of user acceptance of an audio-visual heritage archive for a wider audience (i.e., the general public) by extending the technology acceptance model with the concepts of perceived enjoyment, nostalgia proneness and personal innovativeness. Method. A W

  8. [Mental Health in the General Hospital: Results of the Patient Health Questionnaire (PHQ) in Four Hospital Services].

    Science.gov (United States)

    Castro-Camacho, Leonidas; Escobar, Juan Manuel; Sáenz-Moncaleano, Camilo; Delgado-Barrera, Lucía; Aparicio-Turbay, Soraya; Molano, Juan Carlos; Noguera, Efraín

    2012-03-01

    Few individuals have access to mental health services due in part to underdetection. As it is more likely to consult for medical conditions, primary care may be a useful gateway for early detection of mental health problems. Detection of the frequency of mental health problems in four hospital services at the Fundación Santa Fe de Bogotá: Outpatient unit, hospitalization, emergency department, and primary care through a brief detection questionnaire, the Patient Health Questionnaire (PHQ). Cross-sectional study of patients seen at the four services who answered a Demographic Data Questionnaire and the PHQ together with information gathered about current medical diagnosis, history of visits, and hospitalizations during the last year. 1094 patients seen at the four hospital services between September 2010 and May 2011 were selected at random. A mental health problem was detected in 36.7% of the total sample. Major depressive disorder (7.3%), alcohol abuse (14.4%), and any anxiety disorder (7.7%) showed the highest prevalence with the emergency department showing the highest frequency of detection. The usefulness of a brief detection questionnaire such as the PHQ in hospital settings is demonstrated and implications in the design of mental health programs in the general hospital are discussed. The need to replicate this study in other settings and to undertake further research is outlined. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  9. Communication in the Service of American Health...A Bicentennial Report from the National Library of Medicine.

    Science.gov (United States)

    National Library of Medicine (DHEW), Bethesda, MD.

    Programs of the National Library of Medicine over almost a century and a half are described, ranging from a history of American medical literature and the development of medical indexing to modern technological developments. Activities covered include the development of the Toxicology Information Program and the online data base TOXLINE; the…

  10. PRINSIP-PRINSIP GATS (GENERAL AGREEMENT ON TRADE IN SERVICES TERHADAP PERDAGANGAN JASA PENDIDIKAN TINGGI

    Directory of Open Access Journals (Sweden)

    Alberta Hartiana

    2017-05-01

    Full Text Available International trade in higher education belongs to the more complex reality in the international trade in services, become global trends and reform in system of higher education all over the world. This research is aimed at finding out both modes of supply and principles of GATS regarding international trade in services. The main objective of the GATS is creating a credible and reliable system of international trade rules; ensuring fair and equitable treatment of all members; stimulating economic activity through guaranteed policy bindings and promoting trade and development through progressive liberalization. This study used normative research. The method used for collecting data was the statute approach. Primary legal sources derived from WTO Trade in Services Division regarding GATS obligations and the principles of the international trade in services. The result of this study, it was found that, there were four modes of supply trade in education under GATS (article 1:2 such as: cross-border supply; consumption abroad; commercial presence and delivery abroad; and the principles of GATS divided into two categories; Firstly, unconditionally obligations, such as the Most-Favoured Nation (article II GATS and Transparency (article III GATS apply directly and automatically to all WTO members and services sector regardless of whether WTO member schedule commitment or not; Secondly, conditionally obligations such as: National Treatment (article XVII and Market Access (article XVI  and only applies to commitment listed in national schedules. Perdagangan internasional dalam pendidikan tinggi milik realitas yang lebih kompleks dalam perdagangan internasional di bidang jasa, menjadi tren global dan reformasi dalam sistem pendidikan tinggi di seluruh dunia. Penelitian ini bertujuan untuk mengetahui model-model pasokan dan prinsip-prinsip GATS mengenai perdagangan internasional di bidang jasa. Tujuan utama dari GATS adalah menciptakan sistem yang kredibel

  11. General practitioners’ suspicion of cancer and other serious diseases: implications for future diagnosis and use of healthcare services

    DEFF Research Database (Denmark)

    Hjertholm, Peter

    serious disease (new)?” These data were combined with registry data regarding subsequent diagnoses and use of healthcare services. Cox regression was used for time-to-diagnosis analyses. Results: Preliminary findings are: Prevalence of suspicion is 5.7%, incidence of serious diagnoses within 6 months is 3......Background: As gatekeepers in the Danish healthcare system, general practitioners (GPs) perform an important and crucial task in the primary visitation of patients. A challenge for the GPs is to distinguish between symptoms and signs of serious disease among frequently presented complaints. However......, but also to characterise the patients in whom the suspicion was raised and how the GPs acted upon it. Moreover, an additional aim was to investigate the significance of a suspicion in terms of future serious disease and the patients’ use of health care services. Methods: A cross-sectional study...

  12. Improving service quality by understanding emergency department flow: a White Paper and position statement prepared for the American Academy of Emergency Medicine.

    Science.gov (United States)

    Eitel, Dave R; Rudkin, Scott E; Malvehy, M Albert; Killeen, James P; Pines, Jesse M

    2010-01-01

    Emergency Department (ED) crowding is a common problem in the United States and around the world. Process reengineering methods can be used to understand factors that contribute to crowding and provide tools to help alleviate crowding by improving service quality and patient flow. In this article, we describe the ED as a service business and then discuss specific methods to improve the ED quality and flow. Methods discussed include demand management, critical pathways, process-mapping, Emergency Severity Index triage, bedside registration, Lean and Six Sigma management methods, statistical forecasting, queuing systems, discrete event simulation modeling and balanced scorecards. The purpose of this review is to serve as a background for emergency physicians and managers interested in applying process reengineering methods to improving ED flow, reducing waiting times, and maximizing patient satisfaction. Finally, we present a position statement on behalf of the American Academy of Emergency Medicine addressing these issues.

  13. Entwicklung von Lernzielen für das Tertial Allgemeinmedizin im Praktischen Jahr [Development of learning targets for the practical year of studies in general medicine

    Directory of Open Access Journals (Sweden)

    Lorenz, Gernot

    2008-02-01

    Full Text Available [english] Background: General medicine as an elective practical subject in the last year of basic medical education has recently been added to our medical school curriculum. Clerkships in general medicine have been widely defined around the world. Their learning objectives vary because they depend on the level of education and specific health care needs. In particular, specific learning objectives for this important practical period of medical education have not been elaborated systematically till now. Methods: We conducted a structured group process with our teaching physicians and elaborated learning objectives classified by categories (history taking, examination, diagnostics, therapy and specified according to Miller. Results: The learning objectives can be clustered in „general medical aspects“, „general skills”, „symptoms”, „diseases”, „treatment” and „documentation/medical terminology”. Conclusion: The categorisation and specification of learning objectives caused an intensive reflexion of our curriculum. Our learning objectives consider the level of education, the frequency and weight of diseases in familiy medicine and the duration of our curriculum. These learning objectives can serve as an orientation guide for us, our teaching physicians and students.[german] Hintergrund: Der Gesetzgeber hat seit Oktober 2003 einen Teil der medizinischen Ausbildung im Praktischen Jahr (PJ an die Allgemeinmedizin delegiert. An unserer Fakultät absolvieren seit 2006 Studierende das PJ in Allgemeinmedizin. Um einer wissenschaftlichen, praxis- und patientenbezogenen sowie fächerübergreifenden Ausbildung nachzukommen, bedarf es der Orientierung an Lernzielen. Diese existieren weltweit für allgemeinmedizinische Curricula und sind variabel und abhängig vom Ausbildungsstand und den Bedürfnissen vor Ort. Speziell für das PJ in Allgemeinmedizin hingegen sind bislang keine systematisch erarbeiteten Lernziele ver

  14. Design of comprehensive general maintenance service system of aerial reconnaissance camera

    Directory of Open Access Journals (Sweden)

    Li Xu

    2016-01-01

    Full Text Available Aiming at the problem of lack of security equipment for airborne reconnaissance camera and universal difference between internal and external field and model, the design scheme of comprehensive universal system based on PC-104 bus architecture and ARM wireless test module is proposed is proposed using the ATE design. The scheme uses the "embedded" technology to design the system, which meets the requirements of the system. By using the technique of classified switching, the hardware resources are reasonably extended, and the general protection of the various types of aerial reconnaissance cameras is realized. Using the concept of “wireless test”, the test interface is extended to realize the comprehensive protection of the aerial reconnaissance camera and the field. The application proves that the security system works stably, has good generality, practicability, and has broad application prospect.

  15. Análisis del programa de la asignatura "Introducción a la medicina general integral" Analysis of the syllabus of "Introduction to comprehensive general medicine" subject

    Directory of Open Access Journals (Sweden)

    Félix J. Sansó Soberats

    2004-02-01

    Full Text Available El presente trabajo constituye un profundo análisis del programa de la asignatura "Introducción a la medicina general integral" que se imparte en el primer año del pregrado en la carrera de medicina en Cuba. En él se presentan juicios críticos en relación con la fundamentación del programa, sus objetivos, la relación objetivo-contenido, el ordenamiento y distribución de los contenidos, los medios de enseñanza que se proponen, el sistema evaluativo y las orientaciones metodológicas que se ofrecen a los tutores y profesores. Se concluye que este es un programa que por los objetivos que se propone y por su estrategia docente responde al perfil de salida del médico general básico. No obstante, necesita ser perfeccionado y se requiere una actualización en sus contenidos, acordes con el desarrollo que ha alcanzado la medicina familiar en el país y con la experiencia acumulada con la impartición de esta asignaturaThe present paper goes deep into the syllabus of "Introduction to general comprehensive medicine" subject that is taught in the first year of the medical career. Critical judgements in connection with the foundation of the syllabus, its objectives, the objective-content relation, the arrangement and distribution of the contents, the proposed teaching tools, the evaluative system and the methodological guidance given to tutors and professors are presented here. It is concluded that according to its objectives and to its teaching strategy, this syllabus answers to the profile of the basic general physician. However, it requires an improvement and updating of its contents, according to the development achieved by family medicine in the country and to the experience accumulated on teaching this subject.

  16. Preliminary checklist of fungi of the Fernow Experimental Forest. Forest Service general technical report (Final)

    Energy Technology Data Exchange (ETDEWEB)

    Stephenson, S.L.; Kumar, A.; Bhatt, R.; Dubey, T.; Landolt, J.C.

    1994-01-01

    The report provides a checklist of fungi found on the Fernow Experimental Forest in West Virginia during 4 years of research and collecting by the authors. More than 500 fungi in seven major taxonomic groups (Acrasiomycetes, Myxomycetes, Chytridiomycetes, Oomycetes, Ascomycetes, Deuteromycetes, and Basidiomycetes) are listed alphabetically by genus and species. Also provided is a general description of the forest vegetation of the Fernow Experimental Forest.

  17. Quality of Services and Health Financing efficiency of Community Health Insurance (Jamkesmas at 21 General and Specialty Hospitals in Indonesia

    Directory of Open Access Journals (Sweden)

    Ristrini Ristrini

    2014-08-01

    Full Text Available Background: Community Health Insurance (Jamkesmas has been implementing maintained since 2008 with 76.4million individual quota increased to 86.4 million in 2012. The major problem of involved is unfairness (inequity in the quality and financing of health services for participants. This study aims to analyse the quality and financing of health perspective of Jamkesmas participants in the hospital. Method: This study was conducted in 21 general and specialty hospitals in Indonesia, The sample were selected purposively They were 9 Central Government hospitals (RSUP, Regional hospital and 3 specialty hospital ie cancer hospital, cardiologie hospital and stroke hospital. Those hospital involved covers 8 RSU Class A General Hospital. 8 RSU Class B, 2 RSU Class Cand 3 Specialty Hospital. Primary data wascollected by interviewing 1700 outpatient and inpatients, and 280 hospital staffs. Secondary data were human resources, finance and coverage. Results: Quality of services review on the adequacy of the physician’s quality was very varied.There were 570–2372 outpatient visits per physician, and 37-674 inpatients per doctor visit. Adequacy of nursing staff(nurses and midwives was better, 123–671 outpatient visits per nursing staff and 3–127 inpatient visits per nursing staff.Quality of services according to health officers perceptions on equipment and facilities was good and complete. Quality ofservices according to patients’ expectations and reality was appropriate, never the less the direct heath services, were low. Hospital financing was very large, 33–460 billion, and one third for Jamkesmas and Regency Community Health Insurance (Jamkesda services. Proportion Jamkesda funding in RSUD was larger than Jamkesmas while in RSUP, Jamkesda was smaller than Jamkesmas. Jamkesmas financing perspective according to the staff, was most of them stated that funding for Jamkesmas was matched and appropriate the number of served patients served

  18. Generalized Alamouti Codes for Trading Quality of Service against Data Rate in MIMO UMTS

    Directory of Open Access Journals (Sweden)

    Rupp Markus

    2004-01-01

    Full Text Available New space-time block coding schemes for multiple transmit and receive antennas are proposed. First, the well-known Alamouti scheme is extended to transmit antennas achieving high transmit diversity. Many receiver details are worked out for four and eight transmit antennas. Further, solutions for arbitrary, even numbers of transmit antennas are presented achieving decoding advantages due to orthogonalization properties while preserving high diversity. In a final step, such extended Alamouti and BLAST schemes are combined, offering a continuous trade-off between quality of service (QoS and data rate. Due to the simplicity of the coding schemes, they are very well suited to operate under UMTS with only very moderate modifications in the existing standard. The number of supported antennas at transmitter alone is a sufficient knowledge to select the most appropriate scheme. While the proposed schemes are motivated by utilization in UMTS, they are not restricted to this standard.

  19. 个性化医疗服务类型及相关数据资源研究%Service Types and Data Resources Research on Personalized Medicine

    Institute of Scientific and Technical Information of China (English)

    刘宁; 武琼; 陈敏

    2016-01-01

    Personalized medicine can chooses the best treatment programs for patients with individual differences. It could effectively reduce health care costs and improves resource utilization. On the basis of the introduction of personalized medicine concepts, this paper analyzes the types of personalized healthcare services and related data resources that support personalized medicine, such as genetic data, electronic medical records, health records and health monitoring information. At the same time, proposes counter measures and suggestions to its launch.%个性化医疗可针对患者个体差异选择并提供最佳诊疗方案,能有效提升医疗服务质量,降低医疗费用。文章在介绍个性化医疗相关概念的基础上,分析了个性化医疗的服务类型及支撑个性化医疗的相关数据资源,如基因数据、电子病历、健康档案及健康监测信息等,并对实现信息资源整合,促进个性化医疗服务的开展,提出了相关对策和建议。

  20. The truncated Hyper-Poisson queues: Hk/Ma,b/C/N with balking, reneging and general bulk service rule

    Directory of Open Access Journals (Sweden)

    Shawky A.I.

    2008-01-01

    Full Text Available The aim of this paper is to derive the analytical solution of the queue: Hk/Ma,b/C/N with balking and reneging in which (I units arrive according to a hyper-Poisson distribution with k independent branches, (II the queue discipline is FIFO; and (III the units are served in batches according to a general bulk service rule. The steady-state probabilities, recurrence relations connecting various probabilities introduced are found and the expected number of units in the queue is derived in an explicit form. Also, some special cases are obtained. .

  1. A survey on the knowledge, beliefs and behaviour of a general adult population in Malaysia with respect to the adverse effects of medicines.

    Science.gov (United States)

    Jose, Jimmy; Chong, David; Lynn, Tay Szu; Jye, Goh Ee; Jimmy, Beena

    2011-08-01

    The aim of the study was to explore, in the Malaysian general population: knowledge and beliefs of the characteristics in general of medication-related side effects and side effects associated with different types of medicines; behaviour related to the safe use of drugs before and after taking a medication; and behaviour in the event of a medication-related side effect. A 24-item self-administered questionnaire was developed and used to survey the general public living or working in suburban Kuala Lumpur, Malaysia. Eight hundred questionnaires were distributed, face to face, by researchers using quota sampling. Respondents' knowledge, belief and behaviour were analysed and correlated with demographics, medical history and experience of side effects. Six hundred and ten respondents completed the questionnaire giving a response rate of 76.3%. The mean knowledge score for the respondents was 18.4±3.6 out of the maximum possible score of 26. Educational level and experience of side effect had an influence on the knowledge score obtained. Respondents had misconceptions regarding the safety of complementary and alternative medicines (CAMs) and over-the-counter medications. Medication history and previous experience with side effects had a significant influence on the higher behaviour score obtained. The survey has shown moderate results with regard to the knowledge of public regarding safety of medications, and there was evidence of under-estimating the risk of medications, especially CAMs. The misconceptions among the public, and inappropriate behaviour on drug safety-related aspects, is a concern which needs to be addressed in the interventions designed. © 2011 The Authors. IJPP © 2011 Royal Pharmaceutical Society.

  2. 26 CFR 31.3306(n)-1 - Services on American vessel whose business is conducted by general agent of Secretary of Commerce.

    Science.gov (United States)

    2010-04-01

    ... conducted by general agent of Secretary of Commerce. 31.3306(n)-1 Section 31.3306(n)-1 Internal Revenue... conducted by general agent of Secretary of Commerce. (a) Section 3306(n) and this section of the regulations... by a general agent of the Secretary of Commerce. Whether services performed by such an officer...

  3. 基于电子邮件的"自动综合服务"%Emall-oriented generalization services architecture

    Institute of Scientific and Technical Information of China (English)

    钱海忠; 孙建东; 张钊; 许俊奎; 朱强

    2011-01-01

    自动综合总体上可分为两种模武,一种用来满足GIS的多尺度表达,另一种用于地图生产等.网络环境下的自动综合主要集中在对前一种模式的研究,而对如何依托网络优势进行面向地图生产的自动综合研究仍然很少,主要原因是面对复杂的自动综合,仍未找到合适的网络自动综合模型.本文在分析自动综合现状和发展趋势的基础上,提出了面向网络的"黑匣子自动综合服务"高级自动综合服务模型,论证了其可行性和不足,并对该模型进行了进一步的修正,提出了"基于电子邮件的自动综合服务"框架模型,该模型有效避免了其他模型的诸多缺点,同时具有成本低、稳定性高等优点.实例证明该模型的科学性和实用性,较好地适应了基于网络自动综合的地图生产.%Automatic generalization might he divided into two kinds, one is for multi-representation of GIS,and the other is for map making In the past decade, the first kind is researched mainly ,while the later on is seldom touched. With the development of internet,the research on web generalization is but still restricted only for rapid mlti-representation of GIS, because automatic generalization is very complex and it is difficult to find a suitable web generalization model for web map making. After analyzing the development and disadvantages of automatic generalization and getting suggestion from service-Oriented Architecture (SOA),WFS and WMS and so on this paper put forward a web genralization model termed" dark-box oriented automatic generalization service.Then,by discussing the feasibility and short comings of this model,a more advanced automatic generalization model called"Email-Oriented Generalization Services (EOGS)"architecture was developed in this paper,which could avoid many disadvangages of previous generalization models.Furthermore, EOGS model owns many advantages such as low coast and high stability etc. Exanmple illustrated

  4. Association of apneic oxygenation with decreased desaturation rates during rapid sequence intubation by a Chinese emergency medicine service.

    Science.gov (United States)

    Mao, Yong; Qin, Zong-He

    2015-01-01

    Rapid and safe airway management has always been of paramount importance in successful management of critically ill and injured patients in the emergency department. The achievement rate of emergency medicine inhabitants in airway management improved enhanced essentially subsequent to finishing anaesthesiology turn. There was a slightly higher rate of quick sequence intubation in the postapneic oxygenation groups (preapneic oxygenation 6.4%; postapneic oxygenation 9.1%). The majority of patients intubated in both groups were men (preapneic oxygenation 72.3%; postapneic oxygenation 63.5%). A higher percentage of patients in the preapneic oxygenation group had a Cormack-Lehane grade III or worse view (23.2% versus 11.8%). Anaesthesiology turns should be considered as an essential component of emergency medicine training programs. A collateral curriculum of this nature should also focus on the acquisition of skills in airway management.

  5. Referral patterns and general anesthesia in a specialized paediatric dental service.

    Science.gov (United States)

    Alkilzy, Mohammad; Qadri, Ghalib; Horn, Janina; Takriti, Moutaz; Splieth, Christian

    2015-05-01

    The caries patterns of child populations in Germany have changed during the last 20 years. This affects the referrals and provision of specialist dental care for children. This study has two aims: first, to investigate referrals received by a specialized pediatric dental institution in 1995 and 2008, and second, to assess the treatments performed during full oral rehabilitations under general anesthesia in this institution from 2007 to 2008. All data of referred patients were evaluated for 1995 and 2008 separately. Comparisons were carried out for different socio-demographic, medical, and dental parameters. All patients treated under general anesthesia (GA) between March/2007 and December/2008 were examined retrospectively and their data were analyzed. In 1995 (n = 191), significantly older children were referred to specialized pediatric dental care compared to 2008 (n = 179). In addition, a shift of surgical referrals to very young children with high caries levels was clearly noticed, resulting in considerably more oral rehabilitation performed under GA in 2008 (n = 73). Thus, the mean values of 6.4 fillings and 2.7 extractions per child were quite high. Preventive treatment approaches for primary dentition in Germany need further improvement by focusing on high caries-risk groups, as specialized pediatric dentistry bears the great burden of providing oral rehabilitations under GA in young children. © 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Association of apneic oxygenation with decreased desaturation rates during rapid sequence intubation by a Chinese emergency medicine service

    OpenAIRE

    Mao, Yong; Qin, Zong-He

    2015-01-01

    Rapid and safe airway management has always been of paramount importance in successful management of critically ill and injured patients in the emergency department. The achievement rate of emergency medicine inhabitants in airway management improved enhanced essentially subsequent to finishing anaesthesiology turn. There was a slightly higher rate of quick sequence intubation in the postapneic oxygenation groups (preapneic oxygenation 6.4%; postapneic oxygenation 9.1%). The majority of patie...

  7. Quality of Activities of General Medicine Subjects VII Teachers in the Different Scenarios Calidad de las actividades de la asignatura medicina general integral VII en los diferentes escenarios docentes

    Directory of Open Access Journals (Sweden)

    Maricel Felicia Castellanos González

    2012-06-01

    Full Text Available Background: as part of the educational process developed in consultation rooms or in any other setting, previously taught contents should be taken into account in order to attain an integration of theoretical knowledge and clinical practice. Objective: to assess teaching settings according to the quality of the activities developed in the subject General Medicine VII, in the context of University Polyclinics. Methods: we conducted a quantitative and qualitative research as to compliance with quality indicators by applying an observation guide in teaching settings of the subject General Medicine VII in the University Polyclinics. Teaching settings evaluated included consultation rooms, vaccination areas, kindergardens, maternity homes, and family planning consultation rooms. Results: consultation rooms, vaccination areas, family planning consultation rooms, schools and kindergardens were assessed as medium proficiency. Only maternity homes and emergency rooms obtained a satisfactory category. Teaching activities with the greatest difficulties were: epidemiological surveillance for the investigation of risk factors, control of communicable disease outbreak, and presentation of the analysis of general health condition of the community. Conclusions: the educational setting was generally assessed as medium proficiency in the subject General Medicine VII. This was caused by the fact that consultation rooms, vaccination areas, family planning consultation rooms, schools and kindergardens were assessed as medium proficiency while only maternity homes and emergency rooms obtained a satisfactory category.Fundamento: en el proceso de enseñanza-aprendizaje que se desarrolla en los diferentes escenarios docentes, se deben tener en cuenta los contenidos ya impartidos, para logar una integración entre los conocimientos teóricos con la práctica m

  8. Introduction of a Microsoft Excel-based unified electronic weekend handover document in Acute and General Medicine in a DGH: aims, outcomes and challenges.

    Science.gov (United States)

    Kostelec, Pablo; Emanuele Garbelli, Pietro; Emanuele Garbelli, Pietro

    2017-01-01

    On-call weekends in medicine can be a busy and stressful time for junior doctors, as they are responsible for a larger pool of patients, most of whom they would have never met. Clinical handover to the weekend team is extremely important and any communication errors may have a profound impact on patient care, potentially even resulting in avoidable harm or death. Several senior clinical bodies have issued guidelines on best practice in written and verbal handover. These include: standardisation, use of pro forma documents prompting doctors to document vital information (such as ceiling of care/resuscitation status) and prioritisation according to clinical urgency. These guidelines were not consistently followed in our hospital site at the onset of 2014 and junior doctors were becoming increasingly dissatisfied with the handover processes. An initial audit of handover documents used across the medical division on two separate weekends in January 2014, revealed high variability in compliance with documentation of key information. For example, ceiling of care was documented for only 14-42% of patients and resuscitation status in 26-72% of patients respectively. Additionally, each ward used their own self-designed pro forma and patients were not prioritised by clinical urgency. Within six months from the introduction of a standardised, hospital-wide weekend handover pro forma across the medical division and following initial improvements to its layout, ceiling of therapy and resuscitation status were documented in approximately 80% of patients (with some minor variability). Moreover, 100% of patients in acute medicine and 75% of those in general medicine were prioritised by clinical urgency and all wards used the same handover pro forma.

  9. ASSESSMENT OF UNDERGRADUATE MEDICAL STUDENTS USING OBJECTIVE STRUCTURED CLINICAL EXAMINATION IN GENERAL MEDICINE: STUDENT’S AND TEACHER’S PERCEPTION

    Directory of Open Access Journals (Sweden)

    Sudhir

    2015-12-01

    Full Text Available BACKGROUND Objective Structured Clinical Examinations (OSCEs have become one of the most widely used methods of assessing aspects of clinical competency in healthcare education. Objective Structured Clinical Examinations (OSCEs is also introduced in our newly formed medical college Indira Gandhi Institute of Medical Sciences (IGIMS, Patna, for last few years in different departments, but this is first study to know the perception of this evaluation method among students and faculties. AIM AND OBJECTIVE The aim of this study was to introduce the newer method of assessment Objective Structured Clinical Examinations (OSCEs. Objective of the study is to assess the perceptions of teachers and students regarding OSCE in general medicine. METHODOLOGY After obtaining permission from ethics committee, this cross-sectional study was conducted in Department of General Medicine; 84 students and 9 faculty members were briefed about OSCEs. At the end of 8th semester, OSCE was conducted and immediate feedback regarding this method of examination was taken using Likert’s scale. Perceptions of students and teachers were collected with suitable statements. Their suggestions and remarks were also collected. RESULTS A 55.55% of faculty members agreed that OSCE covered a wide range of knowledge compared with conventional examination; 66% of faculty members agreed that OSCE assessed the various domain of student’s knowledge in a better way compared with conventional examination; 88% of teachers agreed that checklist in OSCE provided a fair system of marking which removed variability of examiner; 84 out of 87 students of 8th semester undergraduate answered the questionnaire based on Likert’s scale; 67% students strongly agreed that OSCE was a fair method of assessment compared with conventional examination; 58% students found that OSCE tested a wide range of knowledge compared with conventional method. They were disagreed about OSCE being stressful and

  10. General practice out-of-hours service in Ireland provides a new source of syndromic surveillance data on influenza.

    LENUS (Irish Health Repository)

    Brabazon, E D

    2010-01-01

    The use of routinely available electronic sources of healthcare data on the spread of influenza has the potential to enhance current surveillance activities. This study aimed to develop a method for identifying influenza-related records from general practitioner(GP) out-of-hours (OOH) services in Ireland. Data from one such service were interrogated for keywords relating to influenza-like illness (ILI) and a proxy measure of influenza activity in the community setting was developed. Comparison of this syndromic surveillance measure with national data on ILI consultation rates demonstrated a statistically significant temporal correlation.In five out of six influenza seasons investigated,peaks in the GP OOH influenza-related calls appeared at least one week ahead of peaks in the national ILI consultation rates. The method described in this paper has been extended to nine OOH services in Ireland (covering 70% of the Irish population) to provide weekly figures on self-reported illness for influenza in the community and its data have been incorporated into the national weekly influenza reports produced by the Health Protection Surveillance Centre. These data should provide early warnings of both seasonal and pandemic influenza in Ireland.

  11. La opacidad de los acuerdos generales de bienes y servicios en España Opacity of general agreements on goods and services in Spain

    Directory of Open Access Journals (Sweden)

    Román Andrés Umaña Peña

    2006-06-01

    Full Text Available Objetivo: Explorar la intensidad del debate parlamentario sobre el Acuerdo General de Comercio de Servicios (AGCS asumido por España ante la Organización Mundial del Comercio (OMC, y compararla con la del Acuerdo General de Bienes (GATT. Métodos: Búsqueda sistemática y análisis del contenido de todas las iniciativas parlamentarias sobre AGCS y GATT realizadas entre 1979 y 2004 en el Congreso de los Diputados y el Senado. Se calculó la frecuencia y porcentaje de iniciativas parlamentarias de ambos temas, resultado de su tramitación y tipo de iniciativa. Resultados: Se presentaron 185 iniciativas parlamentarias sobre los acuerdos multilaterales de bienes y servicios, de las que 120 se referían al GATT, 8 al AGCS y 57 a ambos acuerdos. La mayoría de las iniciativas no fueron discutidas (GATT, 71%; GATS, 55,4% o estuvieron sujetas a un debate político en el que apenas se dieron intervenciones por parte de los grupos parlamentarios. Conclusiones: A pesar de las implicaciones del acuerdo multilateral de servicios para la política sanitaria española, éste se ha asumido con escaso debate parlamentario previo, incluso menos que en el caso de su homólogo sobre bienes. Se requiere en este tema una intensificación de la función de control al gobierno.Objective: To explore the intensity of the debate in the Spanish Parliament on the General Agreement on Trade in Services (GATS developed by Spain and the World Trade Organization, and to compare it with the debate on the General Agreement on Tariffs and Trade (GATT. Methods: A systematic search and content analysis were performed of all parliamentary initiatives on GATS and GATT undertaken from 1979 to 2004 in the Spanish Parliament and Senate. The frequency and percentages of initiatives on both issues were calculated, and the final result and kinds of initiative were analyzed. Results: A total of 185 initiatives were presented in the Spanish Parliament on these agreements, of which 120 were

  12. Assessment of the impact of the London Olympics 2012 on selected non-genitourinary medicine clinic sexual health services.

    Science.gov (United States)

    Hartley, A; Foster, R; Brook, M G; Cassell, J A; Mercer, C H; Coyne, K; Hughes, G; Crook, P

    2015-04-01

    With minimal information on sexual health provision during mass-gathering events, our aim was to describe the use of sexual health, contraceptive, sex worker and sexual assault services during the London 2012 Olympics. We analysed data from five sources. One contraceptive service provider reported a 10% increase in attendance during the main Games, while emergency contraception prescriptions rose during the main Olympics, compared to the week before, but were similar or lower than at the beginning and end of the summer period. A health telephone advice line reported a 16% fall in sexual health-related calls during the main Olympics, but a 33% increase subsequently. London sexual assault referral centres reported that 1.8% of sexual assaults were Olympics-linked. A service for sex workers reported that 16% started working in the sex industry and 7% moved to London to work during the Olympics. Fifty-eight per cent and 45% of sex workers reported fewer clients and an increase in police crack-downs, respectively. Our results show a change in activity across these services during the 2012 summer, which may be associated with the Olympics. Our data are a guide to other services when anticipating changes in service activity and planning staffing for mass-gathering events.

  13. Medicine use of elderly Chinese and Vietnamese immigrants and attitudes to home medicines review.

    Science.gov (United States)

    White, Lesley; Klinner, Christiane

    2012-01-01

    There is a paucity of research into the perceptions of elderly Australian ethnic minorities towards public health services related to quality use of medicines. Among the six fastest growing ethnic groups in Australia, the Mandarin-speaking Chinese and Vietnamese constitute the largest elderly populations with poor English skills. This paper investigates the relationships of elderly Chinese and Vietnamese migrants with medicines, general practitioners and pharmacists, and how these relationships influence their awareness and attitudes of the home medicines review (HMR) program. Two semi-structured focus groups were held with a total of 17 HMR-eligible patients who have never received a HMR, one with Chinese and one with Vietnamese respondents, each in the respective community language. Confusion about medications and an intention to have a HMR were pronounced among all participants although none of them had heard of the program before participating in the focus groups. Respondents reported difficulties locating a pharmacist who spoke their native language, which contributed to an increased unmet need for medicine information. The Chinese group additionally complained about a lack of support from their general practitioners in relation to their medicine concerns and was adamant that they would prefer to have a HMR without the involvement of their general practitioner. Our results indicate a distinct HMR need but not use among elderly Chinese and Vietnamese eligible patients with poor English skills. Home medicines review service use and perceived medication problems are likely to improve with an increasing availability of bilingual and culturally sensitive health care providers.

  14. Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 5: Needs and implications for future research and policy.

    Science.gov (United States)

    van Royen, Paul; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri E J H; Topsever, Pinar; Ungan, Mehmet; Hummers-Pradier, Eva

    2010-12-01

    The recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe definition of GP/FM, and highlights related needs and implications for future research and policy. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In three subsequent, articles the results for the six core competencies of the European Definition of GP/FM were presented. This article formulates the common aims for further research and appropriate research methodologies, based on the missing evidence and research gaps identified form the comprehensive literature review. In addition, implications of this research agenda for general practitioners/family doctors, researchers, research organizations, patients and policy makers are presented. The concept of six core competencies should be abandoned in favour of a model with four dimensions, including clinical, person related, community oriented and management aspects. Future research and policy should consider more the involvement and rights of patients; more attention should be given to how new treatments or technologies are effectively translated into routine patient care, in particular primary care. There is a need for a European ethics board. The promotion of GP/FM research demands a good infrastructure in each country, including access to literature and databases, appropriate funding and training possibilities.

  15. The research agenda for general practice/family medicine and primary health care in Europe. Part 3. Results: person centred care, comprehensive and holistic approach.

    Science.gov (United States)

    Van Royen, Paul; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri E J H; Topsever, Pinar; Ungan, Mehmet; Hummers-Pradier, Eva

    2010-06-01

    The recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In a second article, the results for the two core competencies 'primary care management' and 'community orientation' were presented. This article reflects on the three core competencies, which deal with person related aspects of GP/FM, i.e. 'person centred care', 'comprehensive approach' and 'holistic approach'. Though there is an important body of opinion papers and (non-systematic) reviews, all person related aspects remain poorly defined and researched. Validated instruments to measure these competencies are lacking. Concerning patient-centredness, most research examined patient and doctor preferences and experiences. Studies on comprehensiveness mostly focus on prevention/care of specific diseases. For all domains, there has been limited research conducted on its implications or outcomes.

  16. Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 4. Results: specific problem solving skills.

    Science.gov (United States)

    Hummers-Pradier, Eva; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri Ejh; Topsever, Pinar; Ungan, Mehmet; van Royen, Paul

    2010-09-01

    The 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. The previous articles presented background, objectives, and methodology, as well results on 'primary care management' and 'community orientation' and the person-related core competencies of GP/FM. This article reflects on the general practitioner's 'specific problem solving skills'. These include decision making on diagnosis and therapy of specific diseases, accounting for the properties of primary care, but also research questions related to quality management and resource use, shared decision making, or professional education and development. Clinical research covers most specific diseases, but often lacks pragmatism and primary care relevance. Quality management is a stronghold of GP/FM research. Educational interventions can be effective when well designed for a specific setting and situation. However, their message that 'usual care' by general practitioners is insufficient may be problematic. GP and their patients need more research into diagnostic reasoning with a step-wise approach to increase predictive values in a setting characterized by uncertainty and low prevalence of specific diseases. Pragmatic comparative effectiveness studies of new and established drugs or non-pharmaceutical therapy are needed. Multi-morbidity and complexity should be addressed. Studies on therapy, communication strategies and educational interventions should consider impact on health and sustainability of effects.

  17. Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ The 6th National General Congress of Chinese Association of Integrative Medicine(CAIM)was convened at 19-20,April 2008 in Beijing.Academician CHEN Zhu,the minister of Ministry of Health indicated at the congress that the integration of Chinese and Westem medicine is very well in keeping with the situation of our countw and the general rule of development in medical science;and as a good integration of Chinese medicine and Western medicine,it is mutually beneficial and advantageous to both of them.Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides,we should and must persist in and develop it.

  18. Nuclear Medicine

    Science.gov (United States)

    ... for Parents/Teachers Resource Links for Students Glossary Nuclear Medicine What is nuclear medicine? What are radioactive ... NIBIB-funded researchers advancing nuclear medicine? What is nuclear medicine? Nuclear medicine is a medical specialty that ...

  19. A Set of Actions to Improve the General Cultural Standard of First Year Transfusion Medicine Students Sistema de acciones para el perfeccionamiento de la cultura general en estudiantes del primer año de Medicina Transfusional

    Directory of Open Access Journals (Sweden)

    José Zabala Cuesta

    2011-02-01

    Full Text Available Background: in order to face the challenges of the present century, universities require teachers and graduate students with a high cultural standard that validates the society model that is being built in Cuba. Objective: to propose a set of actions to improve the general cultural standard of Transfusion Medicine students at the Subsidiary of the Medical Sciences University of Cienfuegos. Method: The sample consisted of all first year Transfusion Medicine students. Theoretical and empirical methods were used. Results: The sources of information students used the most were reading and cinema. Weaknesses were found in the program in relation to the formation of a general cultural standard in future graduates. A first action proposed was to diagnose aspirations and cultural training needs of students. A second action will be to coordinate a project taking these needs into account. Next, an action will be dedicated to political, ideological and aesthetic aspects as well as to communication skills of teachers for the implementation of the project. Finally, evaluation will be conducted. Conclusion: These results show the need of further training in order to achieve a high cultural standard in Transfusion Medicine students.Fundamento: los retos de la universidad en el presente siglo exigen de docentes y egresados con una cultura general integral que valide el modelo de sociedad que se está edificando en Cuba. Objetivo: proponer un sistema de acciones para perfeccionar la formación de una cultura general en los estudiantes del perfil de Medicina Transfusional en la Filial de Ciencias Médicas del municipio de Cienfuegos. Método: el universo estuvo conformado por todos los estudiantes del primer año del perfil. Se utilizaron métodos teóricos y empíricos. Resultados: las fuentes de información más utilizadas por los estudiantes fueron: la lectura y el cine. Se

  20. Development and pilot study of an essential set of indicators for general surgery services.

    Science.gov (United States)

    Soria-Aledo, Victor; Angel-Garcia, Daniel; Martinez-Nicolas, Ismael; Rebasa Cladera, Pere; Cabezali Sanchez, Roger; Pereira García, Luis Francisco

    2016-11-01

    At present there is a lack of appropriate quality measures for benchmarking in general surgery units of Spanish National Health System. The aim of this study is to present the selection, development and pilot-testing of an initial set of surgical quality indicators for this purpose. A modified Delphi was performed with experts from the Spanish Surgeons Association in order to prioritize previously selected indicators. Then, a pilot study was carried out in a public hospital encompassing qualitative analysis of feasibility for prioritized indicators and an additional qualitative and quantitative three-rater reliability assessment for medical record-based indicators. Observed inter-rater agreement, prevalence adjusted and bias adjusted kappa and non-adjusted kappa were performed, using a systematic random sample (n=30) for each of these indicators. Twelve out of 13 proposed indicators were feasible: 5 medical record-based indicators and 7 indicators based on administrative databases. From medical record-based indicators, 3 were reliable (observed agreement >95%, adjusted kappa index >0.6 or non-adjusted kappa index >0.6 for composites and its components) and 2 needed further refinement. Currently, medical record-based indicators could be used for comparison purposes, whilst further research must be done for validation and risk-adjustment of outcome indicators from administrative databases. Compliance results in the adequacy of informed consent, diagnosis-to-treatment delay in colorectal cancer, and antibiotic prophylaxis show room for improvement in the pilot-tested hospital. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.