Access to medicines: relations with the institutionalization of pharmaceutical services

Directory of Open Access Journals (Sweden)

Rafael Damasceno de Barros

2017-11-01

Full Text Available ABSTRACT OBJETIVE To analyze the relationship between access to medicines by the population and the institutionalization of pharmaceutical services in Brazilian primary health care. METHODS This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services 2015, a cross-sectional, exploratory, and evaluative study composed of an information survey in a representative sample of cities, stratified by Brazilian regions. Access was defined based on the acquisition of medicines reported by the patient, ranging between: total, partial, or null. The institutionalization of pharmaceutical services was analyzed based on information provided by pharmaceutical services providers and by those responsible for medicines delivery. Chi-square test and multinomial logistic regression were used in the statistical analysis. RESULTS Full access to medicines was greater when professionals affirmed there were the following aspects of the dimensions: “management tools,” “participation and social control,” “financing,” and “personnel structure,” with significant associations in the bivariate analysis. The “pharmaceutical care” dimension did not achieve such an association. After multinomial logistic regression, full access was more prevalent when those in charge of pharmaceutical services stated that: they always or repeatedly attend meetings of the Municipal Health Council, OR = 3.3 (95%CI 1.5-7.3; there are protocols for medicines delivery, OR = 2.7 (95%CI 1.2-6.1; there is computerized system for managing pharmaceutical services, OR = 3.9 (95%CI 1.9-8.0; those responsible for medicines delivery reported having participated in a course or training for professionals in the past two years, OR = 2.0 (95%CI 1.1-3.5; there is computerized system for pharmaceutical services management, OR

Stakeholder experiences with general practice pharmacist services: a qualitative study.

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Tan, Edwin C K; Stewart, Kay; Elliott, Rohan A; George, Johnson

2013-09-11

To explore general practice staff, pharmacist and patient experiences with pharmacist services in Australian general practice clinics within the Pharmacists in Practice Study. Qualitative study. Two general practice clinics in Melbourne, Australia, in which pharmacists provided medication reviews, patient and staff education, medicines information and quality assurance services over a 6-month period. Patients, practice staff and pharmacists. Semi-structured telephone interviews with patients, focus groups with practice staff and semi-structured interviews and periodic narrative reports with practice pharmacists. Data were analysed thematically and theoretical frameworks used to explain the findings. 34 participants were recruited: 18 patients, 14 practice staff (9 general practitioners, 4 practice nurses, 1 practice manager) and 2 practice pharmacists. Five main themes emerged: environment; professional relationships and integration; pharmacist attributes; staff and patient benefits and logistical challenges. Participants reported that colocation and the interdisciplinary environment of general practice enabled better communication and collaboration compared to traditional community and consultant pharmacy services. Participants felt that pharmacists needed to possess certain attributes to ensure successful integration, including being personable and proactive. Attitudinal, professional and logistical barriers were identified but were able to be overcome. The findings were explained using D'Amour's structuration model of collaboration and Roger's diffusion of innovation theory. This is the first qualitative study to explore the experiences of general practice staff, pharmacists and patients on their interactions within the Australian general practice environment. Participants were receptive of colocated pharmacist services, and various barriers and facilitators to integration were identified. Future research should investigate the feasibility and sustainability of

Areas control of a nuclear medicine service

International Nuclear Information System (INIS)

Silva, Islane C.S.; Silva, Iasmim M.S.; Júnior, Cláudio L.R.; Silva, Isvânia S.; Gonzalez, Kethyllém M.; Melo, Francisca A.; Lima, Fernando R.A.

2017-01-01

The measurement of the exposure rate of the sectors of a nuclear medicine service (NMS), with the purpose of establishing safety to the service workers and the public, classifying the areas according to the monitoring is presented. Following the studies on the classifications of the areas of a Nuclear Medicine service provided by the category regulatory standard, 3.05 CNEN-NN, measures were taken in all sectors of the NMS in order to classify the areas in: Free, controlled and supervised according to with the exposure level. As a measurement instrument, a Geiger-Muller counter of the digital type was used. The results obtained show a correlation with the Brazilian norm satisfactorily, referring to the exposure rate of the studied SMN sectors

General internal medicine at the crossroads of prosperity and despair: caring for patients with chronic diseases in an aging society.

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Larson, E B

2001-05-15

During the past quarter century, general internal medicine has emerged as a vital discipline. In the realm of patient care, it is the integrating discipline par excellence. Ironically, as general internists face the challenge of integrating advances of dizzying speed and complexity, and as their clinical practice becomes increasingly effective, it has become much more difficult for them to earn a living. General internists find themselves at the crossroads of prosperity and despair. Although general medicine research leads the research agenda in many departments of medicine, it is particularly vulnerable. The necessary multidisciplinary "programmatic" infrastructure is expensive, and results often take many years to obtain, particularly in the study of chronic disease. The educational environment in many institutions is particularly difficult for general medicine, both because the current emphasis on technical skills obscures patients' and learners' real needs and because complex patients on general medicine services are now so ill and their turnover so rapid. General internal medicine and geriatrics are synergistic, especially in today's marketplace. A focus on geriatric medicine could help general medicine continue to flourish. General internists are ideally suited to the integrated care of elderly patients with multiple problems, research opportunities are enormous in the geriatric population, and the teaching of geriatrics requires a high level of generalist skills. Problems that plague current generalist practice have unique significance to older patients. Organizations that represent general internists would do well to join forces with many other advocacy groups, especially those representing the interests of elderly patients and geriatric medicine.

Research data services in veterinary medicine libraries

Directory of Open Access Journals (Sweden)

Erin E. Kerby, MSI

2017-01-01

Conclusions: 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.

Distribution of nuclear medicine service in Brazil

International Nuclear Information System (INIS)

Silva, Ana Carolina Costa da; Duarte, Alessandro; Santos, Bianca Maciel dos

2011-01-01

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)

From Surgeon General's bookshelf to National Library of Medicine: a brief history.

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Blake, J B

1986-10-01

The National Library of Medicine originated as a few books in the office of the army's surgeon general, Joseph Lovell, between 1818 and 1836. It became the nation's largest medical library after the Civil War under the direction of John Shaw Billings and began publishing the Index-Catalogue of the Library of the Surgeon General's Office and preparing the Index Medicus. After Billings retired in 1895, the library marked time as army medical officers were rotated through as directors until modernization began under Harold Wellington Jones during World War II. during the directorship of Frank B. Rogers (1949-1963), who introduced MEDLARS, guided the move to a new building in Bethesda, and revitalized other operations, the institution received statutory authority as the National Library of Medicine within the Public Health Service (1956). By 1965, which was marked by the passage of the Medical Library Assistance Act, the library had again regained a position of world leadership.

[Internal Medicine in the curriculum of General Medicine at Universities of Mexico, 2014].

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Maldonado, Jesús Adrián; Peinado, José María

2017-01-01

The aim of this study was to analyze Internal Medicine as a subject and its requirement in each of the Universities curriculum in Mexico that offers a degree in General Medicine. By the end of the first quarter of 2014, the research was closed and 81 campuses were studied. This research was quantitative, using an analytical technique, written discourse, exploratory and purposive sampling not random and homogeneous type. The Likert questionnaire was used in this study to analyse the following variables: the record of Internal Medicine as a subject, the burden of credit, and the location of the program. The procedure consisted of three phases. First obtaining an official list of all the Universities in the Mexican Association of Colleges and Schools of Medicine. Second, obtaining an analysis of each of the Universities' curriculums, and lastly gathering each variable of the study. The results of the Universities were 63% were public and 37% private. Internal Medicine as a subject in the curriculum was 37.1%, and 20% of the universities include it for six months and 9% offer it the whole year. However, the undergraduate internship in Internal Medicine offers it 100%. In conclusion, Internal Medicine as a subject could disappear from the curriculum in General Medicine before coming to the undergraduate internship, even though the latter is declared required in hospital shifts.

[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.

Academic general internal medicine: a mission for the future.

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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.

[Diagnosis and treatment in general internal medicine. Curriculum selection].

Science.gov (United States)

Casal, E R; Vázquez, E N; Husni, C

1994-01-01

In our country general internists are the providers of adult medical care in urban areas. In the past twenty years, with the increasing subspecialization within internal medicine and the development of advances in technology, the role of the general internist seems to be endangered. Recently much attention has been focused on this area and Divisions and Programs of General Internal Medicine have been established in most medical schools in the USA. The University of Buenos Aires instituted a Program of General Internal Medicine in its major teaching hospital in 1987. One of its purposes was to offer an educational experience to residents in the field of internal medicine primary care. This paper summarizes how this program was carried out and the subjects proposed in the area of Diagnosis and Treatment. The Program of General Internal Medicine is performed in the Outpatient Division and it is staffed by 3 faculty members and 4 fellows. Residents in Internal Medicine have a three month, full-time block rotation in the Program. A young, city dwelling, lower middle class population participates in the Program, with almost 10000 visits a year. The Program offers an experience that includes supervised patient care, an average of 100 office visits a month, and seminars and/or workshops covering topics of "Diagnosis and Treatment", "Case Presentations", "Clinical Epidemiology", "Prevention", and "Doctor-Patient Interview". In the area of Diagnosis and Treatment, the criteria used were: 1-frequency of diagnosis as determined by previous investigations, 2-relevant clinical conditions absent from the frequency list as determined by a consensus process by faculty members.(ABSTRACT TRUNCATED AT 250 WORDS)

How is occupational medicine represented in the major journals in general medicine?

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Gehanno, Jean-François; Rollin, Laetitia; Ladner, Joel; Darmoni, Stefan J

2012-08-01

Most physicians have received only limited training in occupational medicine (OM) during their studies. Since they rely mainly on one 'general medical' journal to keep their medical knowledge up to date, it is worthwhile questioning the importance of OM in these journals. The aim of this study was to measure the relative weight of OM in the major journals of general medicine and to compare the journals. The 14,091 articles published in the Lancet, the NEJM, the JAMA and the BMJ in 1997, 2002 and 2007 were analysed. The relative weight of OM and the other medical specialties was determined by categorisation of all the articles, using a categorisation algorithm, which inferred the medical specialties relevant to each MEDLINE article file from the major medical subject headings (MeSH) terms used by the indexers of the US National Library of Medicine to describe each article. The 14,091 articles included in this study were indexed by 22,155 major MeSH terms, which were categorised into 73 different medical specialties. Only 0.48% of the articles had OM as a main topic. OM ranked 44th among the 73 specialties, with limited differences between the four journals studied. There was no clear trend over the 10-year period. The importance of OM is very low in the four major journals of general and internal medicine, and we can consider that physicians get a very limited view of the evolution of knowledge in OM.

[Knowledge and experience of palliative medicine among general practitioners in Germany].

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Papke, J; Freier, W

2007-12-01

Levels of experience and competence in palliative medicine vary considerably among physicians. The aim of the study was to collect information from specially interested general practitioners on education, pivotal lectures and experience regarding the delivery of palliative care. 92 general practitioners (41 women and 22 men) attending a basic course in palliative medicine were asked to fill in a standardized questionnaire relating to their knowledge and experience of palliative medicine. 63 responded (68%), 54 in general private practice, nine worked in a hospital. The same number worked in urban and in rural health care facilities. The majority of those questioned (53%) gained their first experience in palliative medicine as junior hospital doctors about a quarter (26%) only after starting in private practice. Many of the doctors (31%) admitted to taking more interest in palliative medicine only after having made mistakes, a significant percentage (20%) after the death of a relative. 28% expressed the view that practical courses were an important part in learning about palliative medicine. The implementation of practice-based c tuition of medical students and of continuing education of established general practitioners and hospital physicians in palliative medicine is indispensable.

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

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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. Copyright © 2015 Elsevier Inc. All rights reserved.

Basic requirements of nuclear medicine services

Energy Technology Data Exchange (ETDEWEB)

Belcher, E H

1993-12-31

Technological progress in nuclear medicine continues, not always to the immediate advantage of the developing world. The capital expense, operational demands and maintenance requirements of ever more complex equipment, the consequent need for highly trained staff, the necessity to assure regular supplies of costly radioactive materials, all present problems to which compromise or alternative solutions must often be sought. This chapter constitutes an attempt to define the basic requirements for thr practice of nuclear medicine with respect to staff, equipment, accommodation, supplies and supporting services with particular reference to the needs of institutions in developing countries

Basic requirements of nuclear medicine services

International Nuclear Information System (INIS)

Belcher, E.H.

1992-01-01

Technological progress in nuclear medicine continues, not always to the immediate advantage of the developing world. The capital expense, operational demands and maintenance requirements of ever more complex equipment, the consequent need for highly trained staff, the necessity to assure regular supplies of costly radioactive materials, all present problems to which compromise or alternative solutions must often be sought. This chapter constitutes an attempt to define the basic requirements for thr practice of nuclear medicine with respect to staff, equipment, accommodation, supplies and supporting services with particular reference to the needs of institutions in developing countries

Facilitating and securing offline e-medicine service through image steganography

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Islam, M. Mahfuzul

2014-01-01

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. PMID:26609382

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.

Organisation of nuclear medicine services. Health physics. Technical and administrative arrangement

International Nuclear Information System (INIS)

Chanteur, J.; Pellerin, P.

1975-01-01

Apart from safety and quality requirements the organisation of nuclear medicine services, or more generally of installations where non-sealed radioactive sources are used, is governed by profitability and efficiency criteria. In view of the high price of products and apparatus the equipment must be based on a rationalisation of options guiding the organisation arrangements as a whole. The following items are dealt with in succession: various categories of installations; general planning of equipment; equipment regulations based on a major requirement, the confinement of contamination sources; working rules examined with respect to the systematics adopted by the International Health Physics Commission and referred in turn to the protection of the patient and that of the surroundings practical observations concerning administrative and technical questions [fr

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

[Monitoring medication errors in an internal medicine service].

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Smith, Ann-Loren M; Ruiz, Inés A; Jirón, Marcela A

2014-01-01

Patients admitted to internal medicine services receive multiple drugs and thus are at risk of medication errors. To determine the frequency of medication errors (ME) among patients admitted to an internal medicine service of a high complexity hospital. A prospective observational study conducted in 225 patients admitted to an internal medicine service. Each stage of drug utilization system (prescription, transcription, dispensing, preparation and administration) was directly observed by trained pharmacists not related to hospital staff during three months. ME were described and categorized according to the National Coordinating Council for Medication Error Reporting and Prevention. In each stage of medication use, the frequency of ME and their characteristics were determined. A total of 454 drugs were prescribed to the studied patients. In 138 (30,4%) indications, at least one ME occurred, involving 67 (29,8%) patients. Twenty four percent of detected ME occurred during administration, mainly due to wrong time schedules. Anticoagulants were the therapeutic group with the highest occurrence of ME. At least one ME occurred in approximately one third of patients studied, especially during the administration stage. These errors could affect the medication safety and avoid achieving therapeutic goals. Strategies to improve the quality and safe use of medications can be implemented using this information.

Assessment of knowledge of general practitioners about nuclear medicine

International Nuclear Information System (INIS)

Zakavi, R.; Derakhshan, A.; Pourzadeh, Z.

2002-01-01

Nuclear medicine is an important department in most of scientific hospitals in the world. Rapid improvement in the filed of nuclear medicine needs continuing education of medical students. We tried to evaluate the knowledge of general practitioners in the flied of nuclear medicine, hoping that this study help mangers in accurate planning of teaching programs. Methods and materials: We prepared a questionnaire with 14 questions regarding applications of nuclear medicine techniques in different specialities of medicine. We selected questions as simple as possible with considering the most common techniques and best imaging modality in some disease. One question in nuclear cardiology, one in lung disease, two questions in thyroid therapy, another two in gastrointestinal system, two in genitourinary system and the last two in nuclear oncology. Also 4 questions were about general aspects of nuclear medicine. We have another 4 questions regarding the necessity of having a nuclear medicine subject during medical study, the best method of teaching of nuclear medicine and the preferred method of continuing education. Also age, sex, graduation date and university of education of all subjects were recorded. Results: One hundred (General practitioners) were studied. including, 58 male and 42 female with age range of 27-45 years did . About 60% of cases were 27-30 years old and 40 cases were older than 40. Seventy two cases were graduated in the last 5 years. Mashad University was the main university of education 52 cases with Tehran University (16 cases) and Tabriz University (6 cases) in the next ranks. Also 26 cases were graduated from other universities. From four questions in the field of general nuclear nedione 27% were correctly answered to all questions, 37% correctly answered two questions and 10% had correct answered only one question. No correct answer was noted in 26% . correct answer was noted in 80% the held of nuclear cardiology and in 72% in the field of lung

General dental practitioner's views on dental general anaesthesia services.

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Threlfall, A G; King, D; Milsom, K M; Blinkhom, A S; Tickle, M

2007-06-01

Policy has recently changed on provision of dental general anaesthetic services in England. The aim of this study was to investigate general dental practitioners' views about dental general anaesthetics, the reduction in its availability and the impact on care of children with toothache. Qualitative study using semi-structured interviews and clinical case scenarios. General dental practitioners providing NHS services in the North West of England. 93 general dental practitioners were interviewed and 91 answered a clinical case scenario about the care they would provide for a 7-year-old child with multiple decayed teeth presenting with toothache. Scenario responses showed variation; 8% would immediately refer for general anaesthesia, 25% would initially prescribe antibiotics, but the majority would attempt to either restore or extract the tooth causing pain. Interview responses also demonstrated variation in care, however most dentists agree general anaesthesia has a role for nervous children but only refer as a last resort. The responses indicated an increase in inequalities, and that access to services did not match population needs, leaving some children waiting in pain. Most general dental practitioners support moving dental general anaesthesia into hospitals but some believe that it has widened health inequalities and there is also a problem associated with variation in treatment provision. Additional general anaesthetic services in some areas with high levels of tooth decay are needed and evidence based guidelines about caring for children with toothache are required.

Concerning nuclear medicine services. Notes on the practical situation in 1977

International Nuclear Information System (INIS)

Ducassou, Dominique.

1977-01-01

Nuclear medicine presents a certain number of teething problems, which are analysed here. An attempt is made first to estimate the worthwhileness or utility/cost ratio of a nuclear medicine service by determining firstly the expenses involved and secondly the services rendered. Problems connected with the running of nuclear medicine services are then discussed: civil and penal responsibility of the nuclear practitioner in relation to the human administration of radioactive preparations for diagnostic or therapeutic purposes; limited availability of scintillation cameras (1 for 500,000 inhabitants, a number considered hopelessly inadequate at the present time); organisation of premises; training of personnel (nuclear doctors, radiopharmacists, paramedical staff, technical staff). Finally the problems encountered in applying the nomenclature are dealt with [fr

Complementary and Alternative Medicine Services in the Military Health System.

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Herman, Patricia M; Sorbero, Melony E; Sims-Columbia, Ann C

2017-11-01

Surveys of military personnel indicate substantial use of complementary and alternative medicine (CAM) that possibly exceeds use in the general U.S. Although military treatment facilities (MTFs) are known to offer CAM, surveys do not indicate where service members receive this care. This study offers a comprehensive system-wide accounting of the types of CAM offered across the military health system (MHS), the conditions for which it is used, and its level of use. These data will help MHS policymakers better support their population's healthcare needs. A census survey of MTFs across the MHS on all CAM use, supplemented where possible by MHS utilization data. Types of CAM offered by each MTF, reasons given for offering CAM, health conditions for which CAM is used, and number of patient visits for each CAM type. Of the 142 MTFs in the MHS, 133 (94%) responded. Of these, 110 (83%) offer at least one type of CAM and 5 more plan to offer CAM services in the future. Larger MTFs (those reporting ≥25,000 beneficiaries enrolled) are both more likely to offer CAM services (p 10) of different types of CAM (p = 0.010) than smaller MTFs. Three-fourths of MTFs offering CAM provide stress management/relaxation therapy, two-thirds provide acupuncture, and at least half provide progressive muscle relaxation, guided imagery, chiropractic, and mindfulness meditation. MTFs most commonly report CAM use for pain and mental health conditions. Acupuncture and chiropractic are most commonly used for pain, and stress management/relaxation therapy and mind-body medicine combinations are most often used for mental health-related conditions. We estimate 76,000 CAM patient encounters per month across the MHS. The availability of CAM services in the MHS is widespread and is being used to address a range of challenging pain and mental health conditions.

An observational pre-post study of re-structuring Medicine inpatient teaching service: Improved continuity of care within constraint of 2011 duty hours.

Science.gov (United States)

Cheung, Joseph Y; Mueller, Daniel; Blum, Marissa; Ravreby, Hannah; Williams, Paul; Moyer, Darilyn; Caroline, Malka; Zack, Chad; Fisher, Susan G; Feldman, Arthur M

2015-09-01

Implementation of more stringent regulations on duty hours and supervision by the Accreditation Council for Graduate Medical Education in July 2011 makes it challenging to design inpatient Medicine teaching service that complies with the duty hour restrictions while optimizing continuity of patient care. To prospectively compare two inpatient Medicine teaching service structures with respect to residents' impression of continuity of patient care (primary outcome), time available for teaching, resident satisfaction and length-of-stay (secondary endpoints). Observational pre-post study. Surveys were conducted both before and after Conventional Medicine teaching service was changed to a novel model (MegaTeam). Academic General Medicine inpatient teaching service. Surveys before and after MegaTeam implementation were completed by 68.5% and 72.2% of internal medicine residents, respectively. Comparing conventional with MegaTeam, the % of residents who agreed or strongly agreed that the (i) ability to care for majority of patients from admission to discharge increased from 29.7% to 86.6% (pcare, decreases number of handoffs, provides adequate supervision and teaching of interns and medical students, increases resident overall satisfaction and decreases length-of-stay. Copyright © 2015 Elsevier Inc. All rights reserved.

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.

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Witt, Claudia M; Pérard, Marion; Berman, Brian; Berman, Susan; Birdsall, Timothy C; Defren, Horst; Kümmel, Sherko; Deng, Gary; Dobos, Gustav; Drexler, Atje; Holmberg, Christine; Horneber, Markus; Jütte, Robert; Knutson, Lori; Kummer, Christopher; Volpers, Susanne; Schweiger, David

2015-01-01

An increasing number of clinics offer complementary or integrative medicine services; however, clear guidance about how complementary medicine could be successfully and efficiently integrated into conventional health care settings is still lacking. Combining conventional and complementary medicine into integrative medicine can be regarded as a kind of 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. The aim of this project was to transfer the concept of corporate culture in mergers to the merging of two medical systems. 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 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). 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.

Provision of a Medicines Information Service to Consumers on Facebook: An Australian Case Study.

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Benetoli, Arcelio; Chen, Timothy F; Spagnardi, Sarah; Beer, Troy; Aslani, Parisa

2015-11-23

Social networking sites (SNSs) have changed the way people communicate. They may also change the way people seek health advice. This study describes the provision of a medicines information service on Facebook to individual consumers. It aimed to discuss the pros and cons, and inform health and pharmacy stakeholders and researchers about the opportunities and challenges of providing such a service. We adopted an exploratory approach using a case study method. NPS MedicineWise, an independent, not-for-profit Australian organization, runs a public question-and-answer service on Facebook, dubbed Pharmacist Hour. Consumers following the organization's Facebook page are invited to post medication-related questions often with a suggested health topic. A wide range of questions and comments are posted related to medication usage. The pharmacist answers the queries, providing evidence-based medicines information and using consumer-friendly language, during the specific 1-hour period. The most popular questions in the past 12 months were related to adverse effects, treatment options for conditions, and drug interactions. The service had a mean number of engagements (defined as a like or share of the Pharmacy Hour post) of 38 (SD 19) people and a mean 5 (SD 3) questions per session. The Pharmacist Hour Facebook service addresses the medicines information needs of consumers and indirectly promotes other appropriate and relevant NPS MedicineWise products and services to further assist consumers. The service offers a new medium for a quality use of medicines organization committed to promoting awareness about the correct and safe use of medicines in Australia.

An E-mail Service in a Military Adolescent Medicine Clinic: will teens ...

African Journals Online (AJOL)

The goal of this study was to determine utilization patterns of an Adolescent Medicine Clinic e-mail service. An e-mail service was offered to 6134 patients presenting for care to a military Adolescent Medicine Clinic in San Antonio, Texas over a 6-month period. Families had to complete an authorization form acknowledging ...

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

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. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

The role of general nuclear medicine in breast cancer

International Nuclear Information System (INIS)

Greene, Lacey R; Wilkinson, Deborah

2015-01-01

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

42 CFR 413.75 - Direct GME payments: General requirements.

Science.gov (United States)

2010-10-01

...-based providers for the costs of approved residency programs in medicine, osteopathy, dentistry, and... activities means the care and treatment of particular patients, including services for which a physician or..., general internal medicine, general pediatrics, preventive medicine, geriatric medicine or osteopathic...

Views of the Scottish general public on community pharmacy weight management services: international implications.

Science.gov (United States)

Weidmann, Anita Elaine; Cunningham, Scott; Gray, Gwen; Hansford, Denise; Bermano, Giovanna; Stewart, Derek

2012-04-01

Obesity has reached pandemic levels, with more than 1.5 billion adults being affected worldwide. In Scotland two-thirds of men and more than half of women are either overweight or obese, placing Scotland overall third behind the United States of America and Mexico. All community pharmacies in Scotland are contracted to provide public health services such as smoking cessation and there is increasing interest in their contribution to weight management. Researching this area in Scotland may provide valuable information to facilitate the development of community pharmacy services in other parts of the UK and internationally. To describe the views of the Scottish general public on the provision of weight management services via community pharmacies. General public in Scotland. A cross-sectional postal questionnaire survey of 6,000 randomly selected members of the Scottish general public aged 18 years and over. Views on community pharmacy led weight management services. Questionnaires were returned by 20.6% (n = 1,236). Over half 60.1% (n = 751) agreed or strongly agreed that they had easy access to pharmacy services in general and around one-third agreed (35%; n = 438) that it was more convenient to obtain weight management advice from a pharmacist than it is to make an appointment with a GP. Most respondents however lacked awareness of the types of health services available through community pharmacy (13.2%; n = 162) and would not feel comfortable speaking to a pharmacist or medicines counter assistant about weight related issues (25%; n = 320). Concerns over privacy (47.3%; n = 592) and perceived lack of pharmacists' specialist knowledge (open comments) were identified as potential barriers to service uptake by the general public. Overall, respondents appear to be receptive to the idea of accessing weight management services through community pharmacy but a perceived lack of privacy, poor knowledge of pharmacists' skill level and of public health services available to

Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2017.

Science.gov (United States)

Wieland, Mark L; Szostek, Jason H; Wingo, Majken T; Post, Jason A; Mauck, Karen F

2018-02-26

Clinicians are challenged to identify new practice-changing articles in the medical literature. To identify the practice-changing articles published in 2017 most relevant to outpatient general internal medicine, 5 internists reviewed the following sources: 1) titles and abstracts from internal medicine journals with the 7 highest impact factors, including New England Journal of Medicine, Lancet, Journal of the American Medical Association, British Medical Journal, Public Library of Science Medicine, Annals of Internal Medicine, and JAMA Internal Medicine; 2) synopses and syntheses of individual studies, including collections in the American College of Physicians Journal Club, Journal Watch, and Evidence-Based Medicine; 3) databases of synthesis, including Evidence Updates and the Cochrane Library. Inclusion criteria were perceived clinical relevance to outpatient general medicine, potential for practice change, and strength of evidence. This process yielded 140 articles. Clusters of important articles around one topic were considered as a single-candidate series. A modified Delphi method was utilized by the 5 authors to reach consensus on 7 topics to highlight and appraise from the 2017 literature. Copyright © 2018 Elsevier Inc. All rights reserved.

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

Science.gov (United States)

2013-02-13

... GENERAL SERVICES ADMINISTRATION [Notice-MV-2013-02; Docket No. 2013-0002; Sequence 3] 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 Inventories. SUMMARY: In...

Breast cancer patients' satisfaction with individual therapy goals and treatment in a standardized integrative medicine consultancy service.

Science.gov (United States)

Hack, Carolin C; Antoniadis, Sophia; Hackl, Janina; Langemann, Hanna; Schwitulla, Judith; Fasching, Peter A; Beckmann, Matthias W; Theuser, Anna-Katharin

2018-04-27

Complementary medicine services are nowadays usually quite heterogeneous, and little information is available on standards for running an integrative medicine consultancy service. This study aimed to assess patients' satisfaction with a standardized treatment service on integrative medicine. Using a cross-sectional design, 75 breast cancer patients from the integrative medicine consultancy service at the University Breast Center for Franconia were evaluated between January 2016 and March 2017. At primary consultation, patients answered a standardized questionnaire on their medical history and treatment goals regarding integrative medicine. In a subsequent interview, patients evaluated their satisfaction with the treatment service and individual treatment goals. 72% of the patients (n = 54) reported high satisfaction with the overall approach of the treatment service. 76% of the patients (n = 57) were very satisfied or satisfied with their individual treatment plans. The most frequently reported goals were to slow tumor progression (n = 64, 85.3%), reducing the side effects of conventional cancer treatments (n = 60, 80%), and a desire to participate actively in the treatment of breast cancer (n = 64, 85.3%). Using a standardized procedure in integrative medicine allows a high quality level to be offered to patients. Overall, breast cancer patients report very high satisfaction with the integrative medicine consultancy service and state long-term treatment goals. Hence, long-term treatment with integrative medicine methods should be taken into consideration.

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

Science.gov (United States)

Witt, Claudia M; Pérard, Marion; Berman, Brian; Berman, Susan; Birdsall, Timothy C; Defren, Horst; Kümmel, Sherko; Deng, Gary; Dobos, Gustav; Drexler, Atje; Holmberg, Christine; Horneber, Markus; Jütte, Robert; Knutson, Lori; Kummer, Christopher; Volpers, Susanne; Schweiger, David

2015-01-01

Background An increasing number of clinics offer complementary or integrative medicine services; however, clear guidance about how complementary medicine could be successfully and efficiently integrated into conventional health care settings is still lacking. Combining conventional and complementary medicine into integrative medicine can be regarded as a kind of 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. PMID:25632226

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.

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

Science.gov (United States)

2012-02-02

... GENERAL SERVICES ADMINISTRATION [Notice-MV-2012-01; Docket 2012-0002; Sequence 3] 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 availability of FY...

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

Science.gov (United States)

2011-01-31

... GENERAL SERVICES ADMINISTRATION [2011-MV-1; Docket No. 2011-0006; Sequence 4] 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 announces that GSA is...

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 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.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.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.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.

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.

The Defence Medical Library Service and military medicine.

Science.gov (United States)

Walker, S B

2005-01-01

The Defence Medical Library Service (DMLS) supports the clinical practice and career development of military health professionals across the world. Clinical governance and the need for medical knowledge to be evidence-based means the DMLS has a central role to play in support of defence medicine. The DMLS is important for enabling health professionals to make sense of the evidence-based pyramid and the hierarchy of medical knowledge. The Royal Centre for Defence Medicine (RCDM) in Birmingham is recognised as an international centre of excellence. The information, knowledge and research requirements of the RCDM will provide opportunities for the DMLS to support and engage with the academic community.

Integrating complementary and alternative medicine into mainstream healthcare services: the perspectives of health service managers.

Science.gov (United States)

Singer, Judy; Adams, Jon

2014-05-22

Complementary and alternative medicine (CAM) is increasingly included within mainstream integrative healthcare (IHC) services. Health service managers are key stakeholders central to ensuring effective integrative health care services. Yet, little research has specifically investigated the role or perspective of health service managers with regards to integrative health care services under their management. In response, this paper reports findings from an exploratory study focusing exclusively on the perspectives of health service managers of integrative health care services in Australia regarding the role of CAM within their service and the health service managers rational for incorporating CAM into clinical care. Health service managers from seven services were recruited using purposive and snowball sampling. Semi-structured interviews were conducted with the health service managers. The services addressed trauma and chronic conditions and comprised: five community-based programs including drug and alcohol rehabilitation, refugee mental health and women's health; and two hospital-based specialist services. The CAM practices included in the services investigated included acupuncture, naturopathy, Western herbal medicine and massage. Findings reveal that the health service managers in this study understand CAM to enhance the holistic capacity of their service by: filling therapeutic gaps in existing healthcare practices; by treating the whole person; and by increasing healthcare choices. Health service managers also identified CAM as addressing therapeutic gaps through the provision of a mind-body approach in psychological trauma and in chronic disease management treatment. Health service managers describe the addition of CAM in their service as enabling patients who would otherwise not be able to afford CAM to gain access to these treatments thereby increasing healthcare choices. Some health service managers expressly align the notion of treating the whole person

The National Library of Medicine Programs and Services, Fiscal Year 1974.

Science.gov (United States)

National Library of Medicine (DHEW), Bethesda, MD.

The activities and projects of the National Library of Medicine are described. New and continuing programs in library services and operations, on-line computer retrieval services, grants for library assistance, audiovisual programs, and health communications research are included. International activities of the Library are outlined. Summary…

Preparing for the aged in investigative medicine in a General Hospital setting

International Nuclear Information System (INIS)

Richards, P.A.C.

1998-01-01

Full text: The inequalities which exist today between the health of various sectors of society have grown partly out of the different rates of improvement experienced during the 18th, 19th and 20th Centuries. This is especially so for social class, racial and regional differences. Differential health problems between various age groups and disease groups have probably arisen for other reasons. People can now expect to live well into their 70s or early 80s. Many things have contributed to these health gains, including improved public health measures, high quality clinical treatment services, social and environmental conditions and lifestyle changes. The purpose of this paper is to highlight the major health problems of the community served by the Department of Nuclear Medicine at the Launceston General Hospital (Northern Regional Health) with the following perspectives: (i) How an ageing population is impacting in the level of service; (ii) How the aged are to be managed during investigation, after care and follow-up; and (iii) Major areas of investigations and age group analysis

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

2013-11-01

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 general medicine 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.

Aggression and violence directed toward general medicine physicians

Directory of Open Access Journals (Sweden)

Petrov-Kiurski Miloranka

2016-01-01

Full Text Available Objective: To explore the extent of aggression (verbal abuse and violence (physical abuse directed toward General Medicine physicians by their patients, to identify causes and consequences of such behaviour on physicians' professional work and to establish prevention measures. Method: All general medicine physicians who attended an educational seminar from 28 to 29 February 2015 in Belgrade were given the questionnaire and asked to complete it. Results: 411 general medicine physicians have completed the questionnaire. Both genders were included: 86.37% of them were women. Majority of the participants were in the age group of 51-60 years (45.25%, mean age was 49.27±9.32. Mean number of years in practice was 21.10±9.87. Most of them specialized in General Medicine (62.30%. 85.40% of physicians have encountered some kind of abuse during their work and there was no significant difference regarding physicians' gender or qualifications. In the preceding year 62.3% of participants have encountered aggression or violence in their workplace. Aggression was reported by 82.97% and violence by 8.83% of participants. There were no statistically significant differences in terms of physicians' gender (p=0.859, type of workplace (p=0.097, number of years in practice (p=0.640 and specialty (p=0.537. In 83.2% of cases acts of aggression or violence have been committed by patients and in 40.2% by members of their families. In 44.2% of these cases nobody tried to assist the physicians and even less so if they were male doctors (p=0.05. The most common causes were: patients' dissatisfaction (60.4%, long waiting time for examination (37.0% and patient's alcohol or drug intoxication (35.0%. The most common consequence of this on physicians was decreased satisfaction with their job (53.6%. Prevention measures for this issue would be: decreasing of the number of consultations per day (56.0%, introduction of a new 'in line of duty' status for healthcare workers (55

Impact of the prospective payment system on the delivery of nuclear medicine services

International Nuclear Information System (INIS)

Crucitti, T.W.; Pappas, V.M.

1986-07-01

The study evaluates the effect of the Medicare Prospective Payment System (PPS) on nuclear medicine technologists and services. Since 80% of nuclear medicine technologists work in hospitals, a large segment of the professionals would be affected by the new system. The survey was designed to assess the PPSs effect on nuclear medicine departments at the early implementation stage

Requirements of radiation protection and safety for nuclear medicine services

International Nuclear Information System (INIS)

1989-01-01

The requirements of radiation protection and safety for nuclear medicine services are established. The norms is applied to activities related to the radiopharmaceuticals for therapeutics and 'in vivo' diagnostics purposes. (M.C.K.) [pt

Consumer perspectives of the Australian Home Medicines Review Program: benefits and barriers.

Science.gov (United States)

White, Lesley; Klinner, Christiane; Carter, Stephen

2012-01-01

The Australian Home Medicines Review (HMR) is a free consumer service to assist individuals living at home to maximize the benefits of their medicine regimen and prevent medication-related problems. It consists of a pharmacist reviewing a person's medicines and collaborating with the general practitioner to optimize the individual's medicine management. The uptake of this service has remained below the projected use, although the program has shown to successfully identify medication-related problems and improve drug knowledge and adherence of the patient. This study investigates the perceived benefits and barriers of the patients regarding the HMR service who have used the service and who are eligible for it but have never used it. Consumer perceptions were drawn from 14 semistructured focus groups, with patients and carers belonging to the general HMR target population and consumer segments that have been postulated to be underrepresented with regard to this service. The major benefits reported were acquisition of medicine information, reassurance, feeling valued and cared for, and willingness to advocate medication changes to the general practitioner. Perceived barriers were concerns regarding upsetting the general practitioner, pride and independence, confidence issues with an unknown pharmacist, privacy and safety concerns regarding the home visit, and lack of information about the program. Participants agreed that the potential benefits of the service outweighed its potential barriers. It is expected that direct-to-consumer promotion of HMRs would increase the uptake of this valuable service. It would be necessary to ensure that the process and benefits of the service are communicated clearly and sensitively to eligible patients and their carers to obviate common consumer misconceptions and/or barriers regarding the HMR service. Furthermore, any direct-to-consumer promotion of the service must enable patient/carer self-identification of eligibility. Copyright

Assessing Patients' Preference for Integrating Herbal Medicine Within Primary Care Services in Saudi Arabia.

Science.gov (United States)

Allam, Safaa; Moharam, Maha; Alarfaj, Gada

2014-07-01

Family physician advice and follow-up may be important to reduce the negative aspects of locally marketed herbal remedies and improve the patient outcome. There is a lack of studies assessing the preference of Saudi patients for the integration of herbal medicine into primary care services. To examine the knowledge, attitudes, and practice of Saudi patients toward herbal medicine and its integration into primary care services. A cross-sectional study was conducted between February and March 2013 among adult patients attending the family medicine clinics at a primary care center in Riyadh, Saudi Arabia. A self-administered questionnaire (27 items) was developed and administered to all patients. A total of 240 patients were included in the current analysis. The average age was 33.5 ± 9.9 years, and 61% of the patients were women. Approximately 60% of the patients were aware of herbal medicine use and its possible side effects. More than 85% of the patients believed that herbal containers should be labeled with safety information. Approximately 71% of the patients had a favorable attitude toward integrated services. Approximately 65% of the patients used herbal remedies for themselves, and 42% used them for their children. Preference for integrated services was significantly associated with female sex, better knowledge, positive attitudes toward safety and regulations, and higher level of practice. A good knowledge and a very favorable attitude toward integrating herbal medicine into primary care services were found among a group of patients attending a primary care center in Saudi Arabia. © The Author(s) 2014.

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.

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

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false In-kind donations of medicine...-kind donations of medicine, medical devices, and medical services. (a) Effective July 6, 2006, nongovernmental organizations that are U.S. persons are authorized to provide in-kind donations of medicine...

Effects of the regulatory inspections on nuclear medicine services executed by the Radioprotection and Dosimetry Services, Brazil

International Nuclear Information System (INIS)

Alves, C.E.G.R.; Farias, C.; Azevedo, E.M.; Nanni, G.J.; Vasconcellos, L.; Mendes, L.C.G.; Souza, L.A.C.; Franca, W.F.L.; Goncalves, M.

2005-01-01

The advances in the Nuclear Medicine auditing field performed by Nuclear Medicine Group of the Radiotherapy and Nuclear Medicine Division of the Institute of Radiation Protection and Dosimetry are shown. The main aspects observed during the auditing are presented as well as the evolution of the non-conformities. Its is also shown that the occurrence of these non-conformities decreases year by year, primarily as a function of the severity of the auditing and the consciousness of the personal of Nuclear Medicine Services. Results point clearly to the importance of the coercion actions to guarantee a radiation protection level in compliance with the standards established by the Brazilian Nuclear Energy Commission. (author)

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

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false In-kind donations of medicine....515 In-kind donations of medicine, medical devices, and medical services. (a) Effective July 6, 2006, nongovernmental organizations that are U.S. persons are authorized to provide in-kind donations of medicine...

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

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

General practitioners' perceptions of pharmacists' new services in New Zealand.

Science.gov (United States)

Hatah, Ernieda; Braund, Rhiannon; Duffull, Stephen; Tordoff, June

2012-04-01

In recent years, the pharmacy profession has moved towards more patient-oriented services. Some examples are medication review, screening and monitoring for disease, and prescribing. The new services are intended to be in close collaboration with general practitioners (GPs) yet little is known of how GPs in New Zealand perceive these new services. Objective To examine GPs' perceptions of pharmacists' new services. Study was undertaken at GPs' practices in two localities in New Zealand. Qualitative, face to face, semi-structured interviews were undertaken of 18 GPs. The cohort included GPs with less/more than 20 years of practice, and GPs who had experience of working in localities where some patients had undergone a medication review (Medicines Use Review, MUR) by community pharmacists. GPs were asked to share their perceptions about pharmacists providing some new services. Data were thematically analysed with constant comparison using NVivo 8 software. Using a business strategic planning approach, themes were further analysed and interpreted as the services' potential Strengths, Weaknesses, Opportunities and Threats (SWOTs). GPs' perceptions of pharmacists' new services. GPs were more supportive of pharmacists' playing active roles in medication review and less supportive of pharmacists practising screening-monitoring and prescribing. Discussions Pharmacists' knowledge and skills in medication use and the perceived benefits of the services to patients were considered the potential strengths of the services. Weaknesses centred around potential patient confusion and harm, conflict and irritation to GPs' practice, and the potential to fragment patient-care. Opportunities were the possibilities of improving communication, and having a close collaboration and integration with GPs' practice. Apparent threats were the GPs' perceptions of a related, and not renumerated, increase in their workloads, and the perception of limited benefit to patients. Pharmacists should

General beliefs about medicines among doctors and nurses in out-patient care: a cross-sectional study

Directory of Open Access Journals (Sweden)

Hedenrud Tove

2009-05-01

Full Text Available Abstract Background Doctors and nurses are two natural partners in the healthcare team, but they usually differ in their perspectives on how to work for increased health. These professions may also have different beliefs about medicines, a factor important for adherence to medicines. The aim was to explore general beliefs about medicines among doctors and nurses. Methods Questionnaires were sent to 306 private practitioners (PPs, 298 general practitioners (GPs and 303 nurses in the county of Västra Götaland, Sweden. The questionnaire included sociodemographic questions and the general part of the Beliefs about Medicines Questionnaire (BMQ, which measures the beliefs people have about medicines in general. General beliefs about medicines in relation to background variables were explored with independent t-tests and ANOVA analyses. Differences between occupations and influences of interaction variables were analysed with multiple linear regression models for general beliefs about medicines. Results The data collection resulted in 616 questionnaires (62.1% PPs; 61.6% GPs; 80.5% nurses. The majority of the PPs and 40% of the GPs were male but most of the nurses were female. The GPs' mean age was 47 years, PPs' 60 years and nurses' 52 years. Few nurses originated from non-Nordic countries while 15% of the PPs and 25% of the GPs did. Nurses saw medicines as more harmful and less beneficial than did PPs and GPs. These differences could not be explained by the included interaction variables. GPs with a Nordic background saw medicines as more beneficial and less harmful than did GPs with a non-Nordic background. Furthermore, GPs of non-Nordic origin were most likely to believe that medicines were overprescribed by doctors. Conclusion Doctors were more positive about medicines than nurses. The differences in beliefs about medicines found between doctors and nurses could not be explained by any of the included interaction variables. These differences in

General practitioners, complementary therapies and evidence-based medicine: the defence of clinical autonomy.

Science.gov (United States)

Adams, J

2000-12-01

Amidst the substantial change currently gripping primary health care are two developments central to contemporary debate regarding the very nature, territory and identity of general practice - the integration of complementary and alternative medicine (CAM) and the rise of evidence-based medicine (EBM). This paper reports findings from a study based upon 25 in-depth interviews with general practitioners (GPs) personally practising complementary therapies alongside more conventional medicine to treat their NHS patients. The paper outlines the GPs' perceptions of EBM, its relationship to their personal development of CAM, and their notions of good clinical practice more generally. Analysis of the GPs' accounts demonstrates how CAM can be seen as a useful resource with which some GPs defend their clinical autonomy from what they perceive to be the threat of EBM. Copyright 2000 Harcourt Publishers Ltd.

The intellectual contribution of laboratory medicine professionals to research papers on laboratory medicine topics published in high-impact general medicine journals.

Science.gov (United States)

Escobar, Pedro Medina; Nydegger, Urs; Risch, Martin; Risch, Lorenz

2012-03-01

An author is generally regarded as an individual "who has made substantial intellectual academic contributions to a published study". However, the extent of the contribution that laboratory medicine professionals have made as authors of research papers in high-impact medical journals remains unclear. From 1 January 2004 to 31 March 2009, 4837 original research articles appeared in the: New England Journal of Medicine, Lancet, Annals of Internal Medicine, JAMA and BMJ. Using authorship as an indicator of intellectual contribution, we analyzed articles that included laboratory medicine parameters in their titles in an observational cross-sectional study. We also extracted data regarding radiological topics that were published during the same time within the same journals. Out of 481 articles concerning laboratory medicine topics, 380 provided information on the affiliations of the authors. At least one author from an institution within the field of laboratory medicine was listed in 212 articles (55.8%). Out of 3943 co-authors, only 756 (19.2%) were affiliated with laboratory medicine institutions. Authors from laboratory medicine institutions were listed as the first, last or corresponding authors in 99 articles (26.1%). The comparative proportions for author affiliation from 55 radiology articles were significantly higher, as 72.7% (p=0.026) of articles and 24.8% (p=0.001) of authors indicated an affiliation with a radiology institution. Radiology professionals from 72.7% of the articles were listed as either the first, last or corresponding authors (pgeneral medicine journals.

Integrating personal medicine into service delivery: empowering people in recovery.

Science.gov (United States)

MacDonald-Wilson, Kim L; Deegan, Patricia E; Hutchison, Shari L; Parrotta, Nancy; Schuster, James M

2013-12-01

Illness management and recovery strategies are considered evidence-based practices. The article describes how a web-based application, CommonGround, has been used to support implementation of such strategies in outpatient mental health services and assess its impact. The specific focus of this article is Personal Medicine, self-management strategies that are a salient component of the CommonGround intervention. With support from counties and a not-for-profit managed care organization, CommonGround has been introduced in 10 medication clinics, one Assertive Community Treatment (ACT) team, and one peer support center across Pennsylvania. Methods include analysis of data from the application's database and evaluation of health functioning, symptoms, and progress toward recovery. Health functioning improved over time and use of self-management strategies was associated with fewer concerns about medication side effects, fewer concerns about the impact of mental health medicine on physical health, more reports that mental health medicines were helping, and greater progress in individuals' recovery. Using Personal Medicine empowers individuals to work with their prescribers to find a "right balance" between what they do to be well and what they take to be well. This program helps individuals and their service team focus on individual strengths and resilient self-care strategies. More research is needed to assess factors that may predict changes in outcomes and how a web-based tool focused on self-management strategies may moderate those factors. PsycINFO Database Record (c) 2013 APA, all rights reserved.

40 years of biannual family medicine research meetings--the European General Practice Research Network (EGPRN).

Science.gov (United States)

Buono, Nicola; Thulesius, Hans; Petrazzuoli, Ferdinando; Van Merode, Tiny; Koskela, Tuomas; Le Reste, Jean-Yves; Prick, Hanny; Soler, Jean Karl

2013-12-01

To document family medicine research in the 25 EGPRN member countries in 2010. Semi-structured survey with open-ended questions. Academic family medicine in 23 European countries, Israel, and Turkey. 25 EGPRN national representatives. Demographics of the general population and family medicine. Assessments, opinions, and suggestions. EGPRN has represented family medicine for almost half a billion people and > 300,000 general practitioners (GPs). Turkey had the largest number of family medicine departments and highest density of GPs, 2.1/1000 people, Belgium had 1.7, Austria 1.6, and France 1.5. Lowest GP density was reported from Israel 0.17, Greece 0.18, and Slovenia 0.4 GPs per 1000 people. Family medicine research networks were reported by 22 of 25 and undergraduate family medicine research education in 20 of the 25 member countries, and in 10 countries students were required to do research projects. Postgraduate family medicine research was reported by 18 of the member countries. Open-ended responses showed that EGPRN meetings promoted stimulating and interesting research questions such as comparative studies of chronic pain management, sleep disorders, elderly care, healthy lifestyle promotion, mental health, clinical competence, and appropriateness of specialist referrals. Many respondents reported a lack of interest in family medicine research related to poor incentives and low family medicine status in general and among medical students in particular. It was suggested that EGPRN exert political lobbying for family medicine research. Since 1974, EGPRN organizes biannual conferences that unite and promote primary care practice, clinical research and academic family medicine in 25 member countries.

Optimization of the radioprotection for nuclear medicine services

International Nuclear Information System (INIS)

Lira, Renata F. de; Filho, Joao A.; Santos, Luiz A.P.; Lima, Fernando Roberto de Andrade; Vieira, Jose W.

2013-01-01

Nuclear medicine (NM) is a medical specialty which uses small amounts of radioactive material combined with drugs, to make either therapeutic treatments or form diagnostic images of the organ and tissue. Follow the nuclear regulations any activity involving ionizing radiation should be justified and it must have their procedures of work to be optimized. Thus, the aim of the study is to determine the need and the importance of optimization of radiation protection in NM services and reduce occupationally exposed individuals (OEI) doses in order to avoid possible contamination or accidents and reduce the costs of protection. Optimization for a NM service that makes use of ionizing radiation can be performed using different techniques such as the expanded cost-benefit analysis. Such technique introduces one or two attributes associated to the detriment cost, Y, and the protection costs, X. This work was conducted in the year 2011, where it was analyzed data of 56 employees from 2002 to 2010. The value of the cost of protection was R$ 147.645,95, including accessories, courses, training and maintenance costs. On the other hand, the cost of the expense ranged from R$ 1.065.750, 00 up to R$ 28.890.351, 00 and the parameter responsible for this variation is the collective dose. The increasing of these dose values causes the increasing of the total costs, and one can conclude that there really is an importance of applying the optimization technique to improve the safety of OEI at the nuclear medicine service and reducing costs of protection. (author)

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)

Travel Medicine Encounters of Australian General Practice Trainees-A Cross-Sectional Study.

Science.gov (United States)

Morgan, Simon; Henderson, Kim M; Tapley, Amanda; Scott, John; van Driel, Mieke L; Spike, Neil A; McArthur, Lawrie A; Davey, Andrew R; Catzikiris, Nigel F; Magin, Parker J

2015-01-01

Travel medicine is a common and challenging area of clinical practice and practitioners need up-to-date knowledge and experience in a range of areas. Australian general practitioners (GPs) play a significant role in the delivery of travel medicine advice. We aimed to describe the rate and nature of travel medicine consultations, including both the clinical and educational aspects of the consultations. A cross-sectional analysis from an ongoing cohort study of GP trainees' clinical consultations was performed. Trainees contemporaneously recorded demographic, clinical, and educational details of consecutive patient consultations. Proportions of all problems/diagnoses managed in these consultations that were coded "travel-related" and "travel advice" were both calculated with 95% confidence intervals (CIs). Associations of a problem/diagnosis being "travel-related" or "travel advice" were tested using simple logistic regression within the generalized estimating equations (GEE) framework. A total of 856 trainees contributed data on 169,307 problems from 108,759 consultations (2010-2014). Travel-related and travel advice problems were managed at a rate of 1.1 and 0.5 problems per 100 encounters, respectively. Significant positive associations of travel-related problems were younger trainee and patient age; new patient to the trainee and practice; privately billing, larger, urban, and higher socioeconomic status practices; and involvement of the practice nurse. Trainees sought in-consultation information and generated learning goals in 34.7 and 20.8% of travel advice problems, respectively, significantly more than in non-travel advice problems. Significant positive associations of travel advice problems were seeking in-consultation information, generation of learning goals, longer consultation duration, and more problems managed. Our findings reinforce the importance of focused training in travel medicine for GP trainees and adequate exposure to patients in the practice

The Evolution of General Internal Medicine (GIM)in Canada: International Implications.

Science.gov (United States)

Card, Sharon E; Clark, Heather D; Elizov, Michelle; Kassam, Narmin

2017-05-01

General internal medicine (GIM), like other generalist specialties, has struggled to maintain its identity in the face of mounting sub-specialization over the past few decades. In Canada, the path to licensure for general internists has been through the completion of an extra year of training after three core years of internal medicine. Until very recently, the Royal College of Physicians and Surgeons of Canada (RCPSC) did not recognize GIM as a distinct entity. In response to a societal need to train generalist practitioners who could care for complex patients in an increasingly complex health care setting, the majority of universities across Canada voluntarily developed structured GIM training programs independent of RCPSC recognition. However, interest amongst trainees in GIM was declining, and the GIM workforce in Canada, like that in many other countries, was in danger of serious shortfalls. After much deliberation and consultation, in 2010, the RCPSC recognized GIM as a distinct subspecialty of internal medicine. Since this time, despite the challenges in the educational implementation of GIM as a distinct discipline, there has been a resurgence of interest in this field of medicine. This paper outlines the journey of the Canadian GIM to educational implementation as a distinct discipline, the impact on the discipline, and the implications for the international GIM community.

Integrating patient empowerment as an essential characteristic of the discipline of general practice/family medicine.

Science.gov (United States)

Mola, Ernesto; De Bonis, Judith A; Giancane, Raffaele

2008-01-01

Efforts to improve the quality of healthcare for patients with chronic conditions have resulted in growing evidence supporting the inclusion of patient empowerment as a key ingredient of care. In 2002, WONCA Europe issued the European Definition of General Practice/Family Medicine, which is currently considered the point of reference for European health institutions and general medical practice. Patient empowerment does not appear among the 11 characteristics of the discipline. The aim of this study is to show that many characteristics of general practice are already oriented towards patient empowerment. Therefore, promoting patient empowerment and self-management should be included as a characteristic of the discipline. The following investigation was conducted: analysing the concept and approach to empowerment as applied to healthcare in the literature; examining whether aspects of empowerment are already part of general medical practice; and identifying reasons why the European definition of general practice/family medicine should contain empowerment as a characteristic of the discipline. General practice/family medicine is the most suitable setting for promoting patient empowerment, because many of its characteristics are already oriented towards encouraging it and because its widespread presence can ensure the generalization of empowerment promotion and self-management education to the totality of patients and communities. "Promoting patient empowerment and self-management" should be considered one of the essential characteristics of general practice/family medicine and should be included in its definition.

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)

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)

Integrative Medicine in Preventive Medicine Education

Science.gov (United States)

Jani, Asim A.; Trask, Jennifer; Ali, Ather

2016-01-01

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

Hospital Intranet and Extranet in nuclear medicine

International Nuclear Information System (INIS)

Gambini, D.J.; Baum, T.P.; Spector, M.; Dumas, F.; Elgard, M.C.; Collington, M.A.; Barritault, L.

1997-01-01

Since two years ago nuclear medicine service of Laennec Hospital has implemented transmission and distribution networks of scintigraphic images. A new stage was reached at present by developing an Intranet and Extranet system for nursing units and other services of nuclear medicine. The Intranet link to the services of Laennec Hospital and AP HP is based on a image server connected to the service gamma camera and, after a possible post-processing, the images are transmitted in PCX format by e-mail, attached to the medical record. For communication between nuclear medicine services, a heavier procedure making use of a program for image processing under inter-file standards has been implemented. To achieve the Extranet link with services and physicians of town, exterior to AP HP, a procedure was installed which allows reaching any nursing unit or town physicians having at their disposal e-mail on a secured network. This procedure will be generalized when the Health secured network, linking the medical bodies to Health insurance institutions, will be operational. The interactive tele-medicine will be achieved by means of a procedure based on Internet cooperative tools (wild cards, video- and vision-conferences) which will permits in all situations an interactive work on all the transmitted patient files

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.

Institute for Communication, General Services, Administration

International Nuclear Information System (INIS)

Legrain, C.

2007-01-01

The article describes the key activities of the Institute for Communication, General Services and Administration (CSA) of the Belgian Nuclear Research Centre SCK-CEN. CSA deals with communication and knowledge management and co-ordinates courses on the fundamentals and applications of nuclear research. CSA also comprises the administrative, financial, logistic and central technical services, as well as human resources and ICT

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

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false In-kind donations of medicine... Licensing Policy § 597.511 In-kind donations of medicine, medical devices, and medical services. (a... incident to the provision by nongovernmental organizations that are U.S. persons of in-kind donations of...

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.

A cross-sectional survey of the access of older people in the Scottish Highlands to general medical practices, community pharmacies and prescription medicines.

Science.gov (United States)

Rushworth, Gordon F; Cunningham, Scott; Pfleger, Sharon; Hall, Jenny; Stewart, Derek

2018-01-01

Access to medicines and healthcare is more problematic in remote and rural areas. To quantify issues of access to general practitioners (GPs), community pharmacies and prescribed medicines in older people resident in the Scottish Highlands. Anonymized questionnaires were mailed to a random sample of 2000 older people (≥60 years) resident in the Scottish Highlands. Questionnaire items were: access and convenience to GP and pharmacy services (10 items); prescribed medicines (13 items); attitudinal statements based on the Theoretical Domains Framework (12 items); quality of life (SF8, 8 items); and demographics (12 items). Results were analysed using descriptive, inferential and spatial statistics, and principal component analysis (PCA) of attitudinal items. With a response rate of 54.2%, the majority reported convenient access to GPs (89.1%) and community pharmacies (84.3%). Older age respondents (p rural areas to community pharmacies (p rural areas and taking five or more prescribed medicines. Copyright © 2017 Elsevier Inc. All rights reserved.

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. Copyright © 2016 Elsevier Inc. All rights reserved.

Interpretive medicine: Supporting generalism in a changing primary care world.

Science.gov (United States)

Reeve, Joanne

2010-01-01

Patient-centredness is a core value of general practice; it is defined as the interpersonal processes that support the holistic care of individuals. To date, efforts to demonstrate their relationship to patient outcomes have been disappointing, whilst some studies suggest values may be more rhetoric than reality. Contextual issues influence the quality of patient-centred consultations, impacting on outcomes. The legitimate use of knowledge, or evidence, is a defining aspect of modern practice, and has implications for patient-centredness. Based on a critical review of the literature, on my own empirical research, and on reflections from my clinical practice, I critique current models of the use of knowledge in supporting individualised care. Evidence-Based Medicine (EBM), and its implementation within health policy as Scientific Bureaucratic Medicine (SBM), define best evidence in terms of an epistemological emphasis on scientific knowledge over clinical experience. It provides objective knowledge of disease, including quantitative estimates of the certainty of that knowledge. Whilst arguably appropriate for secondary care, involving episodic care of selected populations referred in for specialist diagnosis and treatment of disease, application to general practice can be questioned given the complex, dynamic and uncertain nature of much of the illness that is treated. I propose that general practice is better described by a model of Interpretive Medicine (IM): the critical, thoughtful, professional use of an appropriate range of knowledges in the dynamic, shared exploration and interpretation of individual illness experience, in order to support the creative capacity of individuals in maintaining their daily lives. Whilst the generation of interpreted knowledge is an essential part of daily general practice, the profession does not have an adequate framework by which this activity can be externally judged to have been done well. Drawing on theory related to the

Development of youth friendly family medicine services in Bosnia and Herzegovina: protocol for a cluster randomized controlled trial.

Science.gov (United States)

Haller, Dagmar M; Narring, Françoise; Chondros, Patty; Pejic, Daliborka; Sredic, Ana; Huseinagic, Senad; Perone, Nicolas; Sanci, Lena A; Meynard, Anne

2014-01-01

Young people face many barriers in accessing health services that are responsive to their needs. The World Health Organization has led a call to develop services that address these barriers, i.e. youth-friendly health services. Addressing the needs of young people is one of the priorities of Foundation fami, an organisation working in collaboration with the Swiss Federal Department of Development and Cooperation and Geneva University Hospitals to develop quality family medicine services in Bosnia and Herzegovina. This paper describes the design of a trial to assess the effectiveness of a multifaceted intervention involving family medicine teams (primary care doctors and nurses) to improve the youth-friendliness of family medicine services in Bosnia and Herzegovina. This is a stratified cluster randomised trial with a repeated cross-sectional design involving 59 health services in 10 municipalities of the canton of Zenica in Bosnia and Herzegovina. Municipalities were the unit of randomisation: five municipalities were randomised to the intervention arm and five to a wait-list control arm. Family medicine teams in the intervention arm were invited to participate in an interactive training program about youth-friendly service principles and change processes within their service. The primary outcome was the youth-friendliness of the primary care service measured using the YFHS-WHO + questionnaire, a validated tool which young people aged 15 to 24 years complete following a family medicine consultation. A total of 600 young people aged 15 to 24 years were invited to participate and complete the YFHS-WHO + questionnaire: 300 (30 per municipality) at baseline, and 300 at follow-up, three to five months after the training program. The results of this trial should provide much awaited evidence about the development of youth-friendly primary care services and inform their further development both in Bosnia and Herzegovina and worldwide. Australian New Zealand

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.

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…

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...

[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.

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...

Passive Dosimetry Of Nuclear Medicine Service Staff, Ibn Sina Hospital

International Nuclear Information System (INIS)

Sebihi, R.; Talsmat, K.; Cherkaoui, R.; Ben Rais, N.

2010-01-01

Full text: Since the implementation of Law No. 00571 of 21 Chaabane 1391 on protection against ionizing radiation and its decrees 2: 2-97-30 and 2-97-132 28 October 1997, surveillance of workers has the subject of major regulatory developments in Morocco, including individual registration delayed for dosimetry. As part of optimizing the protection of medical personnel, a dosimetric study was performed for the first time at the national level, the Nuclear Medicine Service of the Ibn Sina hospital in collaboration with the National Center for Energy Sciences and Nuclear Techniques (CNESTEN). Dosimetric monitoring was conducted for 2 weeks with the use of passive thermoluminescent dosimeters, (GR200A), covering all categories of staff. The administration of samarium (β emitter with energy substantially higher than the energies encountered in conventional nuclear medicine) has been studied, given his first service. Other cases of people concerned our study: a pregnant woman doctor, whose exposure of the unborn child must be reduced as much as possible, and a woman from a private company, working without dosimeter, handles maintenance of premises. To control the conditions imposed on all activities requiring exposure to ionizing radiation, we evaluated the dose at the extremities of operators with the use of ring dosimeters (GR200A) and the dose on the ambient environment of staff (dosimeters ALNOR). This experiment has shown exposure levels below legal limits, without been negligible for certain post. The evaluation results equivalent doses manipulators justify the wearing of dosimeter rings as a complementary dosimeter in Nuclear Medicine service and a way of controlling the normal working conditions. Finally Monitoring ambient dosimetry showed that the environment is low radiation doses. Lessons learned from this study, for the protection of personnel are as follows: from the simple awareness of staff and means of optimizing radiation can maintain a dosimetry annual

[Establishing the idea of holistic integrative medicine, optimizing the quality of health care service in prevention and treatment].

Science.gov (United States)

Sun, Xing-guo

2015-07-01

Under background of reductionism in the modern science, physiology and medicine are stepwise refined into system, organ, disease, cell and gene etc. Although clinical medicine, only service in whole human object, obviously brought tremendous progress, it also appeared obvious defects and limits at the same time. Professionalized and specialized medicine not only needs to be integrated from basics to clinical fields, but also from prevention, health management, clinical treatment and functional rehabilitation medicine. People are indivisible organic whole. Professionalization, translation and integration must be combined. In order to provide the best quality and optimized medical service for the Chinese people and to lead in the world, we have to strengthen professional and technical knowledge, and have to establish the holistic integrative medical philosophy for physiology and medicine too.

Quality control of radionuclide calibrators used in nuclear medicine services in the Brazilian northeast region

International Nuclear Information System (INIS)

Fragoso, Maria C.F.; Albuquerque, Antonio M.S.; Oliveira, Mercia L.; Lima, Ricardo A.; Lima, Fabiana F.

2011-01-01

The radionuclide calibrators are essential instruments in nuclear medicine services in order to activity determination of radiopharmaceuticals which will be administered to the patients. Inappropriate performance of these equipment could provide underestimation or overestimation of the activity, compromising the success of diagnosis or therapeutic procedures. To ensure the satisfactory performance of the radionuclide calibrators, quality control tests are recommended by national and international guides. The aim of this work was evaluate the establishment of the quality control program in the radionuclide calibrators at medicine nuclear services in the Brazilian northeast region, highlighting the tests and their frequencies. (author)

Risks and opportunities for plastic surgeons in a widening cosmetic medicine market: future demand, consumer preferences, and trends in practitioners' services.

Science.gov (United States)

D'Amico, Richard A; Saltz, Renato; Rohrich, Rod J; Kinney, Brian; Haeck, Phillip; Gold, Alan H; Singer, Robert; Jewell, Mark L; Eaves, Felmont

2008-05-01

The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery launched a joint Cosmetic Medicine Task Force to address the growing trend of non-plastic surgeons entering the cosmetic medicine field. The task force commissioned two surveys in 2007 to determine consumer attitudes about choosing cosmetic medicine providers and to learn about the cosmetic services that plastic surgeons offer. The first survey obtained responses from 1015 women who had undergone a cosmetic procedure or were considering having one within 2 years. The second survey obtained responses from 260 members of the two societies. Compared with other practitioners, plastic surgeons enjoy higher rates of satisfaction among their patients who undergo noninvasive procedures. Injectables present a particularly promising market for plastic surgeons. Half of consumers surveyed said they were very concerned about complications associated with injectables, and generally, the higher the perceived risk of the procedure, the higher the likelihood that a patient would choose a plastic surgeon to perform it. In addition, injectables were among the noninvasive treatments most frequently being considered by consumers. However, almost half of consumers said that if they had a positive experience with a non-plastic surgeon core provider for a noninvasive procedure, that physician would likely be their first choice for a surgical procedure. These findings suggest that plastic surgeons, and especially those who are building young practices, must expand their offerings of nonsurgical cosmetic services to remain at the core of the cosmetic medicine field.

Use of health services and medicines amongst Australian war veterans: a comparison of young elderly, near centenarians and centenarians

Directory of Open Access Journals (Sweden)

Ryan Philip

2010-11-01

Full Text Available Abstract Background Age and life expectancy of residents in many developed countries, including Australia, is increasing. Health resource and medicine use in the very old is not well studied. The purpose of this study was to identify annual use of health services and medicines by very old Australian veterans; those aged 95 to 99 years (near centenarians and those aged 100 years and over (centenarians. Methods The study population included veterans eligible for all health services subsidised by the Department of Veterans' Affairs (DVA aged 95 years and over at August 1st 2006. A cohort of veterans aged 65 to 74 years was identified for comparison. Data were sourced from DVA claims databases. We identified all claims between August 1st 2006 and July 31st 2007 for medical consultations, pathology, diagnostic imaging and allied health services, hospital admissions, number of prescriptions and unique medicines. Chi squared tests were used to compare the proportion of centenarians (those aged 100 years and over and near centenarians (those aged 95 to 99 years who accessed medicines and health services with the 65 to 74 year age group. For those who accessed health services during follow up, Poisson regression was used to compare differences in the number of times centenarians and near centenarians accessed each health service compared to 65 to 74 year olds. Results A similar proportion (98% of centenarians and near centenarians compared to those aged 65 to 74 consulted a GP and received prescription medicine during follow up. A lower proportion of centenarians and near centenarians had claims for specialist visits (36% and 57% respectively, hospitalisation (19% and 24%, dental (12% and 18%, physiotherapy (13% and 15%, pathology(68% and 78% and diagnostic imaging services (51% and 68% (p Conclusions Medical consultations and medicines are the health services most frequently accessed by Australian veteran centenarians and near centenarians. For most

Drug utilization pattern of Chinese herbal medicines in a general hospital in Taiwan.

Science.gov (United States)

Chen, L C; Wang, B R; Chou, Y C; Tien, J H

2005-09-01

Drug utilization studies are important for the optimization of drug therapy and have received a great attention in recent years. Most of the information on drug use patterns has been derived from studies in modern Western medicines; however, studies regarding the drug utilization of traditional Chinese medicine (CM) are few. The present study was the first clinical research to evaluate the drug utilization patterns of Chinese herbal medicines in a general hospital in Taiwan. Data were collected prospectively from the patients attending the Traditional Medicine Center of Taipei Veteran General Hospital under CM drug treatments. The study was carried out over a period of 1 year, from January 2002 to December 2002. Core drug use indicators, such as the average number of drugs per prescriptions, the dosing frequency of prescriptions, and the most common prescribed CM herbs and formulae were evaluated. The primary diagnosis and the CM drugs prescribed for were also revealed. All data were analyzed by descriptive statistics. A total of 10 737 patients, representing 52 255 CM drugs, were screened during the study period. Regarding the prescriptions, the average number of drugs per prescription was 4.87 and 37.21% of prescriptions were composed by five drugs. Most of prescriptions (91.38%) were prescribed for three times a day. The most often prescribed Chinese herb was Hong-Hwa (5.76%) and the most common Chinese herbal formula was Jia-Wey-Shiau-Yau-San (3.80%). The most frequent main diagnosis was insomnia (15.58%), followed by menopause (5.22%) and constipation (5.09%). The survey revealed the drug use pattern of CMs in a general hospital. The majority of CM prescriptions were composed by 3-6 drugs and often prescribed for three times a day. Generally, the rational drug uses of CM drugs were provided with respect to the various diagnoses. (c) 2005 John Wiley & Sons, Ltd.

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

Science.gov (United States)

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 physical examination in every new patient encounter. In a previous study, the basic physical examination items that should standardly be performed were set by consensus. The aim of the current observational study was to assess whether medical students were able to correctly perform a general physical examination regarding completeness as well as technique at the end of the clerkship internal medicine. Methods One hundred students who had just finished their clerkship internal medicine were asked to perform a general physical examination on a standardized patient as they had learned during the clerkship. They were recorded on camera. Frequency of performance of each component of the physical examination was counted. Adequacy of performance was determined as either correct or incorrect or not assessable using a checklist of short descriptions of each physical examination component. A reliability analysis was performed by calculation of the intra class correlation coefficient for total scores of five physical examinations rated by three trained physicians and for their agreement on performance of all items. Results Approximately 40% of the agreed standard physical examination items were not performed by the students. Students put the most emphasis on examination of general parameters, heart, lungs and abdomen. Many components of the physical examination were not performed as was taught during precourses. Intra-class correlation was high for total scores of the physical examinations 0.91 (p internal medicine clerkship. Possible causes and suggestions for improvement are discussed. PMID:24712683

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

Predictors of patient satisfaction for Brooke Army Medical Center Family Medicine Service primary care clinics was performed. Data was obtained from...Factors Affecting Patient Satisfaction in Family Medicine Service Clinics at Brooke Army Medical Center Presented to MAJ Eric Schmacker, Ph.D. In...study. All patients ’ medical information was protected at all times and under no circumstances will be discussed or released to any outside agency

Establishing a nuclear medicine service within the turnkey contract system

International Nuclear Information System (INIS)

Horton, P.W.

1986-01-01

The turnkey method of developing hospitals and its effect on the provision of nuclear medicine services are described. Accommodation provided is often limited to an imaging suite and a 'hot' laboratory and additional space may be required. Alterations may also be necessary, especially for radiopharmacies to meet current standards. Major items of capital equipment are provided but these may be out of date since they were purchased when hospital building commenced. A 'shortfall' of smaller items will need to be purchased and regular supplies of radiopharmaceuticals established. Radiation protection requirements for a new service in a developing country are listed. Some suggestions for improving the value of the turnkey method are made. (author)

All-Russian service of disaster medicine organizes response of radiative accidents

International Nuclear Information System (INIS)

Avetisov, G.M.; Goncharov, S.F.; Grachev, M.I.

1996-01-01

Theoretical base to establish the All-Russian service for disaster medicine (ARSDM) is elaborated. The arrangement system for medical aid for the population of the Chernobyl NPP (including the aspects of planning and management) is proved in action. COnclusion is made about the necessity to introduce special structure of measures aimed at provision of medical aid of accident victims, of their evacuation and treatment under elimination of radiation accidents. This structure requires to unify all abilities and means of health service into the single system for Medical Provision of population under the emergencies. 4 figs., 2 tabs

Radiation protection on nuclear medicine services

International Nuclear Information System (INIS)

Anon

2000-01-01

Nuclear medicine is a sector of the medicine that studies and applies radionuclide in diagnosis and therapy. Nuclear medicine is a very specific area of the medicine, making use of non-sealed radioactive sources which are prescribed to the patient orally or are injected. Special procedures in radiation protection are required in nuclear medicine to manipulate these kind of sources and to produce technetium-99m through molybdenum generator. The present paper addresses the them radiation protection in a Nuclear Medicine Department (NMD), showing the main requirements of the CNEN- National Commission of Nuclear Energy and the Public Health. Radiation protection procedures adopted in assembling a NMD, as well the daily techniques for monitoring and for individual dosimetry are discussed. Past and present analyses in a level of radiation protection are presented. (author)

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

Emergence of a rehabilitation medicine model for low vision service delivery, policy, and funding.

Science.gov (United States)

Stelmack, Joan

2005-05-01

A rehabilitation medicine model for low vision rehabilitation is emerging. There have been many challenges to reaching consensus on the roles of each discipline (optometry, ophthalmology, occupational therapy, and vision rehabilitation professionals) in the service delivery model and finding a place in the reimbursement system for all the providers. The history of low vision, legislation associated with Centers for Medicare and Medicaid Services coverage for vision rehabilitation, and research on the effectiveness of low vision service delivery are reviewed. Vision rehabilitation is now covered by Medicare under Physical Medicine and Rehabilitation codes by some Medicare carriers, yet reimbursement is not available for low vision devices or refraction. Also, the role of vision rehabilitation professionals (rehabilitation teachers, orientation and mobility specialists, and low vision therapists) in the model needs to be determined. In a recent systematic review of the scientific literature on the effectiveness of low vision services contracted by the Agency for Health Care Quality Research, no clinical trials were found. The literature consists primarily of longitudinal case studies, which provide weak support for third-party funding for vision rehabilitative services. Providers need to reach consensus on medical necessity, treatment plans, and protocols. Research on low vision outcomes is needed to develop an evidence base to guide clinical practice, policy, and funding decisions.

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

Science.gov (United States)

2013-02-06

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-82,095] Verizon Services Corporation, Customer Services Clerk, General Clerk, Clarksburg, WV; Notice of Affirmative Determination... Department of Labor (Department) on January 4, 2013, workers of Verizon Services Corporation, Customer...

Home Care Services as Teaching Sites for Geriatrics in Family Medicine Residencies.

Science.gov (United States)

Laguillo, Edgardo

1988-01-01

A national survey of family medicine programs and residency training in geriatrics found almost half using home care services as teaching sites. In the program design preferred by residents, the resident followed the patient long-term and discussed management with a multidisciplinary team. An alternative combined rotation is discussed. (Author/MSE)

[Dementia friendly care services in general hospitals : Representative results of the general hospital study (GHoSt)].

Science.gov (United States)

Hendlmeier, Ingrid; Bickel, Horst; Hessler, Johannes Baltasar; Weber, Joshua; Junge, Magdalena Nora; Leonhardt, Sarah; Schäufele, Martina

2017-11-06

Mostly model projects report on special care services and procedures for general hospital patients with cognitive impairment. The objective of this study was to determine the frequency of special care services and procedures in general hospitals on the basis of a representative cross-sectional study. From a list of all general hospitals in southern Germany we randomly selected a specified number of hospitals und somatic wards. The hospitals were visited and all older patients on the selected wards on that day were included in the study. Information about care services and their utilization was collected with standardized instruments. A total of 33 general hospitals and 172 wards participated in the study. The patient sample included 1469 persons over 65 (mean age 78.6 years) and 40% of the patients showed cognitive impairments. The staff reported that the most frequent measures for patients with cognitive impairments concerned patients with wandering behavior (63.1%), efforts to involve the patients' relatives to help with their daily care (60.1%), conducting nonintrusive interviews to identify cognitive impairments (59.9%), allocation to other rooms (58%) and visual aids for place orientation of patients (50.6%). In accordance with earlier studies our results show that other dementia friendly services implemented in pilot projects were rare. The existing special services for patients with cognitive impairment were rarely used by the patients or their relatives. The results demonstrate the urgent need to improve special care services and routines for identification of elderly patients with cognitive impairment and risk of delirium in general hospitals.

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

Arizona TeleMedicine Network: System Procurement Specifications.

Science.gov (United States)

Atlantic Research Corp., Alexandria, VA.

Providing general specifications and system descriptions for segments within the Arizona TeleMedicine Project (a telecommunication system designed to deliver health services to rurally isolated American Indians in Arizona), this document, when used with the appropriate route segment document, will completely describe the project's required…

Integrative Medicine in Preventive Medicine Education

OpenAIRE

Jani, Asim A.; Trask, Jennifer; Ali, Ather

2015-01-01

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 esta...

[A physician profile--specialists in social medicine and health services administration].

Science.gov (United States)

Elterlein, E

1989-04-01

Specialists in social medicine and the organization of health services, in particular those in leading functions, are the most important persons who master the argumentation and justification of optimal relations of proposed innovations from the aspect of improving the health status of the population and from the aspect of national economy, ensuring expedient investment into the system of health services and early return of these investments. These leading workers must have exceptional abilities as regards management and organization and moreover be able to stimulate collaborators to creative work, ensure their effective cooperation, team work and consequential integration at the level of different health and economic facilities entrusted to them.

[Environmental medicine in public health service--a social responsibility and its consequences].

Science.gov (United States)

Thriene, B

2001-02-01

The special committee for "Environmental Medicine" established by the Federal Association of Doctors in the German Public Health Service presents its paper entitled "Environmental Medicine in the Public Health Service--A Social Responsibility and its Consequences: Propositions with regard to the situation, aims, strategies, and opportunities for action". The paper includes core ideas and responsibilities in the public health service. It aims at providing a number of guidelines for implementing "Environment and Health" ("Umwelt und Gesundheit"), an action programme by the Federal Ministry of Environmental Protection and the Ministry of Health, as well as "Health 21" ("Gesundheit 21"), the framework concept "Health for all" for the WHO's European Region. The paper also aims at initiating and facilitating steps for joint action by the Public Health Service. These theses were passed on to Mrs. Andrea Fischer, the Federal Minister of Health, during a meeting with the Board of the Association. In Germany, environment-related public health protection is well established in the Public Health Departments and state institutes/departments within the scope of public health provision and disease prevention. Typical responsibilities include environmental hygiene and environment-related medical services which have increased in importance. The range of responsibilities and its current political importance are a result of environment-related public health risks, the social situation of the population, also with regard to health issues, and the scope of responsibilities and competencies by doctors and staff in the public health departments. With the people's demands for health, quality of life and life expectancy, this need for action increases. In this paper, judicial, professional, and personal consequence are presented which arise as public health authorities assume these responsibilities.

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

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.

Precision medicine for psychopharmacology: a general introduction.

Science.gov (United States)

Shin, Cheolmin; Han, Changsu; Pae, Chi-Un; Patkar, Ashwin A

2016-07-01

Precision medicine is an emerging medical model that can provide accurate diagnoses and tailored therapeutic strategies for patients based on data pertaining to genes, microbiomes, environment, family history and lifestyle. Here, we provide basic information about precision medicine and newly introduced concepts, such as the precision medicine ecosystem and big data processing, and omics technologies including pharmacogenomics, pharamacometabolomics, pharmacoproteomics, pharmacoepigenomics, connectomics and exposomics. The authors review the current state of omics in psychiatry and the future direction of psychopharmacology as it moves towards precision medicine. Expert commentary: Advances in precision medicine have been facilitated by achievements in multiple fields, including large-scale biological databases, powerful methods for characterizing patients (such as genomics, proteomics, metabolomics, diverse cellular assays, and even social networks and mobile health technologies), and computer-based tools for analyzing large amounts of data.

Nuclear medicine training and practice in the Czech Republic

International Nuclear Information System (INIS)

Kaminek, Milan; Koranda, Pavel

2014-01-01

Nuclear medicine in the Czech Republic is a full specialty with an exclusive practice. Since the training program was organized and structured in recent years, residents have had access to the specialty of nuclear medicine, starting with a two-year general internship (in internal medicine or radiology). At present, nuclear medicine services are provided in 45 departments. In total, 119 nuclear medicine specialists are currently registered. In order to obtain the title of Nuclear Medicine Specialist, five years of training are necessary; the first two years consist of a general internship in internal medicine or radiology. The remaining three years consist of training in the nuclear medicine specialty itself, but includes three months of practice in radiology. Twenty-one physicians are currently in nuclear medicine training and a mean of three specialists pass the final exam per year. The syllabus is very similar to that of the European Union of Medical Specialists (UEMS), namely concerning the minimum recommended numbers for diagnostic and therapeutic procedures. In principle, the Czech law requires continuous medical education for all practicing doctors. The Czech Medical Chamber has provided a continuing medical education (CME) system. Other national CMEs are not accepted in Czech Republic. (orig.)

Nuclear medicine training and practice in the Czech Republic

Energy Technology Data Exchange (ETDEWEB)

Kaminek, Milan; Koranda, Pavel [University Hospital Olomouc, Department of Nuclear Medicine, Olomouc (Czech Republic)

2014-08-15

Nuclear medicine in the Czech Republic is a full specialty with an exclusive practice. Since the training program was organized and structured in recent years, residents have had access to the specialty of nuclear medicine, starting with a two-year general internship (in internal medicine or radiology). At present, nuclear medicine services are provided in 45 departments. In total, 119 nuclear medicine specialists are currently registered. In order to obtain the title of Nuclear Medicine Specialist, five years of training are necessary; the first two years consist of a general internship in internal medicine or radiology. The remaining three years consist of training in the nuclear medicine specialty itself, but includes three months of practice in radiology. Twenty-one physicians are currently in nuclear medicine training and a mean of three specialists pass the final exam per year. The syllabus is very similar to that of the European Union of Medical Specialists (UEMS), namely concerning the minimum recommended numbers for diagnostic and therapeutic procedures. In principle, the Czech law requires continuous medical education for all practicing doctors. The Czech Medical Chamber has provided a continuing medical education (CME) system. Other national CMEs are not accepted in Czech Republic. (orig.)

Application impact of internal monitoring criteria in radiological protection programs of nuclear medicine services

International Nuclear Information System (INIS)

Dantas, Bernardo M.; Dantas, Ana Leticia A.; Juliao, Ligia Q.C.; Lourenco, Maria Cristina; Melo, Dunstana R.

2005-01-01

This work presents the simulation of the internal monitoring criteria application for the most used radionuclides by the area of nuclear medicine, taking into consideration the usual conditions of usual source handling and the activity bands authorized by the CNEN. It is concluded that the handling of Iodine 131 for therapeutical purposes is the practice which presents the most risk of internal exposure for the works, requiring the adoption of a program for internal monitoring by the nuclear medicine services

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

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

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. © 2017 Society of Hospital Medicine

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

Economic assessment of the general thoracic surgery outpatient service.

Science.gov (United States)

Jones, David R; Vaughters, Ann B R; Smith, Philip W; Daniel, Thomas M; Shen, K Robert; Heinzmann, Janet L

2006-09-01

One aspect of the definition of institutional value for any program is based on the return on investment (ROI) for that program. Program requests for future resource allocations depend, in part, on that information. The purpose of this project was to determine the ROI for initial outpatient visits only for our General Thoracic Surgery (GTS) program. The number of GTS outpatient visits, studies, and requested consultations ordered by GTS surgeons only was determined after review of the hospital database and office records for the calendar year 2003. Only charges associated with the initial outpatient visits (no inpatient or physician charges) were included. Charges were based on hospital finance department data. The ROI for GTS outpatient services was calculated using total hospital costs and hospital collections. There were 689 initial outpatient GTS visits. The majority were for lung cancer (48%), benign lung diseases (21%), and esophageal diseases (14%). Total outpatient charges were 1.25M dollars and by disease process were lung cancer (644,000 dollars), benign lung disease (90,000 dollars), esophageal disease (159,000 dollars), and other (357,000 dollars). The most significant hospital charges were the following: radiology (850,000 dollars), laboratory studies (82,000 dollars), gastrointestinal medicine studies (59,000 dollars), and cardiology (42,000 dollars). Total operational costs for the GTS clinic were 415,000 dollars and hospital collections were 513,000 dollars, yielding an ROI of 98,000 dollars or an operating margin of 19%. An operating margin of 19% for GTS outpatient services is better than most Fortune 500 companies. Acquisition of this type of information by GTS surgeons may be helpful for future program development and institutional resource allocation.

A review of issues of nomenclature and taxonomy of Hypericum perforatum L. and Kew's Medicinal Plant Names Services.

Science.gov (United States)

Dauncey, Elizabeth Anne; Irving, Jason Thomas Whitley; Allkin, Robert

2017-10-16

To review which names are used to refer to Hypericum perforatum L. in health regulation and medicinal plant references, and the potential for ambiguity or imprecision. Structured searches of Kew's Medicinal Plant Names Services Resource, supplemented with other online bibliographic resources, found that the scientific name Hypericum perforatum L. is used consistently in the literature, but variation between subspecies is rarely considered by researchers. Research is still published using only the common name 'St John's wort' despite it being imprecise; at least 80 other common names are also used for this plant in multiple languages. Ambiguous and alternative plant names can lead to ineffective regulation, misinterpretation of literature, substitution of raw material or the failure to locate all published research. Kew's Medicinal Plant Names Services (MPNS) maps all names used for each plant in medicinal plant references onto current taxonomy, thereby providing for disambiguation and comprehensive access to the regulations and references that cite that plant, regardless of the name used. MPNS also supplies the controlled vocabulary for plant names now required for compliance with a new standard (Identification of Medicinal Products, IDMP) adopted by medicines regulators worldwide. © 2017 Royal Pharmaceutical Society.

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

Medicinal plants used with Thai Traditional Medicine in modern healthcare services: a case study in Kabchoeng Hospital, Surin Province, Thailand.

Science.gov (United States)

Chotchoungchatchai, Somtanuek; Saralamp, Promchit; Jenjittikul, Thaya; Pornsiripongse, Saowapa; Prathanturarug, Sompop

2012-05-07

Thai Traditional Medicine (TTM) is available in many modern hospitals in Thailand. However, there have been difficulties in integrating TTM, particularly the practices of the use of herbal medicines, into modern healthcare services. Kabchoeng Hospital is one hospital that has been able to overcome these difficulties. Thus, this study aimed to document the successful utilization of herbal medicine at Kabchoeng Hospital. The documentation focused on both the knowledge of medicinal plants and the success factors that facilitated the utilization of herbal medicine in the context of a modern hospital in Thailand. Kabchoeng Hospital was intentionally selected for this case study. Participatory observation was used for the data collection. There were six groups of key informants: three applied Thai Traditional Medicine practitioners (ATTMPs), a pharmacist, two physicians, two folk healers, the head of an herbal cultivation and collection group, and 190 patients. The plant specimens were collected and identified based on the botanical literature and a comparison with authentic specimens; these identifications were assisted by microscopic and thin layer chromatography (TLC) techniques. Eighty-nine medicinal plants were used for the herbal preparations. The ATTMPs used these plants to prepare 29 standard herbal preparations and occasional extemporaneous preparations. Moreover, in this hospital, seven herbal preparations were purchased from herbal medicine manufacturers. In total, 36 preparations were used for 10 groups of symptoms, such as the treatment of respiratory system disorders, musculo-skeletal system disorders, and digestive system disorders. Four success factors that facilitated the utilization of herbal medicine at Kabchoeng Hospital were determined. These factors included a proper understanding of the uses of herbal medicines, the successful integration of the modern and TTM healthcare teams, the support of an herbal cultivation and collection group, and the

Hospitalist Perspective of Interactions with Medicine Subspecialty Consult Services.

Science.gov (United States)

Adams, Traci N; Bonsall, Joanna; Hunt, Daniel; Puig, Alberto; Richards, Jeremy B; Yu, Liyang; McSparron, Jakob I; Shah, Nainesh; Weissler, Jonathan; Miloslavsky, Eli M

2018-05-01

Medicine subspecialty consultation is becoming increasingly important in inpatient medicine. We conducted a survey study in which we examined hospitalist practices and attitudes regarding medicine subspecialty consultation. The survey instrument was developed by the authors based on prior literature and administered online anonymously to hospitalists at 4 academic medical centers in the United States. The survey evaluated 4 domains: (1) current consultation practices, (2) preferences regarding consultation, (3) barriers to and facilitating factors of effective consultation, and (4) a comparison between hospitalist-fellow and hospitalist-subspecialty attending interactions. One hundred twenty-two of 261 hospitalists (46.7%) responded. The majority of hospitalists interacted with fellows during consultation. Of those, 90.9% reported that in-person communication occurred during less than half of consultations, and 64.4% perceived pushback at least "sometimes " in their consult interactions. Participants viewed consultation as an important learning experience, preferred direct communication with the consulting service, and were interested in more teaching during consultation. The survey identified a number of barriers to and facilitating factors of an effective hospitalist-consultant interaction, which impacted both hospitalist learning and patient care. Hospitalists reported more positive experiences when interacting with subspecialty attendings compared to fellows with regard to multiple aspects of the consultation. The hospitalist-consultant interaction is viewed as important for both hospitalist learning and patient care. Multiple barriers and facilitating factors impact the interaction, many of which are amenable to intervention.

[Assessment of the Polish occupational medicine service (oms) system made by OMS nurses].

Science.gov (United States)

Sakowski, Piotr

2012-01-01

This paper presents the results of an assessment of the Polish occupational medicine service (OMS) system made by OMS nurses. The survey was carried out on a random group of OMS nurses. OMS nurses form a professional group comprised of rather experienced personnel. In the opinion of almost 70% of respondents the system guarantees good occupational heath care, whereas 20% took the opposite view. The great majority of respondents think that all employees have to undergo mandatory prophylactic examinations. The nurses have rather critical opinion about the legal regulations pertaining to occupational health care--their number and complexity, and also express negative opinion about the quality of cooperation with employers (who are contractors for OMS units). OMS nurses believe that prophylactic examinations are the strongest point of the system. They are often the only opportunity for establishing contact between an employee and a physician and learning about diseases he or she was previously unaware of. Although the general assessment of the OMS system is rather positive, it is not free of shortcomings. Improvements in such fields as legislation, financing of service, professional attitude towards responsibilities of the OMS staff, cooperation with employers (contractors) and primary health care units would undoubtedly result in even better assessment, and what is more important in better functioning of the Polish OMS system.

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.

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...

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.

Perspectives of resettled African refugees on accessing medicines and pharmacy services in Queensland, Australia.

Science.gov (United States)

Bellamy, Kim; Ostini, Remo; Martini, Nataly; Kairuz, Therese

2017-10-01

The aim of this study was to explore the barriers to accessing medicines and pharmacy services among refugees in Queensland, Australia, from the perspectives of resettled African refugees. A generic qualitative approach was used in this study. Resettled African refugees were recruited via a purposive snowball sampling method. The researcher collected data from different African refugee communities, specifically those from Sudanese, Congolese and Somalian communities. Participants were invited by a community health leader to participate in the study; a community health leader is a trained member of the refugee community who acts as a 'health information conduit' between refugees and the health system. Invitations were done either face-to-face, telephonically or by email. The focus groups were digitally recorded in English and transcribed verbatim by the researcher. Transcripts were entered into NVIVO© 11 and the data were analysed using inductive thematic analysis. Four focus groups were conducted between October and November 2014 in the city of Brisbane with African refugees, one with five Somali refugees, one with five Congolese refugees, one with three refugee community health leaders from South Sudan, Liberia and Eritrea and one with three refugee community health leaders from Uganda, Burundi and South Sudan. Eleven sub-themes emerged through the coding process, which resulted in four overarching themes: health system differences, navigating the Australian health system, communication barriers and health care-seeking behaviour. With regard to accessing medicines and pharmacy services, this study has shown that there is a gap between resettled refugees' expectations of health services and the reality of the Australian health system. Access barriers identified included language barriers, issues with the Translating and Interpreter Service, a lack of professional communication and cultural beliefs affecting health care-seeking behaviour. This exploratory study has

Designing better medicines delivery in the UK National Health Services (NHS

Directory of Open Access Journals (Sweden)

P. John Clarkson

2009-11-01

Full Text Available Background: Prescribed medicines are delivered through a variety ofroutes to patients in the UK National Health Service (NHSand are regulated by a host of health and trade related policy and law. These ensure the efficient and safe supply of medicines of appropriate quality from the pharmaceutical manufacturer through to the end-user, the patient. However, persisting medication errors and therecent discovery of counter feit medicines in the bona fide supply chain have meant there are growing concerns aboutthe timely, accurate and safe supply of medicines in the NHS. Methods: This study undertakes a systems design approach to processmodelling and understanding three key supply routes fromthe manufacturer through to the patient, across bothprimary and secondary care. A systems design approachwas deployed to investigate complex interactions betweenprofessionals, products and processes to improve patient safety in collaboration with twenty five clinical and non-linical stakeholders across the supply chain and six enduser patients.Results: Several system process models were developed from the literature, field observations and alongside the interviewees. The results reveal that risk to medication safety is perceived as occurring most at the patient-end ofthe medicines supply chain: the pharmacy and the ward.There are differences observed in the responses ofinterviewees when they engage with system models.Conclusions: This paper reflects on the use of a systems design, a mainly engineering approach, to understanding a health care domain problem of medication errors. The approach provided an enhanced insight into the complex set of system factors and interactions involved in generating medication errors. This study is among the first to develop asystems-wide view of the medicines supply process ‘as-is’and identify opportunities for re-design to improve patient safety.

perception and utilization of oral histopathology services by general ...

African Journals Online (AJOL)

GENERAL PRACTICE DENTIST IN SOUTHWEST NIGERIA pathology ... Keywords: Oral; Histopathology; General dental practice; Southwest Nigeria. Ann Ibd. Pg. Med .... Table 3: Distribution of responses indicating barriers and utilization of oral histopathology services. Perception of respondents χ2 p value. Poor. Good.

Residents examine factors associated with 30-day, same-cause hospital readmissions on an internal medicine service.

Science.gov (United States)

Moran, Jennifer; Colbert, Colleen Y; Song, Juhee; Hull, Joshua; Rajan, Sabitha; Varghees, Sunita; Arroliga, Alejandro C; Reddy, Santosh P

2013-01-01

In recent years, there has been increased interest in stemming the tide of hospital readmissions in an attempt to improve quality of care. This study presents the Phase I results of a resident-led quality improvement initiative to determine the percentage of and risk factors for same-cause readmissions (SCRs; defined as hospital readmission within 30 days of hospital discharge for treatment of the same condition) to the internal medicine service of a multispecialty teaching hospital in central Texas. Results indicate that patients diagnosed with chronic obstructive pulmonary disease/asthma or anemia may be at increased risk for SCRs. Those patients who are insured by Medicaid and those who require assistance from social services also demonstrated an increased risk for SCRs. This study appears to be the first resident-led initiative in the field to examine 30-day SCRs to an internal medicine service for demographic and clinical risk factors.

Development and Assessment of Service Learning Projects in General Biology

Science.gov (United States)

Felzien, Lisa; Salem, Laura

2008-01-01

Service learning involves providing service to the community while requiring students to meet learning goals in a specific course. A service learning project was implemented in a general biology course at Rockhurst University to involve students in promoting scientific education in conjunction with community partner educators. Students were…

An evaluation system for financial compensation in traditional Chinese medicine services.

Science.gov (United States)

Dou, Lei; Yin, Ai-Tian; Hao, Mo; Lu, Jun

2015-10-01

To describe the major factors influencing financial compensation in traditional Chinese medicine (TCM) and prioritize what TCM services should be compensated for. Two structured questionnaires-a TCM service baseline questionnaire and a service cost questionnaire-were used to collect information from TCM public hospitals on TCM services provided in certain situations and service cost accounting. The cross-sectional study examined 110 TCM services provided in four county TCM public hospitals in Shandong province. From the questionnaire data, a screening index system was established via expert consultation and brainstorming. Comprehensive evaluation of TCM services was performed using the analytic hierarchy process method. Weighted coefficients were used to measure the importance of each criterion, after which comprehensive evaluation scores for each service were ranked to indicate what services should receive priority for financial compensation. Economy value, social value, and efficacy value were the three main criteria for screening for what TCM services should be compensated for. The economy value local weight had the highest value (0.588), of which the profit sub-criterion (0.278) was the most important for TCM financial compensation. Moxibustion was tied for the highest comprehensive evaluation scores, at 0.65 while Acupuncture and Massage Therapy were tied for the second and third highest, with 0.63 and 0.58, respectively. Government and policymakers should consider offer financial compensation to Moxibustion, Acupuncture, Massage Therapy, and TCM Orthopedics as priority services. In the meanwhile, it is essential to correct the unreasonable pricing, explore compensation methods, objects and payment, and revise and improve the accounting system for the costs of TCM services. Copyright © 2015 Elsevier Ltd. All rights reserved.

How are the different specialties represented in the major journals in general medicine?

Science.gov (United States)

Gehanno, Jean-Francois; Ladner, Joel; Rollin, Laetitia; Dahamna, Badisse; Darmoni, Stefan J

2011-01-21

General practitioners and medical specialists mainly rely on one "general medical" journal to keep their medical knowledge up to date. Nevertheless, it is not known if these journals display the same overview of the medical knowledge in different specialties. The aims of this study were to measure the relative weight of the different specialties in the major journals of general medicine, to evaluate the trends in these weights over a ten-year period and to compare the journals. The 14,091 articles published in The Lancet, the NEJM, the JAMA and the BMJ in 1997, 2002 and 2007 were analyzed. The relative weight of the medical specialities was determined by categorization of all the articles, using a categorization algorithm which inferred the medical specialties relevant to each article MEDLINE file from the MeSH terms used by the indexers of the US National Library of Medicine to describe each article. The 14,091 articles included in our study were indexed by 22,155 major MeSH terms, which were categorized into 81 different medical specialties. Cardiology and Neurology were in the first 3 specialties in the 4 journals. Five and 15 specialties were systematically ranked in the first 10 and first 20 in the four journals respectively. Among the first 30 specialties, 23 were common to the four journals. For each speciality, the trends over a 10-year period were different from one journal to another, with no consistency and no obvious explanatory factor. Overall, the representation of many specialties in the four journals in general and internal medicine included in this study may differ, probably due to different editorial policies. Reading only one of these journals may provide a reliable but only partial overview.

Establishment of the Auditing National Service of quality to the instrumentation of Nuclear medicine in Cuba

International Nuclear Information System (INIS)

Varela C, C.; Diaz B, M.; Lopez B, G.M.; Torres A, L.A.; Coca P, M.A.

2006-01-01

Next to the vertiginous development of the technology in the Nuclear Medicine field, the possibility of early diagnosis of pathological processes without anatomical alterations, as well as its application with therapeutic purposes in the cancer treatment has grown. To assure a diagnosis and adapted therapy, it is vital to establish quality guarantee programs to the instrumentation. The State Medical Equipment Control Center (CCEEM), as regulator organ attributed to the Public Health Ministry of Cuba, it has licensed the Service of Quality Audits to the Nuclear medicine services, fulfilling all the technical and legal requirements to such effect. As base of these, the National Protocol for the Quality Control of the Instrumentation in Nuclear Medicine has been implemented, put out in vigour 2 national regulations, and an inter-institutional and multidisciplinary auditor equipment has been licensed. The different followed steps, as well as the realization of the first quality audits, its show not only a better execution of the tests and bigger professionalism of the involved specialists, but an increment in the taking of conscience to apply adequately the quality concepts for achieving a better service to the patient. On the other hand, the necessity of incorporating the clinical aspects to the audits, fomenting an integral harmonized advance of the quality guarantee programs is evidenced. (Author)

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

Science.gov (United States)

Bairami, Firoozeh; Soleymani, Fatemeh; Rashidian, Arash

2016-01-01

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). PMID:27239881

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.

A qualitative evaluation of general practitioners' perceptions regarding access to medicines in New Zealand.

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Babar, Zaheer-Ud-Din; Grover, Piyush; Butler, Rachael; Bye, Lynne; Sheridan, Janie

2012-01-01

The objective of this study was to evaluate general practitioners' (GPs) perceptions regarding access to medicines in New Zealand. Qualitative. Primary care. GPs. GPs' views and perceptions. GPs were of the view that the current range of medicines available in New Zealand was reasonable; however, it was acknowledged that there were some drugs that patients were missing out on. When considering the range of subsidised medicines available in New Zealand, some GPs felt that there had been an improvement over recent years. It was highlighted that unexpected funding changes could create financial barriers for some patients and that administrative procedures and other complexities created barriers in receiving a subsidy for restricted medicines. GPs also reported problems with the availability and sole supply of certain medicines and claimed that switching from a branded medicine to its generic counterpart could be disruptive for patients. The research concluded that although there were some issues with the availability of certain drugs, most GPs were satisfied with the broader access to medicines situation in New Zealand. This view is to contrary to the situation presented by the pharmaceutical industry. The issues around sole supply, the use of generic medicines and the administrative barriers regarding funding of medicines could be improved with better systems. The current work provides a solid account of what GPs see as the advantages and disadvantages of the current system and how they balance these demands in practice.

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

Science.gov (United States)

2012-09-06

... GENERAL SERVICES ADMINISTRATION [Notice-MV-2012-02; Docket No. 2012-0002; Sequence 14] Public Availability of General Services Administration FY 2012 Federal Activities Inventory Reform (FAIR) Act Inventory AGENCY: General Services Administration (GSA). ACTION: Notice of Public Availability of Fiscal...

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.

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

Science.gov (United States)

Freibaum, Jerry

1990-01-01

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.

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

Science.gov (United States)

2013-12-09

... GENERAL SERVICES ADMINISTRATION [Notice-MV-2013-03; Docket No. 2013-0002; Sequence 37] Public... Inventory AGENCY: General Services Administration (GSA). ACTION: Notice of public availability of FY 2013...) Circular A-76, General Services Administration (GSA) is publishing this notice to advise the public of the...

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.

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.

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.

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

Science.gov (United States)

2012-02-01

... INFORMATION: A. Purpose The General Services Administration will be requesting the Office of Management and... GENERAL SERVICES ADMINISTRATION [OMB Control No. 3090-0007; Docket 2011-0001; Sequence 12] General... Qualifications and Financial Information AGENCY: Office of the Chief Finance Officer, GSA. ACTION: Notice of...

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.

Beijing nuclear medicine survey 2005: general information

International Nuclear Information System (INIS)

Geng Jianhua; Si Hongwei; Chen Shengzu

2008-01-01

Objective: To evaluate the status of nuclear medicine department in Beijing area. Methods: Staff, equipment and clinical applications of nuclear medicine departments in Beijing area during 2005 were evaluated by postal questionnaires. Results: Thirty nuclear medicine departments responded to our survey. In these departments, 321 staff, 141 doctors, 122 technicians, 7 physicists, 22 nurses and 29 other staff were employed; and 41 large imaging equipments, 37 SPECT, 3 PET, 1 PET-CT were equipped. During 2005, 88135 radionuclide imaging (84734 for SPECT, 3401 for PET), 462246 radioimmunoassay and 2228 radionuclide therapies (the most for Graves' disease, the second for thyroid cancer, the third for bone metastasis) were performed. For only 41.5% and 22.0% equipments the daily quality control (QC) and weekly QC were conducted. Conclusions Staff, equipments and activities of nuclear medicine department in Beijing were in a considerable scale, but did not balance among hospitals. Most departments should increase the number of physicists and the equipment QC procedures to improve the image quality. (authors)

Effective collective dose imparted by a medicine nuclear service to Cordoba and Jaen populations

International Nuclear Information System (INIS)

Arias, M.C.; Galvez, M.; Torres, M.

1997-01-01

The application of diagnostic techniques in nuclear medicine is ever growing as part of clinical daily routine. Although the diagnostic procedures carry a negligible clinical risk, the introduction of radioactive substances into the patient makes it imperative to determine the effective dose to minimize the stochastic effects to the patient thus establishing the collective dose to the community. The aim of our work is to study the collective effective dose imparted by Nuclear Medicine Service during 1997 to Cordoba and Jaen inhabitants (1 448 988). The nuclear medicine techniques of bone exploration with 11 454 mSv-person (4,6 mSv/exploration) and thyroid scintigraphy with 6181 mSv-person (7,0 mSv /exploration) are the main techniques implicated in the relative contribution to the total annual effective collective dose of 35 901.2 mSv-person

The efficiency of training for doctors of general practice — family medicine concerning to features work of teenagers at risk

Directory of Open Access Journals (Sweden)

Bobkova O.V.

2016-05-01

Full Text Available Medical personnel provide assistance to teenagers and young people because of understanding their problems and a common search for ways to resolve them to change risky behavior and health. A major problem for doctors of general practice — family medicine is the condition of adolescent morbidity diseases that are transmitted mainly through sexual contact, HIV infection, which requires the formation of the teenagers responsible attitude to their own health. Doctor of general practice — family medicine should actively influence on health status, including reproductive health specified target group of patients. The aim of the study was analysis of the effectiveness of educational training on( monitoring and evaluation M & E within the scientific support project «HIV prevention among young women of sex business, people who inject drugs and young people who live or work on the street» and development of an effective system of improving professional qualification of doctors of general practice — family medicine relative characteristics of health care among risk adolescents. During 2015 there were trainings for doctors, psychologists, social workers and nurses. Investigation of the effectiveness of the activities performed on a specially designed questionnaire monitoring and evaluation (M & E. 53 respondents were interviewed — doctors of general practice — family medicine of the Zaporozhye region and the city. Zaporozhye. Questioning was conducted before and after training exercises investigated by experts of department of medical care teenagers and youth KU «Zaporozhye Regional Children Clinical Hospital.» The rating was given on a 5-point scale. The study made the following findings: therapeutic and preventive work with teenagers and young people, is one of the major problems of medical and social work in Ukraine and practice of general practitioner — family medicine; training on the basis of a single M & E system is an effective means

[History of the 4th Department of Internal Medicine of the First Faculty of Medicine at Charles University and the General University Hospital in Prague].

Science.gov (United States)

Bartůněk, Petr

In 2015, the doctors and nurses of the 4th Department of Internal Medicine of the First Faculty of Medicine, Charles University and the General University Hospital in Prague celebrated the 70th anniversary of its founding. The article summarizes the clinics contribution to the field of internal medicine, and particularly to angiology, hepatogastroenterology and lipidology. It comments the clinics current activities and the possibilities of its further development. Attention is also paid to the tradition of high ethical and professional standards of medical care in accordance with the norms established by the clinic's founder, prof. MUDr. Bohumil Prusík.

[The use of scores in general medicine].

Science.gov (United States)

Huber, Ursula; Rösli, Andreas; Ballmer, Peter E; Rippin, Sarah Jane

2013-10-01

Scores are tools to combine complex information into a numerical value. In General Medicine, there are scores to assist in making diagnoses and prognoses, scores to assist therapeutic decision making and to evaluate therapeutic results and scores to help physicians when informing and advising patients. We review six of the scoring systems that have the greatest utility for the General Physician in hospital-based care and in General Practice. The Nutritional Risk Screening (NRS 2002) tool is designed to identify hospital patients in danger of malnutrition. The aim is to improve the nutritional status of these patients. The CURB-65 score predicts 30-day mortality in patients with community acquired pneumonia. Patients with a low score can be considered for home treatment, patients with an elevated score require hospitalisation and those with a high score should be treated as having severe pneumonia; treatment in the intensive care unit should be considered. The IAS-AGLA score of the Working Group on Lipids and Atherosclerosis of the Swiss Society of Cardiology calculates the 10-year risk of a myocardial infarction for people living in Switzerland. The working group makes recommendations for preventative treatment according to the calculated risk status. The Body Mass Index, which is calculated by dividing the body weight in kilograms by the height in meters squared and then divided into weight categories, is used to classify people as underweight, of normal weight, overweight or obese. The prognostic value of this classification is discussed. The Mini-Mental State Examination allows the physician to assess important cognitive functions in a simple and standardised form. The Glasgow Coma Scale is used to classify the level of consciousness in patients with head injury. It can be used for triage and correlates with prognosis.

Determination of the presence of molybdenum-99 in the technetium-99m solutions used at the nuclear medicine services of Recife, Pernambuco, Brazil

International Nuclear Information System (INIS)

Sena, Thiago G. de; Souza, Fernanda R. de L.; Lopes Filho, Ferdinand de J.; Vieira, Jose W.; Lima, Fernando R. de A.

2009-01-01

The main objective of this work is to calculate the percentage of 99 Mo in the eluates of the 99 mTc used at the nuclear medicine services localized at the Recife city, Pernambuco, Brazil. At the present moment three nuclear medicine services were evaluated verifying the 99 Mo in the eluates of 99 mTc, and in two services, the contamination were superior to the limits stipulated by the international organism adopted as reference in this work. The work follows in other nuclear medicine institutions evaluating and orienting the professionals on these quality control not only for the optimization of the patient dose, but also for the improvement of the image to be used for the diagnostic

Areas control of a nuclear medicine service; Controle de áreas de um serviço de medicina nuclear

Energy Technology Data Exchange (ETDEWEB)

Silva, Islane C.S.; Silva, Iasmim M.S.; Júnior, Cláudio L.R.; Silva, Isvânia S.; Gonzalez, Kethyllém M.; Melo, Francisca A. [Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil). Dept. de Energia Nuclear; Vieira, Wilson J.; Lopes Filho, Ferdinand de J. [Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco (IFPE), Recife, PE (Brazil); Lima, Fernando R.A. [Centro Regional de Ciências Nucleares do Nordeste (CRCN-NE/CNEN), Recife, PE (Brazil)

2017-07-01

The measurement of the exposure rate of the sectors of a nuclear medicine service (NMS), with the purpose of establishing safety to the service workers and the public, classifying the areas according to the monitoring is presented. Following the studies on the classifications of the areas of a Nuclear Medicine service provided by the category regulatory standard, 3.05 CNEN-NN, measures were taken in all sectors of the NMS in order to classify the areas in: Free, controlled and supervised according to with the exposure level. As a measurement instrument, a Geiger-Muller counter of the digital type was used. The results obtained show a correlation with the Brazilian norm satisfactorily, referring to the exposure rate of the studied SMN sectors.

[What is new in 2016 for the specialist in hospital internal medicine?

Science.gov (United States)

Mraihi, Hamza; Chevaux, Fabienne; Castoni, Julien; Aebischer, Oriane; Christou, Foetini; Jaccard, Evrim; Benmachiche, Malik; Tasheva, Plamena; Giroud, Sabine; Kraege, Vanessa; Lamy, Olivier

2017-01-18

The year 2016 was rich in significant advances in all areas of internal medicine. Many of them have an impact on our daily practice in general internal medicine. From the treatment of NSTEMI in population older than 80, to new sepsis and septic shock criteria to antidotes of new oral anticoagulants, this selection offers to the readers a brief overview of the major advances. The chief residents in the Service of internal medicine of the Lausanne University hospital are pleased to share their readings.

[Implementation of evidence based medicine in primary care].

Science.gov (United States)

Rinnerberger, Andreas; Grafinger, Michaela; Melchardt, Thomas; Sönnichsen, Andreas

2009-01-01

The particular situation of primary care - i.e. decentralized setting, comprehensive medical care, and limited access to continuous medical education - makes it difficult to implement evidence-based medicine into daily practice. Therefore, the Institute of General Practice of the Paracelsus University (PMU) in Salzburg and Actavis GmbH Austria developed "REM" (Rechercheservice evidenzbasierte Medizin). This is a web-based enquiry service offered mainly to GPs who can submit questions arising in daily practice which are answered by the service according to current best evidence. In 8.5 months 176 physicians registered to participate. A total of 31 submitted at least one question. In total, REM processed 134 questions. The number of physicians registered and the frequency of enquiries show that REM can facilitate the implementation of evidence-based medicine in primary care. Nonetheless, only a small proportion of the physicians registered actually made use of the service. Improvements are necessary to promote interest in this new way of continuous medical education.

Risk estimation in association with diagnostic techniques in the nuclear medicine service of the Camaguey Ciego de Avila Territory

International Nuclear Information System (INIS)

Barrerras, C.A.; Brigido, F.O.; Naranjo, L.A.; Lasserra, S.O.; Hernandez Garcia, J.

1999-01-01

The nuclear medicine service at the Maria Curie Oncological Hospital, Camaguey, has experience of over three decades in using radiofarmaceutical imaging agents for diagnosis. Although the clinical risk associated with these techniques is negligible, it is necessary to evaluate the effective dose administered to the patient due to the introduction of radioactive substances into the body. The study of the dose administered to the patient provides useful data for evaluating the detriment associated with this medical practice, its subsequently optimization and consequently, for minimizing the stochastic effects on the patient. The aim of our paper is to study the collective effective dose administered by nuclear medicine service to Camaguey and Ciego de Avila population from 1995 to 1998 and the relative contribution to the total annual effective collective dose of the different diagnostic examinations. The studies were conducted on the basis of statistics from nuclear medicine examinations given to a population of 1102353 inhabitants since 1995. The results show that the nuclear medicine techniques of neck examinations with 1168.8 Sv man (1.11 Sv/expl), thyroid explorations with 119.6 Sv man (55.5 mSv/expl) and iodide uptake with 113.7 Sv man (14.0 mSv/expl) are the main techniques implicated in the relative contribution to the total annual effective collective dose of 1419.5 Sv man. The risk estimation in association with diagnostic techniques in the nuclear medicine service studied is globally low (total detriment: 103.6 as a result of 16232 explorations), similar to other published data

Sleep medicine in Saudi Arabia: Current problems and future challenges

Science.gov (United States)

BaHammam, Ahmed S.

2011-01-01

Sleep medicine is a relatively new specialty in the medical community. The practice of sleep medicine in Saudi Arabia (KSA) began in the mid to late nineties. Since its inception, the specialty has grown, and the number of specialists has increased. Nevertheless, sleep medicine is still underdeveloped in the KSA, particularly in the areas of clinical service, education, training and research. Based on available data, it appears that sleep disorders are prevalent among Saudis, and the demand for sleep medicine service is expected to rise significantly in the near future. A number of obstacles have been defined that hinder the progress of the specialty, including a lack of trained technicians, specialists and funding. Awareness about sleep disorders and their serious consequences is low among health care workers, health care authorities, insurance companies and the general public. A major challenge for the future is penetrating the educational system at all levels to demonstrate the high prevalence and serious consequences of sleep disorders. To attain adequate numbers of staff and facilities, the education and training of health care professionals at the level of sleep medicine specialists and sleep technologists is another important challenge that faces the specialty. This review discusses the current position of sleep medicine as a specialty in the KSA and the expected challenges of the future. In addition, it will guide clinicians interested in setting up new sleep medicine services in the KSA or other developing countries through the potential obstacles that may face them in this endeavor. PMID:21264164

Sleep medicine in Saudi Arabia: Current problems and future challenges

Directory of Open Access Journals (Sweden)

BaHammam Ahmed

2011-01-01

Full Text Available Sleep medicine is a relatively new specialty in the medical community. The practice of sleep medicine in Saudi Arabia (KSA began in the mid to late nineties. Since its inception, the specialty has grown, and the number of specialists has increased. Nevertheless, sleep medicine is still underdeveloped in the KSA, particularly in the areas of clinical service, education, training and research. Based on available data, it appears that sleep disorders are prevalent among Saudis, and the demand for sleep medicine service is expected to rise significantly in the near future. A number of obstacles have been defined that hinder the progress of the specialty, including a lack of trained technicians, specialists and funding. Awareness about sleep disorders and their serious consequences is low among health care workers, health care authorities, insurance companies and the general public. A major challenge for the future is penetrating the educational system at all levels to demonstrate the high prevalence and serious consequences of sleep disorders. To attain adequate numbers of staff and facilities, the education and training of health care professionals at the level of sleep medicine specialists and sleep technologists is another important challenge that faces the specialty. This review discusses the current position of sleep medicine as a specialty in the KSA and the expected challenges of the future. In addition, it will guide clinicians interested in setting up new sleep medicine services in the KSA or other developing countries through the potential obstacles that may face them in this endeavor.

Impact of the application of criteria of internal monitoring in radiological protection programmes in nuclear medicine services

International Nuclear Information System (INIS)

Dantas, B.M.; Dantas, A.L.A.; Juliao, L.Q.C.; Lourenco, M.C.; Melo, D.R.

2005-01-01

The manipulation of open sources in Nuclear Medicine services involves risks of external exposure and internal contamination. The radiological protection plan of facilities licensed by CNEN - Brazilian Nuclear Energy Commission - must include the evaluation of such risks and propose a programme of individual monitoring to control exposure and ensure the maintenance of conditions of radiation safety. The IAEA - International Atomic Energy Agency - recommendations presented in the Safety Guide RS-G-1.2 suggest that an internal worker monitoring program be implemented where there is a possibility of internal contamination lead to effective dose committed annual values equal to or greater than 1 mSv. This paper presents the application of such criteria to the radionuclides most frequently used in the field of Nuclear Medicine, taking into account the normal conditions of handling and the ranges of activity authorized by CNEN. It is concluded that iodine 131 manipulation for therapeutic purposes is the practice that presented the greatest risk of internal exposure of workers, requiring the adoption of a programme of internal monitoring of Nuclear Medicine services

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

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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

Experiences of the Nuclear Medicine Service at the University Hospital Surgical Clinic Dr. Salvador Allende 2013-2015

International Nuclear Information System (INIS)

Suárez Iznaga, Rodolfo; Pozo Almaguer, Armando del; Gil Valdés, Doris; Fleitas Anaya, Ricardo

2016-01-01

The Nuclear Medicine Service of the University Hospital Surgical Clinic D r. Salvador Allende , located in the municipality of Cerro, began the provision of scintigraphic services in May 2013. A retrospective descriptive and analytical study was carried out from May 2013 to December 2015 from the archived scintigraphic reports. The objective of the study was to present the results of the Nuclear Medicine Service during this period. The data were reflected in percentages, using tables and graphs. To determine the existence of a statistically significant relationship between the variables were used: Chi square test with a level of significance α = 0.05 being positive if p <0.05. Until December 2015, 798 cases had been reported, which included Bone scans (88.34%), renal (10.65%) and thyroid scans for follow-up of cancer patients (1%); (76.82%) and the female sex was the most attended with 446 (55.89%) patients, there were no statistically significant differences between the scintigraphic studies and the sex of the patients. There were statistically significant differences between the scintigraphic studies and the age of the patients. The most frequent diagnoses were: bone scintigraphy, metastasis in 86.52% of patients, renal cyst scintigraphy (48.78%) and dynamic scintigraphy of the kidneys with obstructive functional involvement (63.64%) It was recommended to create the necessary technical and human resources conditions to be able to introduce other scintigraphy studies in the Nuclear Medicine Service such as: breast scintigraphy and lymph node scans, high demand in the medical center. In addition, to use scientifically the criteria of approval of patients in the consultation of classification of the service, with the aim of achieving a better selection of the applicants for scintigraphic studies, which would favor a more rational and efficient use of these studies.

Job satisfaction of occupational medicine nurses in Poland.

Science.gov (United States)

Sakowski, Piotr

2012-03-01

The study aimed at assessment of the Polish occupational medicine service system after over ten years of functioning in the current shape, made by occupational nurses. The article focuses on the job satisfaction level among Polish occupational medicine nurses. The survey was performed among 600 randomly selected occupational medicine nurses, registered in the regional occupational medicine centers. A questionnaire, designed by the research team, containing several questions concerning different aspects of OMS system assessment, including a part dedicated to job satisfaction assessment, was sent to the selected occupational nurses. The response rate was 33.3% (200 questionnaires). The survey shows a relatively high satisfaction level in case of five out of eleven investigated job aspects, and a very low satisfaction level in case of two of them ("Possibility of professional promotion", "Salary"). 26% of the OMS nurses had considered going abroad to work as a nurse in the general health care system, and 17% in the OHS system. Almost 25% of them would not choose a profession of an occupational nurse once again, including 10% who would not choose a nurse job at all. There is a statistically significant correlation between the general job satisfaction and satisfaction with other aspects of nursing work. A strong correlation was observed in case of "Scope of performed tasks" and "Cooperation with employers (clients of the occupational medicine service units)". There is a statistically significant correlation of average strength between the decision concerning choosing an occupational nurse job in case of taking a decision on professional carrier once again and "General job satisfaction". Polish occupational nurses are satisfied with their job, however only 26% are fully satisfied. In their work there is place for improvement. The areas which definitely need attention and improvement are "Possibility of professional promotion" and "Salary". Improvements in cooperation

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. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Proposal of a monitoring program of occupational exposure by incorporation of radioactive material for nuclear medicine services in the Caja Costarricense del Seguro Social

International Nuclear Information System (INIS)

Badilla Segura, Mirta

2013-01-01

A monitoring program of the occupational exposure by incorporation of radioactive material is proposed. Nuclear medicine services of the Caja Costarricense del Seguro Social (CCSS) are evaluated. The monitoring program is based on the provisions of the International Atomic Energy Agency and of study of nuclear medicine services of the CCSS. Radionuclides are determined for monitoring of the occupational exposure, according to the radioactive material that is worked in nuclear medicine services of the CCSS. The appropriate and alternative techniques are established for the monitoring of the occupational exposure by incorporation of radioactive material, depending on the type of radionuclide that is worked in nuclear medicine services. The worker occupationally exposed (TOE) should be subject of monitoring and how often should be realized the monitoring of the occupational exposure. The monitoring of the radiation by radioactive material must be applied to personnel working in radiopharmacies and the worker has carried out therapeutic procedures for handling of significant amounts of 13 1 I. The calculation of the committed effective dose is proposed by incorporation of radioactive material with the TOE [es

Consumers' willingness to use a medication management service: the effect of medication-related worry and the social influence of the general practitioner.

Science.gov (United States)

Carter, Stephen R; Moles, Rebekah J; White, Lesley; Chen, Timothy F

2013-01-01

Some consumers at risk of experiencing medication-related problems have chosen not to use pharmacist-provided medication management services. Previous research has shown that consumers' willingness to use the Australian Home Medicines Review (HMR) service depends on the extent to which they believe that they will receive medication information to assist them with self-management. The aim of this study was to develop and test a model of willingness to use HMR among consumers who were eligible to receive the service but have not yet experienced it. Specifically, this study aimed to determine the effects of consumers' medication-related worry and the social influence of the consumer's general practitioner (GP) over willingness. A cross-sectional postal survey was conducted among 1600 members of Council on the Ageing (NSW, Australia). Respondents were included in the study if they had not experienced an HMR and were taking more than 5 medicines daily or more than 12 doses daily. Measurement scales were developed or were based on previous research. Confirmatory factor analysis was used to test the reliability and validity of the multi-item scales. Multiple regression analysis and structural equation modeling (SEM) were used to test the model. Surveys received from 390 respondents (24.3%) were analyzed. Respondents held overall low-to-neutral positive outcome expectancy (POE). The SEM analysis revealed that worry had a direct effect on POE (β=0.35, Psocial influence over willingness to use this medication management service. Copyright © 2013 Elsevier Inc. All rights reserved.

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.

Missed Diagnosis of Cardiovascular Disease in Outpatient General Medicine: Insights from Malpractice Claims Data.

Science.gov (United States)

Quinn, Gene R; Ranum, Darrell; Song, Ellen; Linets, Margarita; Keohane, Carol; Riah, Heather; Greenberg, Penny

2017-10-01

Diagnostic errors are an underrecognized source of patient harm, and cardiovascular disease can be challenging to diagnose in the ambulatory setting. Although malpractice data can inform diagnostic error reduction efforts, no studies have examined outpatient cardiovascular malpractice cases in depth. A study was conducted to examine the characteristics of outpatient cardiovascular malpractice cases brought against general medicine practitioners. Some 3,407 closed malpractice claims were analyzed in outpatient general medicine from CRICO Strategies' Comparative Benchmarking System database-the largest detailed database of paid and unpaid malpractice in the world-and multivariate models were created to determine the factors that predicted case outcomes. Among the 153 patients in cardiovascular malpractice cases for whom patient comorbidities were coded, the majority (63%) had at least one traditional cardiac risk factor, such as diabetes, tobacco use, or previous cardiovascular disease. Cardiovascular malpractice cases were more likely to involve an allegation of error in diagnosis (75% vs. 47%, p <0.0001), have high clinical severity (86% vs. 49%, p <0.0001) and result in death (75% vs. 27%, p <0.0001), as compared to noncardiovascular cases. Initial diagnoses of nonspecific chest pain and mimics of cardiovascular pain (for example, esophageal disease) were common and independently increased the likelihood of a claim resulting in a payment (p <0.01). Cardiovascular malpractice cases against outpatient general medicine physicians mostly occur in patients with conventional risk factors for coronary artery disease and are often diagnosed with common mimics of cardiovascular pain. These findings suggest that these patients may be high-yield targets for preventing diagnostic errors in the ambulatory setting. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Self reported involvement in emergency medicine among GPs in Norway.

Science.gov (United States)

Hjortdahl, Magnus; Zakariassen, Erik; Halvorsen, Peder A

2018-04-10

To examine general practitioners' (GPs') perception of their role in emergency medicine and participation in emergency services including ambulance call outs, and the characteristics of the GPs and casualty clinics associated with the GPs' involvement in emergency medicine. Cross-sectional online survey. General practice. General practitioners in Norway (n = 1002). Proportion of GPs perceiving that they have a large role in emergency medicine, regularly being on call, and the proportion of ambulance callouts with GP participation. Forty six percent of the GPs indicated that they play a large role in emergency medicine, 63 percent of the GPs were regularly on call, and 28 percent responded that they usually took part in ambulance call outs. Multivariable logistic regression analyses indicated that these outcomes were strongly associated with participation in multidisciplinary training. Furthermore, the main outcomes were associated with traits commonly seen at smaller casualty clinics such as those with an absence of nursing personnel and extra physicians, and based on the distance to the hospital. Our findings suggest that GPs play an important role in emergency medicine. Multidisciplinary team training may be important for their continued involvement in prehospital emergencies. Key Points   Health authorities and other stakeholders have raised concerns about general practitioner's (GPs) participation in emergency medicine, but few have studied opinions and perceptions among the GPs themselves.   • Norwegian GPs report playing a large role in emergency medicine, regularly being on call, and taking part in selected ambulance call outs.   • A higher proportion of GPs who took part in team training perceived themselves as playing a large role in emergency medicine, regularly being on call, and taking part in ambulance call outs.   • These outcomes were also associated with attributes commonly seen at smaller casualty clinics.

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

[Current Research Activities on Person-Centered Medicine in Academic Institutes of General Practice in Germany and Austria].

Science.gov (United States)

Weber, Annemarie; Schelling, Jörg; Kohls, Niko; van Dyck, Marcus; Poggenburg, Stephanie; Vajda, Christian; Hirsch, Jameson; Sirois, Fuschia; Toussaint, Loren; Offenbächer, Martin

2017-10-11

Aim of study Person-centered medicine (PCM) with its focus on humanistic-biographical-oriented medicine and integrated, positive-salutogenic health is a central aspect in the patient-physician relationship in general practice. The objective of this analysis is to assess the prevalence and type of research project in academic institutions of general practice in Germany (Ger) and Austria (At) and the thematic priorities of the projects in the areas PCM, health promotion (HP), prevention (PRE) and conventional medicine (CM). Methods A search was conducted (September-December 2015) on the websites of 30 institutes and divisions of general medicine for their current research projects. The retrieved projects were assigned to five categories: PCM, HP, PRE, CM and others. Subsequently, we identified the targeted patient groups of the projects as well as the thematic focus in the categories PCM, HP, PRE and CM with focus on PCM and HP. Results 541 research projects were identified, 452 in Germany and 89 in Austria. Research projects were only included if they were explicitly indicated as research-oriented. Seventy projects addressed PCM aspects, 15 projects HP aspects, 32 projects PRE aspects and 396 projects CM aspects. The most frequently target groups in the categories PCM (24 of 70) and HP (7 of 15) were chronically ill patients. The most common thematic focus in PCM was communication (13 of 70) and in HP, physical activity (6 of 15). Conclusion The vast majority of research projects investigated conventional medical topics. The percentage of research activities in the field of PCM (13%) or PCM including HP (16%) in Ger and At is below the European average of 20%. From our point of view, PCM and HP need to be implemented to a greater extent in general practice. © Georg Thieme Verlag KG Stuttgart · New York.

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.

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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

Place of the indigenous and the western systems of medicine in the health services of India.

Science.gov (United States)

Banerji, D

1979-01-01

The interrelationships of the indigenous (traditional and western (modern) systems of medicine are a function of the interplay of social, economic, and political forces in the community. In India, western medicine was used as a political weapon by the colonialists to strengthen the oppressing classes and to weaken the oppressed. Not only were the masses denied access to the western system of medicine, but this system contributed to the decay and degeneration of the preexisting indigenous systems. This western and privileged-class orientation of the health services has been actively perpetuated and promoted by the postcolonial leadership of India. The issue in formulating an alternative health care system for India is essentially that of rectifying the distortions which have been brought about by various forces. The basic premise for such an alternative will be to start with the people. Action in this field will lead to a more harmonious mix between the indigenous and western systems of medicine.

Protection of consumer rights in the field of economic services of general economic interest

Directory of Open Access Journals (Sweden)

Vasile Dinu

2013-06-01

Full Text Available Over the years, the demand for services of general interest and the manner they are provided have evolved significantly. Services that the state would traditionally provide in a direct form have been increasingly outsourced by national, regional and local authorities, and are now often provided by the private sector (with or without profit. This changed approach is driven by the processes of deregulation, the changes in government policies and the changing needs and expectations of users According to its European definition, a general interest service is a service that "public authorities classify as being general interest, and is subject to specific public service obligations". These services were identified as having a central role in the European model of society that the European Union has been built on, because they meet people’s basic needs.

Cost of Treatment of Hospitalized Patients with Diabetes in Prenda Hospital Medicine Service, Angola

Directory of Open Access Journals (Sweden)

António Zangulo

2017-07-01

Full Text Available Introduction: Diabetes has a major impact on morbidity and mortality today. It is estimated that by 2040, about 642 million people are affected worldwide, of which, 34.2 million are from sub-Saharan countries. The direct annual cost of diabetes health care worldwide is estimated at about 153 billion dollars. These patients represent 30% to 40% of all admissions to emergency services, leading to high values of hospital expenditure. We aim to evaluate the cost of treatment of patients with diabetes admitted to Prenda Hospital Medicine Service in 2012. Methods: Retrospective analytical observational study, with data collected from the clinical processes of medical service (age and gender, length of hospitalization, resources consumed, cost of treatment per patient and discharge. Results: Out of 121 patients, the majority was female (n = 70, 57.9%. The age group of 36 to 45 years old was the most frequent among these patients (n = 26, 21.5%. November was the month that recorded the largest number of admissions (n = 17, 14%. About 45.5% were hospitalized during five to eight days, on average for nine days. The majority (76.9% was discharged due to health condition improvement. The price of materials used for treatment of the disease had high variation, and 31 550.15 kwanzas was spent to acquire them. The direct cost per patient per day was 4170.11 kwanzas and the estimated annual cost of care of diabetic patients admitted to Prenda Hospital was 45 525 490.9 kwanzas in 2012. Discussion and Conclusion: These results are in accordance with other studies, indicating a relevant cost of treatment of diabetic patients admitted to Prenda Hospital Medicine Service in 2012.

On the relation between cost and service models for general inventory systems

NARCIS (Netherlands)

Houtum, van G.J.J.A.N.; Zijm, W.H.M.

2000-01-01

In this paper, we present a systematic overview of possible relations between cost and service models for fairly general single- and multi-stage inventory systems. In particular, we relate various types of penalty costs in pure cost models to equivalent types of service measures in service models.

Validated Competency Task Lists for General Merchandise Retailing, Food Service Management, and Business and Personal Services Marketing.

Science.gov (United States)

Faught, Suzanne G.

This publication contains competency task lists that address principal entry-level and career-sustaining jobs in the occupational categories of general merchandise retailing, food service management, and business and personal services marketing. Section I, Development of the Competency Task Lists, provides details on how the competencies were…

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 demographics affect TMH use. It was concluded that staff in neither deaf mental health services nor general mental health services had adequate knowledge of or access to TMH. Staff expressed concerns over TMH's appropriateness in their work. Previous use of videoconferencing was assosciated significantly with confidence, but previous use of videophones was not. Neither staff in deaf services nor deaf staff were more experienced with or more confident about videoconferencing, whereas, within deaf services, deaf staff were significantly more confident about videophone use. Training implications are discussed.

Increased ICU resource needs for an academic emergency general surgery service*.

Science.gov (United States)

Lissauer, Matthew E; Galvagno, Samuel M; Rock, Peter; Narayan, Mayur; Shah, Paulesh; Spencer, Heather; Hong, Caron; Diaz, Jose J

2014-04-01

ICU needs of nontrauma emergency general surgery patients are poorly described. This study was designed to compare ICU utilization of emergency general surgery patients admitted to an acute care emergency surgery service with other general surgery patients. Our hypothesis is that tertiary care emergency general surgery patients utilize more ICU resources than other general surgical patients. Retrospective database review. Academic, tertiary care, nontrauma surgical ICU. All patients admitted to the surgical ICU over age 18 between March 2004 and June 2012. None. Six thousand ninety-eight patients were evaluated: 1,053 acute care emergency surgery, 1,964 general surgery, 1,491 transplant surgery, 995 facial surgery/otolaryngology, and 595 neurosurgery. Acute care emergency surgery patients had statistically significantly longer ICU lengths of stay than other groups: acute care emergency surgery (13.5 ± 17.4 d) versus general surgery (8.7 ± 12.9), transplant (7.8 ± 11.6), oral-maxillofacial surgery (5.5 ± 4.2), and neurosurgery (4.47 ± 9.8) (all psurgery patients: acute care emergency surgery 73.4% versus general surgery 64.9%, transplant 63.3%, oral-maxillofacial surgery 58.4%, and neurosurgery 53.1% (all p surgery patients: acute care emergency surgery 10.8% versus general surgery 4.3%, transplant 6.6%, oral-maxillofacial surgery 0%, and neurosurgery 0.5% (all p surgery patients were more likely interhospital transfers for tertiary care services than general surgery or transplant (24.5% vs 15.5% and 8.3% respectively, p surgery (13.7% vs 6.7% and 3.5%, all p surgery and general surgery, whereas transplant had fewer. Emergency general surgery patients have increased ICU needs in terms of length of stay, ventilator usage, and continuous renal replacement therapy usage compared with other services, perhaps due to the higher percentage of transfers and emergent surgery required. These patients represent a distinct population. Understanding their resource needs

General Services Administration: FY 1998 Congressional Justification.

Science.gov (United States)

1997-03-20

APPROPRIATIONS: Consumer Information Center CIC GSA InSite STATEMENT OF DAVID J. BARRAM ACTING ADMINISTRATOR, GENERAL SERVICES ADMINISTRATION BEFORE THE...When I tell people about change at GSA, they sometimes give me a strange look, perhaps thinking that "this poor guy from California believes that a...in every area in which we operate. I think three impulses drive us toward change. First, we believe the customer is king. We’re learning what that

[Evaluating health effects--a preventive medicine responsibility of public health offices. Summary of a workshop presentation by the public health services at the Travemünde federal congress 1989].

Science.gov (United States)

Wodarg, W

1989-11-01

It appears that Federal Public Health services are getting increasingly engaged in curative activities both in individual medicine and in medicine concerned with the general population. Public Health services are expected to draw attention to this fact and to demand that suitable methods be employed to ensure that all the people live in healthy conditions. Such environmental health protection should not be just a safety valve to "let off steam" if planning had been based on miscalculations and false appraisals--it should function in advance to prevent such social and political mishaps. A method is presented utilising the systematic scrutiny of the effects of projects on healthy as an interactive process. Since Public Health offices possess multidisciplinary competence, they are likely to cope with the multifarious problems of environmental medicine. They should act as though they were the attorneys of the population in respect of popular health demands, and must enlist competent staff capable of handling the pertinent problems. It has become apparent that the average citizen is most inclined to comply with the demands made on him by the environment if he becomes aware of the ecological linkups via his own experience. This is precisely where Public Health offices have important educational chances to accomplish their mission.

Emergency supply of prescription-only medicines to patients by community pharmacists: a mixed methods evaluation incorporating patient, pharmacist and GP perspectives.

Science.gov (United States)

Morecroft, Charles W; Mackridge, Adam J; Stokes, Elizabeth C; Gray, Nicola J; Wilson, Sarah E; Ashcroft, Darren M; Mensah, Noah; Pickup, Graham B

2015-07-10

To evaluate and inform emergency supply of prescription-only medicines by community pharmacists (CPs), including how the service could form an integral component of established healthcare provision to maximise adherence. Mixed methods. 4 phases: prospective audit of emergency supply requests for prescribed medicines (October-November 2012 and April 2013); interviews with CPs (February-April 2013); follow-up interviews with patients (April-May 2013); interactive feedback sessions with general practice teams (October-November 2013). 22 community pharmacies and 6 general practices in Northwest England. 27 CPs with experience of dealing with requests for emergency supplies; 25 patients who received an emergency supply of a prescribed medicine; 58 staff at 6 general practices. Clinical audit in 22 pharmacies over two 4-week periods reported that 526 medicines were requested by 450 patients. Requests peaked over a bank holiday and around weekends. A significant number of supplies were made during practice opening hours. Most requests were for older patients and for medicines used in long-term conditions. Difficulty in renewing repeat medication (forgetting to order, or prescription delays) was the major reason for requests. The majority of medicines were 'loaned' in advance of a National Health Service (NHS) prescription. Interviews with CPs and patients indicated that continuous supply had a positive impact on medicines adherence, removing the need to access urgent care. General practice staff were surprised and concerned by the extent of emergency supply episodes. CPs regularly provide emergency supplies to patients who run out of their repeat medication, including during practice opening hours. This may aid adherence. There is currently no feedback loop, however, to general practice. Patient care and interprofessional communication may be better served by the introduction of a formally structured and funded NHS emergency supply service from community pharmacies, with

Academic retainer medicine: an innovative business model for cross-subsidizing primary care.

Science.gov (United States)

Lucier, David J; Frisch, Nicholas B; Cohen, Brian J; Wagner, Michael; Salem, Deeb; Fairchild, David G

2010-06-01

Retainer-medicine primary care practices, commonly referred to as "luxury" or "concierge" practices, provide enhanced services to patients beyond those available in traditional practices for a yearly retainer fee. Adoption of retainer practices has been largely absent in academic health centers (AHCs). Reasons for this trend stem primarily from ethical concerns, such as the potential for patient abandonment when physicians downsize from larger, traditional practices to smaller, retainer-medicine practices.In 2004, the Department of Medicine at Tufts Medical Center developed an academic retainer-medicine primary care practice within the Division of General Medicine that not only generates financial support for the division but also incorporates a clinical and business model that is aligned with the mission and ethics of an academic institution.In contrast to private retainer-medicine practices, this unique business model addresses several of the ethical issues associated with traditional retainer practices-it does not restrict net access to care and it neutralizes concerns about patient abandonment. Addressing the growing primary care shortage, the model also presents the opportunity for a retainer practice to cross-subsidize the expansion of general medicine in an academic medical setting. The authors elucidate the benefits, as well as the inherent challenges, of embedding an academic retainer-medicine practice within an AHC.

77 FR 28390 - General Services Administration Acquisition Regulation; Submission for OMB Review; GSA Form 527...

Science.gov (United States)

2012-05-14

.... Purpose The General Services Administration will be requesting the Office of Management and Budget to... GENERAL SERVICES ADMINISTRATION [OMB Control No. 3090-0007; Docket 2011-0016; Sequence 12] General... Qualifications and Financial Information AGENCY: Office of the Chief Finance Officer, GSA. ACTION: Notice of...

Policy implementation in practice: the case of national service frameworks in general practice.

Science.gov (United States)

Checkland, Kath; Harrison, Stephen

2004-10-01

National Service Frameworks are an integral part of the government's drive to 'modernise' the NHS, intended to standardise both clinical care and the design of the services used to deliver that clinical care. This article uses evidence from qualitative case studies in three general practices to illustrate the difficulties associated with the implementation of such top-down guidelines and models of service. In these studies it was found that, while there had been little explicit activity directed at implementation overall, the National Service Framework for coronary heart disease had in general fared better than that for older people. Gunn's notion of 'perfect implementation' is used to make sense of the findings.

Regenerative Medicine Build-Out

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Pfenning, Michael A.; Gores, Gregory J.; Harper, C. Michel

2015-01-01

Summary Regenerative technologies strive to boost innate repair processes and restitute normative impact. Deployment of regenerative principles into practice is poised to usher in a new era in health care, driving radical innovation in patient management to address the needs of an aging population challenged by escalating chronic diseases. There is urgency to design, execute, and validate viable paradigms for translating and implementing the science of regenerative medicine into tangible health benefits that provide value to stakeholders. A regenerative medicine model of care would entail scalable production and standardized application of clinical grade biotherapies supported by comprehensive supply chain capabilities that integrate sourcing and manufacturing with care delivery. Mayo Clinic has rolled out a blueprint for discovery, translation, and application of regenerative medicine therapies for accelerated adoption into the standard of care. To establish regenerative medical and surgical service lines, the Mayo Clinic model incorporates patient access, enabling platforms and delivery. Access is coordinated through a designated portal, the Regenerative Medicine Consult Service, serving to facilitate patient/provider education, procurement of biomaterials, referral to specialty services, and/or regenerative interventions, often in clinical trials. Platforms include the Regenerative Medicine Biotrust and Good Manufacturing Practice facilities for manufacture of clinical grade products for cell-based, acellular, and/or biomaterial applications. Care delivery leverages dedicated interventional suites for provision of regenerative services. Performance is tracked using a scorecard system to inform decision making. The Mayo Clinic roadmap exemplifies an integrated organization in the discovery, development, and delivery of regenerative medicine within a growing community of practice at the core of modern health care. Significance Regenerative medicine is at the

Regenerative Medicine Build-Out.

Science.gov (United States)

Terzic, Andre; Pfenning, Michael A; Gores, Gregory J; Harper, C Michel

2015-12-01

Regenerative technologies strive to boost innate repair processes and restitute normative impact. Deployment of regenerative principles into practice is poised to usher in a new era in health care, driving radical innovation in patient management to address the needs of an aging population challenged by escalating chronic diseases. There is urgency to design, execute, and validate viable paradigms for translating and implementing the science of regenerative medicine into tangible health benefits that provide value to stakeholders. A regenerative medicine model of care would entail scalable production and standardized application of clinical grade biotherapies supported by comprehensive supply chain capabilities that integrate sourcing and manufacturing with care delivery. Mayo Clinic has rolled out a blueprint for discovery, translation, and application of regenerative medicine therapies for accelerated adoption into the standard of care. To establish regenerative medical and surgical service lines, the Mayo Clinic model incorporates patient access, enabling platforms and delivery. Access is coordinated through a designated portal, the Regenerative Medicine Consult Service, serving to facilitate patient/provider education, procurement of biomaterials, referral to specialty services, and/or regenerative interventions, often in clinical trials. Platforms include the Regenerative Medicine Biotrust and Good Manufacturing Practice facilities for manufacture of clinical grade products for cell-based, acellular, and/or biomaterial applications. Care delivery leverages dedicated interventional suites for provision of regenerative services. Performance is tracked using a scorecard system to inform decision making. The Mayo Clinic roadmap exemplifies an integrated organization in the discovery, development, and delivery of regenerative medicine within a growing community of practice at the core of modern health care. Regenerative medicine is at the vanguard of health care

How blockchain technology can change medicine.

Science.gov (United States)

Roman-Belmonte, Juan M; De la Corte-Rodriguez, Hortensia; Rodriguez-Merchan, E Carlos

2018-05-01

Although the best-known use of blockchain technology (BCT) is in the field of economics and cryptocurrencies in general, its usefulness is extending to other fields, including the biomedical field. The purpose of this article is to clarify the role that BCT can play in the field of medicine. We have performed a narrative review of the literature on BCT in general and on medicine in particular. The great advantage of BCT in the health arena is that it allows development of a stable and secure data set with which users can interact through transactions of various types. This environment allows the entry and operation of clinical data without compromising other sensitive data. Another important advantage of BCT is that the entire network is decentralized and is maintained by the users themselves; thus, there is no need to rely on organizations for storage. The Blockchain code is open source and can be used, modified and revised by its users. BCT literature is scarce so far. This article describes the basics of this technology and summarizes the various aspects in which BCT could change the paradigm of current medicine. The great potential of BCT, as well as its many applications in the field of health sciences, encompasses the fields of legal medicine, research, electronic medical records, medical data analysis (big data), teaching and the regulation of payment for medical services. If technological advances continue along these lines, it could bring about a revolution in medicine as we know it.

Sports medicine and drug control programs of the U.S. Olympic Committee.

Science.gov (United States)

Clarke, K S

1984-05-01

The Amateur Sports Act of 1978 reconstituted the U.S. Olympic Committee ( USOC ), giving it new responsibilities and opportunities as a unifying force in amateur sports, including sports medicine. Sports medicine is the sum of attentions that promote and protect the health of the active person. Olympic sports medicine includes attention to the needs of both the elite athlete and the developing athlete. In some instances the attentions are the same; in others they are not. Those in Olympic sports medicine must thereby reduce the increasing array of general concepts and issues to the applicable specifics of the respective occasion, sport, and individual. The USOC Sports Medicine Program is guided by a 15-person volunteer Sports Medicine Council and implemented by a core Sports Medicine Division staff. Services are provided at the Olympic training centers in Colorado Springs and Lake Placid and extended through a budding network of colleagues in the field to clusters of athletes across the nations. Organizationally , the Division is composed of departments of biomechanics, sports physiology, clinical services, and educational services. Special projects are developed as warranted to provide focal attention to sports psychology, nutrition, chronobiology, vision enhancement, and drug control. The USOC Drug Control Program was born at the 1983 Pan American Games in Caracas after a long gestation period. Drug education in sports has been a frequent activity for the past 20 yr. sometimes focusing on illicit drugs (e.g., marijuana and cocaine) and sometimes on sports performance drugs (e.g., amphetamines and anabolic steroids).(ABSTRACT TRUNCATED AT 250 WORDS)

Exploring the Educational Value of Clinical Vignettes from the Society of General Internal Medicine National Meeting in the Internal Medicine Clerkship

Science.gov (United States)

Wofford, James L; Singh, Sonal

2006-01-01

INTRODUCTION Whether the clinical vignettes presented at the Society of General Internal Medicine (SGIM) annual meeting could be of educational value to third year students in the Internal Medicine clerkship has not been studied. OBJECTIVE To explore the relevance and learning value of clinical vignettes from the SGIM national meeting in the Internal Medicine clerkship. SETTING Third year Ambulatory Internal Medicine clerkship at one academic medical center (academic year 2005 to 2006). METHODS Students were introduced to the clinical vignette and oriented to the database of clinical vignettes available through the SGIM annual meeting website. Students then reviewed 5 to 10 clinical vignettes using a worksheet, and rated the learning value of each vignette using a 5-point Likert scale (1 = least, 5 = greatest). A single investigator evaluated congruence of the vignette with the Clerkship Directors of Internal Medicine (CDIM)-SGIM curriculum to assess relevance. MAIN RESULTS A total of 42 students evaluated 371 clinical vignettes from the 2004 and 2005 meetings. The clinical vignettes were curriculum-congruent in 42.6% (n = 175), and clearly incongruent in 40.4% (n = 164). The mean rating for learning value was 3.8 (±1.0) (5 signifying greatest learning value). Curriculum-congruent vignettes had a higher mean learning value compared with curriculum-incongruent vignettes (4.0 vs 3.6, Student's t-test, P =.017). CONCLUSION The clinical vignettes presented at the national SGIM meeting offer clinical content that is relevant and of some educational value for third year clerkship students. Based on this pilot study, the educational value and strategies for their use in the clinical clerkships deserve further study. PMID:17026730

Inspector General, DOD, Oversight of the Naval Audit Service Audit of the Navy General Fund Financial Statements for FY 1998

National Research Council Canada - National Science Library

1999-01-01

.... This report provides our endorsement of the Naval Audit Service disclaimer of opinion on the Navy General Fund Financial Statements for FY 1998, along with the Naval Audit Service report, "Department...

Nuclear Medicine and Application of Nuclear Techniques in Medicine

International Nuclear Information System (INIS)

Wiharto, Kunto

1996-01-01

The use of nuclear techniques medicine covers not only nuclear medicine and radiology in strict sense but also determination of body mineral content by neutron activation analysis and x-ray fluorescence technique either in vitro or in vivo, application of radioisotopes as tracers in pharmacology and biochemistry, etc. This paper describes the ideal tracer in nuclear medicine, functional and morphological imaging, clinical aspect and radiation protection in nuclear medicine. Nuclear technique offers facilities and chances related to research activities and services in medicine. The development of diagnostic as well as therapeutic methods using monoclonal antibodies labeled with radioisotope will undoubtedly play an important role in the disease control

Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project.

Science.gov (United States)

Hoyer, Erik H; Friedman, Michael; Lavezza, Annette; Wagner-Kosmakos, Kathleen; Lewis-Cherry, Robin; Skolnik, Judy L; Byers, Sherrie P; Atanelov, Levan; Colantuoni, Elizabeth; Brotman, Daniel J; Needham, Dale M

2016-05-01

To determine whether a multidisciplinary mobility promotion quality-improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS). Implemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. There were 3352 patients admitted during the QI project period. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale, an 8-point ordinal scale ranging from bed rest (score = 1) to ambulating ≥250 feet (score = 8), was used to quantify mobility. Changes in JH-HLM scores were compared for the first 4 months of the project (ramp-up phase) versus 4 months after project completion (post-QI phase) using generalized estimating equations. We compared the relative change in median LOS for the project months versus 12 months prior among the QI units, using multivariable linear regression analysis adjusting for 7 demographic and clinically relevant variables. Comparing the ramp-up versus post-QI phases, patients reaching JH-HLM's ambulation status increased from 43% to 70% (P mobility scores between admission and discharge increased from 32% to 45% (P 7 days), were associated with a significantly greater adjusted median reduction in LOS of 1.11 (95% CI: -1.53 to -0.65, P mobility was not associated with an increase in injurious falls compared to 12 months prior on the QI units (P = 0.73). Active prevention of a decline in physical function that commonly occurs during hospitalization may be achieved with a structured QI approach. In an adult medicine population, our QI project was associated with improved mobility, and this may have contributed to a reduction in LOS, particularly for more complex patients with longer expected hospital stay. Journal of Hospital Medicine 2016. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

Response of monitors of surface contamination to internal exposition control from 131I in the 'nuclear medicine services'

International Nuclear Information System (INIS)

Puerta, Nancy; Rojo, Ana M.; Villella, Adrian; Gossio, Sebastian; Parada, Ines Gomez; Acosta, Norma; Arenas, German

2013-01-01

The IAEA, in its publication RS-G-1.2, proposes individual control of workers occupationally exposed with risk of internal exposure when the potential exposure provided by incorporation leads to a value of annual committed effective dose equal to or greater than 1 mSv. Because the radionuclide 131 I is the most important to control internal exposure in Nuclear Medicine Services, it is evaluated if the surface contamination monitors, commonly used in nuclear medicine centers of Argentina, would implement individual control of internal exposure to 131 I. Selected detectors were calibrated with a dummy neck and thyroid with calibrated sources of 131 I and 133 Ba reference. For each detector is was estimated the detection efficiency for 131 I and its detection limit. Each instrument was evaluated for the lowest effective dose possible to detect compromised by individual routine monitoring with different measurement intervals . We analyzed the response of each team for determining conditions that may be effective for the control of internal exposure of 131 I. Finally , we conclude that the daily individual monitoring surface contamination detectors available in the Nuclear Medicine Services is feasible to implement and ensures detection of significant additions of 131 I

Giving Voice to the Medically Under-Served: A Qualitative Co-Production Approach to Explore Patient Medicine Experiences and Improve Services to Marginalized Communities.

Science.gov (United States)

Latif, Asam; Tariq, Sana; Abbasi, Nasa; Mandane, Baguiasri

2018-01-27

With an aging population, the appropriate, effective and safe use of medicines is a global health priority. However, "'medically under-served" patients continue to experience significant inequalities around access to healthcare services. This study forms part of a wider project to co-develop and evaluate a digital educational intervention for community pharmacy. The aim of this paper is to explore the medicine needs of patients from marginalized communities and suggest practical way on how services could be better tailored to their requirements. Following ethical approval, qualitative data was gathered from: (1) workshops with patients and professionals ( n = 57 attendees); and (2) qualitative semi-structured interviews (10 patients and 10 pharmacists). Our findings revealed that patients from marginalized communities reported poor management of their medical conditions and significant problems with adherence to prescribed medicines. Their experience of pharmacy services was found to be variable with many experiencing discrimination or disadvantage as a result of their status. This study highlights the plight of medically under-served communities and the need for policy makers to tailor services to an individual's needs and circumstances. Furthermore, patients and professionals can work in collaboration using a co-production approach to develop educational interventions for pharmacy service improvements.

77 FR 9659 - General Services Administration Acquisition Regulation; Information Collection; GSA Mentor...

Science.gov (United States)

2012-02-17

... Services Administration Acquisition Regulation; Information Collection; GSA Mentor-Prot[eacute]g[eacute... collection concerning the GSA Mentor-Prot[eacute]g[eacute] Program, General Service Administration...- 0286, GSA Mentor-Prot[eacute]g[eacute] Program by any of the following methods: Regulations.gov : http...

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\

[Teaching family medicine in Lausanne].

Science.gov (United States)

Bischoff, Thomas; Junod, Michel; Cornuz, Jacques; Herzig, Lilli; Bonvin, Raphael

2010-12-01

The Faculty of Biology and Medicine of Lausanne has integrated education of family medicine all along its new undergraduate medical curriculum. The Institute of general medicine is in charge to implement those offers among which two are presented hereafter. In the new module "Generalism" several courses cover the specificities of the discipline as for example medical decision in the practice. A mandatory one-month internship in the medical practice offers an experiential immersion into family medicine for all students. In a meeting at the end of their internship, students discuss in group with their peers their individual experiences and are asked to identify, based on their personal experience, the general concepts of the specialty of family medicine and general practice.

First, keep it safe: Integration of a complementary medicine service within a hospital.

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Schiff, Elad; Levy, Ilana; Arnon, Zahi; Ben-Arye, Eran; Attias, Samuel

2018-05-01

This paper sought to explore risk/safety considerations associated with the integration of a complementary medicine (CM) service within a public academic medical centre in Israel. We reviewed various sources pertaining to the CM service (interviews with CM staff, patients' electronic charts, service guidelines, correspondence with hospital administration) and conducted a thematic analysis to evaluate safety-related incidents during the 7 years of operation. In addition, we systematically assessed the charts for reports of treatment-associated adverse effects, which were documented in an obligatory field on treatment reports. After reviewing transcripts of interviews with 12 CM practitioners and with the director and vice-director of the CM service as well as transcripts of 8560 consultations that included 7383 treatments, we categorised 3 major domains of CM safety management: (i) prevention of safety-related incidents by appropriate selection of CM practitioners and modalities, (ii) actual adverse incidents and (iii) prevention of their recurrence using both hospital and CM service safety protocols. CM staff reported 5 categories of adverse incidents, most of which were minor. Twenty-nine adverse incidents were documented in the 7383 treatment sessions (0.4%). Safety management needs to be addressed both before introducing CM services in hospitals and throughout their integration. Important considerations for the safe integration of CM practices in the hospital include communication between CM and conventional practitioners, adherence to hospital safety rules, implementing a systematic approach for detecting and reporting safety-related incidents and continuous adaptation of the CM service safety protocols. © 2018 John Wiley & Sons Ltd.

Delivery of genomic medicine for common chronic adult diseases: a systematic review.

Science.gov (United States)

Scheuner, Maren T; Sieverding, Pauline; Shekelle, Paul G

2008-03-19

The greatest public health benefit of advances in understanding the human genome may be realized for common chronic diseases such as cardiovascular disease, diabetes mellitus, and cancer. Attempts to integrate such knowledge into clinical practice are still in the early stages, and as a result, many questions surround the current state of this translation. To synthesize current information on genetic health services for common adult-onset conditions by examining studies that have addressed the outcomes, consumer information needs, delivery, and challenges in integrating these services. MEDLINE articles published between January 2000 and February 2008. Original research articles and systematic reviews dealing with common chronic adult-onset conditions were reviewed. A total of 3371 citations were reviewed, 170 articles retrieved, and 68 articles included in the analysis. Data were independently extracted by one reviewer and checked by another with disagreement resolved by consensus. Variables assessed included study design and 4 key areas: outcomes of genomic medicine, consumer information needs, delivery of genomic medicine, and challenges and barriers to integration of genomic medicine. Sixty-eight articles contributed data to the synthesis: 5 systematic reviews, 8 experimental studies, 35 surveys, 7 pre/post studies, 3 observational studies, and 10 qualitative reports. Three systematic reviews, 4 experimental studies, and 9 additional studies reported on outcomes of genetic services. Generally there were modest positive effects on psychological outcomes such as worry and anxiety, behavioral outcomes have shown mixed results, and clinical outcomes were less well studied. One systematic review, 1 randomized controlled trial, and 14 other studies assessed consumer information needs and found in general that genetics knowledge was reported to be low but that attitudes were generally positive. Three randomized controlled trials and 13 other studies assessed how

Changing author counts in five major general medicine journals: effect of author contribution forms.

Science.gov (United States)

Baerlocher, Mark Otto; Gautam, Tina; Newton, Marshall; Tomlinson, George

2009-08-01

Objective and indirect evidence was used to determine whether required author contribution forms were associated with a decrease in author counts in four major general medicine journals (British Medical Journal [BMJ], Journal of the American Medical Association [JAMA], Canadian Medical Association Journal [CMAJ], and the Lancet). The number of authors listed per article before and after the introduction of explicit author contribution requirements were counted and compared with that found for the New England Journal of Medicine (NEJM) that did not require such disclosure. The primary hypothesis was that author counts decreased more in the BMJ, CMAJ, JAMA, and the Lancet after introduction of the rules than they did in the NEJM. The number of authors listed per original research article published in the five general medical journals with the greatest 2004 Impact Factors in the first issue of each month in the years before and after introduction of required author contribution forms was compared. Introduction of the required author contribution forms by the four leading general medical journals did not result in a drop in the rate of increasing authors per article per year, or in the number of authors per article compared with the control. Overall, there was a trend of an increasing number of authors listed per article. Based on the presented objective and indirect evidence, required author contribution forms were not associated with a decrease in author counts.

The validity of peer review in a general medicine journal.

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Jackson, Jeffrey L; Srinivasan, Malathi; Rea, Joanna; Fletcher, Kathlyn E; Kravitz, Richard L

2011-01-01

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. Our study purpose was to assess the predictive validity of reviewer quality ratings and editorial decisions in a general medicine journal. 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. 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. 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 reviewers is low, the accuracy of sorting is improved with a greater

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

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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.

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

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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.

Use of medical services and medicines attributable to diabetes in Sub-Saharan Africa.

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Jonathan Betz Brown

Full Text Available Although the large majority of persons with diabetes and other non-communicable diseases (NCDs lives and dies in low- and middle-income countries, the prevention and treatment of diabetes and other NCDs is widely neglected in these areas. A contributing reason may be that, unlike the impacts of acute and communicable diseases, the demands on resources imposed by diabetes is not superficially obvious, and studies capable of detecting these impacts have not be done.To ascertain recent use of medical services and medicines and other information about the impact of ill-health, we in 2008-2009 conducted structured, personal interviews with 1,780 persons with diagnosed diabetes (DMs and 1,770 matched comparison subjects (MCs without diabetes in Cameroon, Mali, Tanzania and South Africa. We sampled DMs from diabetes registries and, in Cameroon and South Africa, from attendees at outpatient diabetes clinics. To recruit MCs, we asked subjects with diabetes to identify five persons living nearest to them who were of the same sex and approximate age. We estimated diabetes impact on medical services use by calculating ratios and differences between DMs and MCs, testing for statistical significance using two-stage multivariable hurdle models.DMs consumed 12.95 times more days of inpatient treatment, 7.54 times more outpatient visits, and 5.61 times more medications than MCs (all p<0.001. DMs used an estimated 3.44 inpatient days per person per year, made 10.72 outpatient visits per person per year (excluding traditional healers, and were taking an average of 2.49 prescribed medicines when interviewed.In Sub-Saharan Africa, the relative incremental use of medical care and medicines associated with diagnosed diabetes is much greater than in industrialized countries and in China. Published calculations of the health-system impact of diabetes in Africa are dramatic underestimates. Although non-communicable diseases like diabetes are commonly thought to be minor

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

Science.gov (United States)

2011-12-21

..., Customer Service Department General Motors and Tier Finished Goods/Finished Goods Division; a Subsidiary of... Manpower El Paso, TX; Amended Certification Regarding Eligibility To Apply for Worker Adjustment Assistance... should read Penske Logistics, LLC, Customer Service Department, General Motors and Tier Finished Goods...

Evaluation of quality control of radiopharmaceuticals in Nuclear Medicine service

International Nuclear Information System (INIS)

Tavares, Jamille A. Lopes; Lira, Renata F. de; Santos, Marcus Aurelio P. dos

2014-01-01

Radiopharmaceuticals are a type of pharmaceutical preparation associated with radionuclides with purpose of diagnosis and therapy. Nuclear Medicine Services (NMS) should perform quality control of radiopharmaceuticals according to the recommendations of the manufacturer and scientific evidences accepted by the National Agency Sanitary Surveillance ( Brazilian ANVISA). This study evaluated the quality of the main radiopharmaceuticals in a NMS of the state of Pernambuco in relation to pH and radiochemical purity. The results showed that 96.8% of the radiopharmaceuticals showed radiochemical purity and all pH values were within the range recommended by the American pharmacopoeia. The study found that the quality control when inserted into the NMS, provides important data that allows exclusion of radiopharmaceuticals with low radiochemistry purity, favoring a reliable diagnosis and ensuring good radiation protection practices and biosecurity for patient and occupationally exposed individuals

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

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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.

[Preliminary study on general safe medication regularity of Chinese patent orthopedic medicines based on adverse reaction/event literature analysis].

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Wang, Yu-guang; Shi, Xin-yuan; Jin, Rui; Li, Hong-yan; Kong, Xiang-wen; Qiao, Yan-jiang

2015-03-01

Chinese patent orthopedic medicines feature complex components, mainly including desperate and toxic herbal pieces, narrow safety window, more clinical contraindications and frequent adverse drug reaction/events (ADR/ADE). To study the general safe medication regularity of Chinese patent orthopedic medicines, define key points in the medication education and ensure rational clinical medication, the authors took 80 types of commonly used Chinese patent orthopedic medicines as the study objects, collect 237 cases from 164 ADR/ADE documents through a system retrieval strategy, make a multidimensional literature analysis to determine the common risk factors for safe and rational medication of Chinese patent orthopedic medicines and establish an ADR/ADE prevention regularity. First, in the aspect of clinical symptoms, skin allergy is the most common ADR/ADE and closely related to the toxic ingredients, particularly accumulated liver or kidney damage caused by some drugs. Second, there are three time nodes in the ADR/ADE occurrence; The ADR/ADE occurred in 30 minutes is closely related to the idiosyncrasy; the ADR/ADE occurred between several months and half a year is related to the drug-induced liver and kidney damages; The most common ADR/ADE was observed within 7 days and predictable according to the pharmacological actions; Third, toxicity is an important factor in the occurrence of ADR/ADE of Chinese patent orthopedic medicines. Fourth, emphasis shall be given to the special medication factors, such as the combination with western medicines and Chinese herbal decoctions, overdose and long-course medication and self-medical therapy. In conclusion, the general ADR/ADE prevention regularity for Chinese patent orthopedic medicines was summarized to provide supports for clinicians in safe and rational medication and give the guidance for pharmacist in medication education.

Checklists for quality assurance and audit in nuclear medicine

International Nuclear Information System (INIS)

Williams, E.D.; Harding, L.K.; McKillop, J.H.

1989-01-01

A series of checklists are given which aim to provide some guidance to staff in determining whether their working procedures in nuclear medicine are likely to produce a good service and avoid mistakes. The checklists relate to the special equipment used in nuclear medicine departments, radiopharmaceuticals, nuclear medicine staff, services to medical and other hospital staff and finally the service to patients. The checklists are relevant to an average nuclear medicine department performing less than 2000 imaging studies per year. (U.K.)

Availability of essential medicines in primary health care of the Brazilian Unified Health System

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Renata Cristina Rezende Macedo do Nascimento

2017-11-01

Full Text Available ABSTRACT OBJECTIVE To characterize the availability of tracer medicines in pharmaceutical services in primary health care of the Brazilian Unified Health System (SUS. METHODS This is a cross-sectional and evaluative study, part of the Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015. To analyze the availability of medicines, we verified 50 items selected from the Relação Nacional de Medicamentos Essenciais (Rename – National List of Essential Medicines of 2012. Observation scripts were applied to medicine dispensing services in the primary health care. Interviews were carried out with patients, health care professionals, and public managers, using semi-structured questionnaires. The availability index was presented as the percentage of health units where the medicines were available. For statistical analysis, absolute, relative, and mean frequencies were presented (with 95% confidence intervals. The comparison of groups was carried out by Pearson Chi-square tests or variance analysis, when needed. RESULTS One thousand, one hundred, and seventy-five observation scripts were filled in a national representative sample composed by 273 cities. Statistically significant differences were observed regarding the type of unit, infrastructure, and presence of a pharmacist between regions of Brazil. The average availability of tracer medicines in primary health care was 52.9%, with differences between regions and sampling strata. This index increased to 62.5% when phytotherapic medicines were excluded. We found limited availability of medicines for treatment of chronic and epidemiological diseases, such as tuberculosis and congenital syphilis. CONCLUSIONS The low availability of essential medicines purchased centrally by the Brazilian Ministry of Health indicates deficiencies in supply chain

Availability of essential medicines in primary health care of the Brazilian Unified Health System.

Science.gov (United States)

Nascimento, Renata Cristina Rezende Macedo do; Álvares, Juliana; Guerra, Augusto Afonso; Gomes, Isabel Cristina; Costa, Ediná Alves; Leite, Silvana Nair; Costa, Karen Sarmento; Soeiro, Orlando Mario; Guibu, Ione Aquemi; Karnikowski, Margô Gomes de Oliveira; Acurcio, Francisco de Assis

2017-11-13

To characterize the availability of tracer medicines in pharmaceutical services in primary health care of the Brazilian Unified Health System (SUS). This is a cross-sectional and evaluative study, part of the Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). To analyze the availability of medicines, we verified 50 items selected from the Relação Nacional de Medicamentos Essenciais (Rename - National List of Essential Medicines) of 2012. Observation scripts were applied to medicine dispensing services in the primary health care. Interviews were carried out with patients, health care professionals, and public managers, using semi-structured questionnaires. The availability index was presented as the percentage of health units where the medicines were available. For statistical analysis, absolute, relative, and mean frequencies were presented (with 95% confidence intervals). The comparison of groups was carried out by Pearson Chi-square tests or variance analysis, when needed. One thousand, one hundred, and seventy-five observation scripts were filled in a national representative sample composed by 273 cities. Statistically significant differences were observed regarding the type of unit, infrastructure, and presence of a pharmacist between regions of Brazil. The average availability of tracer medicines in primary health care was 52.9%, with differences between regions and sampling strata. This index increased to 62.5% when phytotherapic medicines were excluded. We found limited availability of medicines for treatment of chronic and epidemiological diseases, such as tuberculosis and congenital syphilis. The low availability of essential medicines purchased centrally by the Brazilian Ministry of Health indicates deficiencies in supply chain management. The different views on the availability of tracer

Spatial variation in general medical services income in dublin general practitioners.

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Teljeur, Conor; Kelly, Alan; O'Dowd, Tom

2011-01-01

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.

Evaluating the fundamental qualities of a nuclear medicine radiographer for the provision of an optimal clinical service

International Nuclear Information System (INIS)

Griffiths, Marc; King, Simon; Stewart, Rob; Dawson, Gary

2010-01-01

The developing nature of nuclear medicine practice highlights the need for an evaluation of the fundamental qualities of a Radiographer working within this discipline. Existing guidelines appear to be in place for clinical technologists working within nuclear medicine. However, limited guidance has been provided for Radiographers practicing within this discipline. This article aims to discuss the fundamental qualities that are considered essential for optimal service delivery, following consultation with various stakeholders. Areas such as technical expertise and knowledge, appropriate use of imaging equipment and current models of safe working practice will be discussed. Patient care and ethical considerations will also be evaluated, along with some core recommendations for future advanced practice.

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

International Nuclear Information System (INIS)

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

Complementary and Alternative Medicine in Rural Communities: Current Research and Future Directions

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Wardle, Jon; Lui, Chi-Wai; Adams, Jon

2012-01-01

Contexts: The consumption of complementary and alternative medicine (CAM) in rural areas is a significant contemporary health care issue. An understanding of CAM use in rural health can provide a new perspective on health beliefs and practice as well as on some of the core service delivery issues facing rural health care generally. Purpose: This…

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

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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.

Multimedia services in intelligent environments recommendation services

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Virvou, Maria; Jain, Lakhmi

2013-01-01

Multimedia services are now commonly used in various activities in the daily lives of humans. Related application areas include services that allow access to large depositories of information, digital libraries, e-learning and e-education, e-government and e-governance, e-commerce and e-auctions, e-entertainment, e-health and e-medicine, and e-legal services, as well as their mobile counterparts (i.e., m-services). Despite the tremendous growth of multimedia services over the recent years, there is an increasing demand for their further development. This demand is driven by the ever-increasing desire of society for easy accessibility to information in friendly, personalized and adaptive environments. In this book at hand, we examine recent Recommendation Services. Recommendation services appear in the mobile environment, medicine/biology, tourism, education, and so on. The book includes ten chapters, which present various recently developed recommendation services. This research book is directed to professors...

Need of Department of General Practice / Family Medicine at AIIMS (All India Institute of Medical Sciences): Why the apex medical institute in India should also contribute towards training and education of general practitioners and family physicians.

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Pal, Ranabir; Kumar, Raman

2017-01-01

Family medicine or general practice is the practicing discipline of the majority doctors in India, however formal academic departments of general practice (or family medicine) do not exist in India, as it is not a mandatory requirement as prescribed by the Medical Council of India; the principal regulator of medical education. Currently India has capacity to produce more than 60,000 medical graduates per year, majority of whom are expected to become general practitoners or primary care doctors without under going any vocational training in general practice or family medicine. The 92 nd parliamentary standing committee report (on health and family welfare) of the Indian Parliament recommended that Government of India in coordination with State Governments should establish robust postgraduate programs in Family Medicine and facilitate introducing Family Medicine discipline in all medical colleges. This will not only minimize the need for frequent referrals to specialist and decrease the load on tertiary care but also provide continuous health care for the individuals and families. The authors concur with the parliament of India and strongly feel that "Family Medicine" (community-based comprehensive clinical practice) deserves dedicated and distinct department at all medical colleges in India in order to availability of qualified medical doctors in the community-based health system. AIIMS, New Delhi, along with other newly established AIIMS, should rise to their foundation mandate of supporting excellence in all disciplines of medical science and to this historic responsibility; and not just remain an ivory tower of tertiary care based fragmented (into sub specialties) hospital culture.

Military Internal Medicine Resident Decision to Apply to Fellowship and Extend Military Commitment.

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Barsoumian, Alice E; Hartzell, Joshua D; Bonura, Erin M; Ressner, Roseanne A; Whitman, Timothy J; Yun, Heather C

2018-02-06

Nationally, the number of internal medicine physicians practicing in primary care has decreased amidst increasing interest in hospitalist medicine. Current priorities in the Military Health System include access to primary care and retention of trained personnel. Recently, we have conducted a study of military internal medicine residents' decision to enter infectious disease. As part of our larger effort, we saw an opportunity to characterize factors impacting decision making of internal medicine residents' desire to apply for subspecialty training and to extend active duty service obligations. Questions were developed after discussion with various military graduate medical education and internal medicine leaders, underwent external review, and were added to a larger question set. The survey link was distributed electronically to all U.S. military affiliated residencies' graduating internal medicine residents in December 2016-January 2017. Data were analyzed by decision to apply to fellowship and decision to extend military obligation using Fisher's exact test or Pearon's chi-square test. Sixty-eight residents from 10 of 11 military residency programs responded, for a response rate of 51%. The majority (62%) applied to fellowship to start after residency completion. Reasons cited for applying to fellowship included wanting to become a specialist as soon as possible (74%), wishing to avoid being a general internist (57%), and because they are unable to practice as a hospitalist in the military (52%). Fellowship applicants were more likely to plan to extend their military obligation than non-applicants, as did those with longer duration of military commitments. No other factors, including Uniformed Services University attendance or participation in undergraduate military experiences, were found to impact plan to extend active duty service commitment. The majority of graduating internal medicine residents apply for fellowship and report a desire to avoid being a

[Design and implementation of supply security monitoring and analysis system for Chinese patent medicines supply in national essential medicines].

Science.gov (United States)

Wang, Hui; Zhang, Xiao-Bo; Huang, Lu-Qi; Guo, Lan-Ping; Wang, Ling; Zhao, Yu-Ping; Yang, Guang

2017-11-01

The supply of Chinese patent medicine is influenced by the price of raw materials (Chinese herbal medicines) and the stock of resources. On the one hand, raw material prices show cyclical volatility or even irreversible soaring, making the price of Chinese patent medicine is not stable or even the highest cost of hanging upside down. On the other hand, due to lack of resources or disable some of the proprietary Chinese medicine was forced to stop production. Based on the micro-service architecture and Redis cluster deployment Based on the micro-service architecture and Redis cluster deployment, the supply security monitoring and analysis system for Chinese patent medicines in national essential medicines has realized the dynamic monitoring and intelligence warning of herbs and Chinese patent medicine by connecting and integrating the database of Chinese medicine resources, the dynamic monitoring system of traditional Chinese medicine resources and the basic medicine database of Chinese patent medicine. Copyright© by the Chinese Pharmaceutical Association.

A Model Curriculum for an Emergency Medical Services (EMS Rotation for Emergency Medicine Residents

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Michael Mancera

2018-01-01

Full Text Available Audience: This EMS curriculum is designed for Emergency Medicine residents at all levels of training. Introduction: Emergency Medicine (EM physicians have routine interaction with Emergency Medical Services (EMS in their clinical practice. Additionally, the American College of Graduate Medical Education (ACGME mandates that all Emergency Medicine resident physicians receive specific training in the area of EMS.1 Historically, EMS training for EM residents has been conducted in the absence of a standardized didactic curriculum. Despite advancements in the area of prehospital training, there remains wide inconsistency in EMS training experiences among EM residency training programs.2 To our knowledge a standardized and reproducible EMS curriculum for EM residents does not exist. Objectives: The aim of this curriculum is to provide a robust learning experience for EM residents around prehospital care and EMS that fulfills the ACGME requirements and which can be easily replicated and implemented in a variety of EM residency training programs. Method: The educational strategies used in this curriculum include didactics, asynchronous learning through online modules and a focused reading list, experiential learning through ride-alongs, structured small group discussion, supervised medical command shifts, and mentored practice in organizing and delivering didactics to EMS providers.

Veterans Affairs general surgery service: the last bastion of integrated specialty care.

Science.gov (United States)

Poteet, Stephen; Tarpley, Margaret; Tarpley, John L; Pearson, A Scott

2011-11-01

In a time of increasing specialization, academic training institutions provide a compartmentalized learning environment that often does not reflect the broad clinical experience of general surgery practice. This study aimed to evaluate the contribution of the Veterans Affairs (VA) general surgery surgical experience to both index Accreditation Council for Graduate Medical Education (ACGME) requirements and as a unique integrated model in which residents provide concurrent care of multiple specialty patients. Institutional review board approval was obtained for retrospective analysis of electronic medical records involving all surgical cases performed by the general surgery service from 2005 to 2009 at the Nashville VA. Over a 5-year span general surgery residents spent an average of 5 months on the VA general surgery service, which includes a postgraduate year (PGY)-5, PGY-3, and 2 PGY-1 residents. Surgeries involved the following specialties: surgical oncology, endocrine, colorectal, hepatobiliary, transplant, gastrointestinal laparoscopy, and elective and emergency general surgery. The surgeries were categorized according to ACGME index requirements. A total of 2,956 surgeries were performed during the 5-year period from 2005 through 2009. Residents participated in an average of 246 surgeries during their experience at the VA; approximately 50 cases are completed during the chief year. On the VA surgery service alone, 100% of the ACGME requirement was met for the following categories: endocrine (8 cases); skin, soft tissue, and breast (33 cases); alimentary tract (78 cases); and abdominal (88 cases). Approximately 50% of the ACGME requirement was met for liver, pancreas, and basic laparoscopic categories. The VA hospital provides an authentic, broad-based, general surgery training experience that integrates complex surgical patients simultaneously. Opportunities for this level of comprehensive care are decreasing or absent in many general surgery training

How does a quality audits work in national harmonization of activity measurement over nuclear medicine measurement in Cuba

International Nuclear Information System (INIS)

Varela, C.

2006-01-01

The National Control Center for Medical Devices (CCEEM) is a regulatory agency, belongs to the Cuban Ministry of Public Heath. It works to guarantee the safety and effectiveness of medical devices used into the National Health System (NHS) and the patient, and user protection. Quality Control assures that particular aspect will be satisfied, so since several years ago a national programme for the quality control of nuclear medicine instruments has been organized and established. A service was created in order to control periodically the state of the instrumentation in all the nuclear medicine departments, it is making annual quality control audits and participating in comparisons exercises organises by CCEEM. 3 comparisons exercises with CENTIS and services of NHS were made and eleven nuclear medicine departments were audited in order to perform a practical evaluation of this service, giving the two new regulations and general instructions to dose administration. The objects of the present work is shows, by those results, how does a quality audits work in National Harmonization of Activity Measurement over Nuclear Medicine Measurement in Cuba

Sports medicine in The Netherlands: consultation with a sports physician without referral by a general practitioner

Directory of Open Access Journals (Sweden)

de Bruijn MC

2013-01-01

Full Text Available Matthijs C de Bruijn,1 Boudewijn J Kollen,2 Frank Baarveld21Center for Sports Medicine, 2Department of General Practice, University Medical Center Groningen, University of Groningen, The NetherlandsBackground: In The Netherlands, sports medicine physicians are involved in the care of about 8% of all sports injuries that occur each year. Some patients consult a sports physician directly, without being referred by a general practitioner. This study aims to determine how many patients consult a sports physician directly, and to explore differences in the profiles of these patients compared with those who are referred.Methods: This was an exploratory cross-sectional study in which all new patients presenting with an injury to a regional sports medical center during September 2010 were identified. The characteristics of patients who self-referred and those who were referred by other medical professionals were compared.Results: A total of 234 patients were included (mean age 33.7 years, 59.1% male. Most of the injuries occurred during soccer and running, particularly injuries of the knee and ankle. In this cohort, 39.3% of patients consulted a sports physician directly. These patients were significantly more often involved in individual sports, consulted a sports physician relatively rapidly after the onset of injury, and had received significantly less care before this new event from medical professionals compared with patients who were referred.Conclusion: In this study, 39.3% of patients with sports injuries consulted a sports physician directly without being referred by another medical professional. The profile of this group of patients differed from that of patients who were referred. The specific roles of general practitioners and sports physicians in medical sports care in The Netherlands needs to be defined further.Keywords: sports injuries, sports medicine physician, primary care, secondary care

Barriers to Medical Compassion as a Function of Experience and Specialization: Psychiatry, Pediatrics, Internal Medicine, Surgery, and General Practice.

Science.gov (United States)

Fernando, Antonio T; Consedine, Nathan S

2017-06-01

Compassion is an expectation of patients, regulatory bodies, and physicians themselves. Most research has, however, studied compassion fatigue rather than compassion itself and has concentrated on the role of the physician. The Transactional Model of Physician Compassion suggests that physician, patient, external environment, and clinical factors are all relevant. Because these factors vary both across different specialities and among physicians with differing degrees of experience, barriers to compassion are also likely to vary. We describe barriers to physician compassion as a function of specialization (psychiatry, general practice, surgery, internal medicine, and pediatrics) and physician experience. We used a cross-sectional study using demographic data, specialization, practice parameters, and the Barriers to Physician Compassion Questionnaire. Nonrandom convenience sampling was used to recruit 580 doctors, of whom 444 belonged to the targeted speciality groups. The sample was characterized before conducting a factorial Multivariate Analysis of Covariance and further post hoc analyses. A 5 (speciality grouping) × 2 (more vs. less physician experience) Multivariate Analysis of Covariance showed that the barriers varied as a function of both speciality and experience. In general, psychiatrists reported lower barriers, whereas general practitioners and internal medicine specialists generally reported greater barriers. Barriers were generally greater among less experienced doctors. Documenting and investigating barriers to compassion in different speciality groups have the potential to broaden current foci beyond the physician and inform interventions aimed at enhancing medical compassion. In addition, certain aspects of the training or practice of psychiatry that enhance compassion may mitigate barriers to compassion in other specialities. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Quality management audits in nuclear medicine practices

International Nuclear Information System (INIS)

2008-12-01

An effective management system that integrates quality management (QM) is essential in modern nuclear medicine departments in Member States. The IAEA, in its Safety Standards Series, has published a Safety Requirement (GS-R-3) and a Safety Guide (GS-G-3.1) on management systems for all facilities. These publications address the application of an integrated management system approach that is applicable to nuclear medicine organizations as well. Quality management systems are maintained with the intent to continuously improve effectiveness and efficiency, enabling nuclear medicine to achieve the expectations of its quality policy, and to satisfy its customers. The IAEA has a long history of providing assistance in the field of nuclear medicine to its Member States. Regular quality audits and assessments are essential for modern nuclear medicine departments. More importantly, the entire QM and audit process has to be systematic, patient oriented and outcome based. The management of services should also take into account the diversity of nuclear medicine services around the world and multidisciplinary contributions. The latter include clinical, technical, radiopharmaceutical and medical physics procedures. Aspects of radiation safety and patient protection should also be integral to the process. Such an approach ensures consistency in providing safe, quality and superior services to patients. Increasingly standardized clinical protocol and evidence based medicine is used in nuclear medicine services, and some of these are recommended in numerous IAEA publications, for example, the Nuclear Medicine Resources Manual. Reference should also be made to other IAEA publications such as the IAEA Safety Standards Series, which include the regulations for the safe transport of nuclear material and on waste management as all of these have an impact on the provision of nuclear medicine services. The main objective of this publication is to introduce a routine of conducting an

The Symbiotic Relationship Between Operational Military Medicine, Tactical Medicine, and Wilderness Medicine: A View Through a Personal Lens.

Science.gov (United States)

Llewellyn, Craig H

2017-06-01

There are direct and indirect linkages and a form of symbiosis between operational military medicine from World War II and present wilderness medicine, from the beginnings to contemporary practice, and the more recently evolved field of tactical emergency medical support. Each of these relationships will be explored from the historical perspective of the Department of Military & Emergency Medicine, Uniformed Services University of the Health Sciences from 1982 to the present. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

42 CFR 412.87 - Additional payment for new medical services and technologies: General provisions.

Science.gov (United States)

2010-10-01

... payment for new medical services and technologies: General provisions. (a) Basis. Sections 412.87 and 412... establish a mechanism to recognize the costs of new medical services and technologies under the hospital... that are new medical services and technologies, if the following conditions are met: (1) A new medical...

Quality Management Audits in Nuclear Medicine Practices. 2. Ed

International Nuclear Information System (INIS)

2015-01-01

Quality management systems are essential and should be maintained with the intent to continuously improve effectiveness and efficiency, enabling nuclear medicine to achieve the expectations of its quality policy, satisfy its customers and improve professionalism. The quality management (QM) audit methodology in nuclear medicine practice, introduced in this publication, is designed to be applied to a variety of economic circumstances. A key outcome is a culture of reviewing all processes of the clinical service for continuous improvement in nuclear medicine practice. Regular quality audits and assessments are vital for modern nuclear medicine services. More importantly, the entire QM and audit process has to be systematic, patient oriented and outcome based. The management of services should also take into account the diversity of nuclear medicine services around the world and multidisciplinary contributions. The latter include clinical, technical, radiopharmaceutical, medical physics and radiation safety procedures

Beliefs about medicines and self-reported adherence among pharmacy clients.

Science.gov (United States)

Mårdby, Ann-Charlotte; Akerlind, Ingemar; Jörgensen, Tove

2007-12-01

To analyse any association between general beliefs about medicines and self-reported adherence among pharmacy clients. Further, to examine general beliefs about medicines by background variables. The data were collected by questionnaires including the general section of the Beliefs about Medicines Questionnaire (BMQ), the self-reporting Medication Adherence Report Scale (MARS) and the following background variables: gender, age, education, country of birth and medicine use. The General BMQ measures beliefs about medicines as something harmful (General-Harm), beneficial (General-Benefit) and beliefs about how doctors prescribe medicines (General-Overuse). Of the 324 participating pharmacy clients, 54% were considered non-adherent. An association was found between General-Harm and adherence. Adherent behaviour and higher level of education were associated respectively with more beneficial and less harmful beliefs about medicines. Those born in the Nordic countries regarded medicines as more beneficial. Current users of herbal medicines and non-users of medicines were more likely to believe that doctors overprescribed medicines. General-Harm was associated with adherence to medication among Swedish pharmacy clients. Country of birth, education and medicine use influenced beliefs about medicines. Increased awareness of the patient's beliefs about medicines is needed among healthcare providers. We should encourage patients to express their views about medicines in order to optimize and personalize the information process. This can stimulate concordance and adherence to medication.

PTSD and Use of Outpatient General Medical Services Among Veterans of the Vietnam War.

Science.gov (United States)

Schlenger, William E; Mulvaney-Day, Norah; Williams, Christianna S; Kulka, Richard A; Corry, Nida H; Mauch, Danna; Nagler, Caryn F; Ho, Chia-Lin; Marmar, Charles R

2016-05-01

The primary goal of this analysis was to assess whether recent use of outpatient services for general medical concerns by Vietnam veterans varies according to level of posttraumatic stress disorder (PTSD) symptomatology over time. Another goal was to determine whether PTSD symptomatology was associated with veterans' reports of discussing behavioral health issues as part of a general medical visit. Self-reported service use data and measures of PTSD were from a nationally representative sample of 848 male and female Vietnam theater veterans (individuals who were deployed to the Vietnam theater of operations) who participated in the National Vietnam Veterans Longitudinal Study, a 25-year follow-up of a cohort of veterans originally interviewed from 1984-1988 as part of the National Vietnam Veterans Readjustment Study. Four categories of PTSD symptomatology course over 25 years were defined, and logistic regression models were used to assess their relationship with recent use of outpatient general medical services. Male and female theater veterans with high or increasing PTSD symptomatology over the period were more likely than those with low symptomatology to report recent VA outpatient visits. Males in the increasing and high categories were also more likely to discuss behavioral health issues at general medical visits. Vietnam veterans with high and increasing PTSD symptomatology over time were likely to use VA outpatient general health services. Attention to stressors of the aging process and to persistence of PTSD symptoms is important for Vietnam veterans, as is addressing PTSD with other psychiatric and medical comorbidities within the context of outpatient general medical care.

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.

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

Science.gov (United States)

2012-03-08

..., Submission, and Negotiation of Subcontracting Plans; Correction AGENCY: General Services Administration (GSA..., Preparation, Submission, and Negotiation of Subcontracting Plans; Correction. Correction In the information...

A culturally competent education program to increase understanding about medicines among ethnic minorities

DEFF Research Database (Denmark)

Cantarero-Arévalo, Lourdes; Kassem, Dumoue; Traulsen, Janine Marie

2014-01-01

specific ethnic minority groups compared to the majority population. OBJECTIVE: The focus of this study was on reducing medicine-related problems among Arabic-speaking ethnic minorities living in Denmark. The aim was twofold: (1) to explore the perceptions, barriers and needs of Arabic-speaking ethnic...... minorities regarding medicine use, and (2) to use an education program to enhance the knowledge and competencies of the ethnic minorities about the appropriate use of medicines. SETTINGS: Healthcare in Denmark is a tax-financed public service that provides free access to hospitals and general practitioners...... focus group interviews were conducted before and four after the education program. Thirty Arabic-speaking participants were recruited from language and job centers in Copenhagen. Participants received teaching sessions in Arabic on appropriate medicine use. The education program was evaluated by two...

What Is a Service of General Economic Interest?

DEFF Research Database (Denmark)

Ølykke, Grith Skovgaard; Møllgaard, Peter

2016-01-01

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......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...... of the SGEI may engage in behaviour which would otherwise be contrary to the rules of the Treaties, notably the competition rules. Member States retain a wide discretion to define, provide and finance SGEIs; i.e. to use the entrustment of an SGEI as a tool to intervene in the market. This discretion...

Quality assessment of radiopharmaceuticals in nuclear medicine services at Northeast states, Brazil

International Nuclear Information System (INIS)

Andrade, Wellington Gomes de

2012-01-01

The radiopharmaceuticals are used in the field nuclear medicine services (NMS) as tracer in the diagnoses and treatment of many diseases. Radiopharmaceuticals used in nuclear medicine and usually have a minimum of pharmacological effect. The procedures for labelling Radiopharmaceuticals should be observed in order to minimize risks to patients, employees and individuals from the public, and to be administered in humans, must be sterile and free of pyrogens and possess elements all measures of quality controls required a conventional drug. The 'Agencia Nacional de Vigilancia Sanitaria (ANVISA)' in its 'Resolucao de Diretoria Colegiada' (RDC) No. 38 of June 4 th 2008, decided that the NMS must perform quality control in the generators eluate and radiopharmaceuticals according to recommendations of manufacturers and scientific evidence accepted by ANVISA. Thus, this study proposes to evaluate the quality of the generator 99M o- 99m Tc eluate and radiopharmaceuticals labeled with 99m Tc used in most NMS of some states in the Northeast, in relation to radionuclide, chemical, radiochemical purity and pH and promote the inclusion of procedure for quality control of radiopharmaceuticals in routine NMS. The results show that 90% radionuclidic purity, 98.2% purity chemical and radiochemical purity of 46% and 100% of the eluates are in agreement with international pharmacopoeias; already radiopharmaceuticals showed 82.6% purity and all radiochemical pH values are also in accordance with international pharmacopoeias. Even with so many positive results, staff the majority of MNS was not able to perform the quality control of the eluates and radiopharmaceuticals. Showing the importance of implementing of quality control programs of the eluates and radiopharmaceuticals in nuclear medicine. (author)

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

2017-10-01

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.

Navy Medicine - World Class Care... Anytime, Anywhere

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Search Saturday, May 26th, 2018 Home About Disclaimer Search Navy Medicine Navy Medicine World Class Care... Anytime, Anywhere Home Disclaimer Navy Medicine WebSite About Leadership Readiness Health Partnerships Inside Navy Medicine Dental Corps Hospital Corps Medical Corps Medical Service Corps Nurse Corps

Comparison of activity measurements of the 67Ga and 123I at Brazilian nuclear medicine services

International Nuclear Information System (INIS)

Santos, J.A. dos; Silva, M.A.L. da; Lopes, R.T.; Iwahara, A.; Oliveira, A.E. de; Tauhata, L.

2003-01-01

Since 1998, the National Laboratory for Ionizing Radiations (LNMRI), of Institute for Radioprotection and Dosimetry, belonging to the Brazilian Commission for Nuclear Energy (IRD/CNEN), is conducting a comparison program for the measurements of radiopharmaceutical activities applied to to patients at the nuclear medicine sector, viewing to assessment the quality of that measurements. This work presents the results of three comparison rounds using the 67 Ga and 123 I, establishing the metrological tracking of the calibrators used by the participants. The results were analysed under the the viewpoint of the conformal with the regulatory authority and show that those comparisons are necessary to improve the quality of radiopharmaceutical measurement activities, identify failures on the equipment and technical procedures used by the nuclear medicine services all over the country

Ayurvedic medicine for rheumatoid arthritis: a systematic review.

Science.gov (United States)

Park, Jongbae; Ernst, Edzard

2005-04-01

To systematically review all randomized controlled trials (RCTs) on the effectiveness of Ayurvedic medicine for rheumatoid arthritis (RA). Computerized literature searches for all RCTs of Ayurvedic medicine for RA in the following databases: Medline (March 1969 to March 2003), Embase (February 1985 to February 2003), AMED (March 1980 to March 2003), Cochrane Controlled Trial Register (October 1997 to March 2003), and the abstract service of Central Council for Research in Ayurveda and Siddha (CCRAS; 1976 to March 2003). Hand searches were performed in 1 Sri Lankan and 3 Indian journals and the authors' personal files. Key data of included studies were extracted and reviewed. The methodological quality of all studies was evaluated with the Jadad scale. Seven studies met our inclusion criteria. Trials tested either Ayurvedic medicine against placebo or other Ayurvedic medicines. In general, patient and physician global assessments on the severity of pain, and morning stiffness were used as endpoints. Of 3 placebo-controlled RCTs, 1 high-quality trial did not show benefit of the active treatment against placebo, while another incompletely reported study indicated beneficial effects of an Ayurvedic medicine. A further incompletely reported study showed no significant difference. The remaining 4 trials were difficult to interpret because they tested an Ayurvedic medicine against other Ayurvedic medicines whose effects were not proven. There is a paucity of RCTs of Ayurvedic medicines for RA. The existing RCTs fail to show convincingly that such treatments are effective therapeutic options for RA.

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)

Mohamed, Khalid G; Hunskaar, Steinar; Abdelrahman, Samira Hamid; Malik, Elfatih M

2014-01-21

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. 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. 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. 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.

Radiation protection medicine - a special field of health care and industrial safety

International Nuclear Information System (INIS)

Arndt, D.

1988-01-01

The definition of the term radiation protection medicine is followed by a brief account of the pathophysiology of radiation effects. Developments in the special field of general and occupational health are also described together with relevant GDR regulations. Information is provided on what is done at present at various levels in the GDR, in the context of peaceful use of nuclear energy, to provide adequate services in radiation protection medicine for all radiation workers and the population, with reference to the scope of activities of the Institute of Medicine attached to the National Board for Atomic Safety and Radiation Protection, the network of works medical officers in charge of radiation protection and the system for clinical treatment of acute radiation damage. (author)

REKAYASA KOMPONEN WEB SERVICE GENERAL LEDGER BERBASIS MICROSOFT .NET

Directory of Open Access Journals (Sweden)

Suhadi Lili

2004-01-01

Full Text Available Normal 0 false false false IN X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} Kebutuhan akan akuntansi menjadi suatu kebutuhan yang begitu mendasar bagi perusahaan baik yang skala kecil, menengah sampai yang besar. Tak pernah terlepas sedikitpun kegiatan ekonomi di suatu perusahaan dari akuntansi dan bagian-bagian yang ada di dalamnya. Salah satu bagian dari akuntansi itu adalah General Ledger atau Buku Besar. General Ledger atau Buku Besar menjadi inti dan pokok dari akuntansi. Pada penelitian ini dikembangkan sebuah komponen yang dapat digunakan untuk membangun web service General Ledger, dimana fungsinya adalah untuk melakukan proses penjurnalan sehingga dapat secara otomatis menghasilkan laporan-laporan keuangan. Tahapan untuk membuatnya adalah dengan waterfall development model dimulai dari pencarian masalah, membuat model class, pengaturan layer hingga aplikasi dapat diimplementasikan. Dalam ujicoba yang dilakukan, komponen telah dapat berfungsi dengan baik pada saat diimplementasikan, dengan melakukan pengisian data master, pengisian jurnal dan pembuatan laporan-laporan akuntansi. Kata kunci : Komponen, Web Service, General Ledger, Akuntansi, Microsoft .NET

Working styles of medicine professionals in emergency medical service

Directory of Open Access Journals (Sweden)

Lazarević Marija

2015-01-01

Full Text Available Introduction: Transactional analysis is a personality and communication theory established by psychiatrist Eric Berne, at the end of the fifties. Counter script is the way of life in accordance with parental imperative. The person with a counter-script has a compulsion to fulfill the required task in order to avoid the disaster of ban. There are five drivers that are considered essential, and these are: 'Be perfect!', 'Be strong!', 'Hurry up!', 'Please others!' and 'Work hard!' Objective: a Determination of the most dominant driver in this medical service. b Because of the specifics of this job which requires speed and humanity, the emphasis will be on doublet: 'Hurry up!' and 'Please others!' Method: The study was conducted on a group of subjects employed in a general service with medical emergency. The instrument used in the study was Julie Hay's questionnaire for diagnosing the working styles. Results: Statistical research was conducted on a sample of 30 subjects employed in the emergency medical service. Availability of all afore mentioned drivers was tested. The research hypotheses were formulated as follows: H0: The driver is not present among the employees in this service; H1: The driver is present among the employees in this service. Calculated value of the t-statistics for the driver 'Hurry up!' is 1.398; for the driver 'Be perfect!' 3.616; for the driver 'Please others!' 11.693; for the driver 'Work hard!' -0.673; and for the driver 'Be strong!' 3.880. Since the realizable value of the t-statistics for the drivers: 'Be perfect!' and 'Please others!' and 'Be strong!' is bigger than the critical value 1.699, and p<0.05 we reject the null hypothesis and we accept the alternative hypothesis on the significance level of 95%. For the drivers 'Hurry up!' and 'Work hard!' the values of t-statistics are lower than the critical value 1.699 for significance level of 95%, so the alternative hypothesis are not acceptable. Conclusion: The results of

Managing the innovation supply chain to maximize personalized medicine.

Science.gov (United States)

Waldman, S A; Terzic, A

2014-02-01

Personalized medicine epitomizes an evolving model of care tailored to the individual patient. This emerging paradigm harnesses radical technological advances to define each patient's molecular characteristics and decipher his or her unique pathophysiological processes. Translated into individualized algorithms, personalized medicine aims to predict, prevent, and cure disease without producing therapeutic adverse events. Although the transformative power of personalized medicine is generally recognized by physicians, patients, and payers, the complexity of translating discoveries into new modalities that transform health care is less appreciated. We often consider the flow of innovation and technology along a continuum of discovery, development, regulation, and application bridging the bench with the bedside. However, this process also can be viewed through a complementary prism, as a necessary supply chain of services and providers, each making essential contributions to the development of the final product to maximize value to consumers. Considering personalized medicine in this context of supply chain management highlights essential points of vulnerability and/or scalability that can ultimately constrain translation of the biological revolution or potentiate it into individualized diagnostics and therapeutics for optimized value creation and delivery.

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.

[The importance of chronic migraine in a general neurology service].

Science.gov (United States)

Gracia-Naya, M; Alarcia-Alejos, R; Modrego-Pardo, P J

Chronic migraine is a primary headache that is difficult to treat and has an important impact on the patient's quality of life. The international headache classification recently modified the criteria for chronic migraine and therefore few studies have been conducted that analyse groups according to these new criteria. AIM. To analyse a group of patients with chronic migraine who were referred to a general neurology service. The first 100 patients with migraine were selected. Researchers established and analysed a number of subgroups of patients with episodic, chronic or chronic migraine with probable headache due to medication abuse, in accordance with the International Headache Society (IHS) headache classification and its revised version from 2006. Of the total sample of 738 new patients, 100 (13.5%) suffered from migraines and of these 100 new patients with migraine 42 (5.6% of the total series) satisfied criteria for chronic migraine and 15 patients with chronic migraine met the criteria for probable headache due to medication abuse. Before visiting the neurology service, only 41% had been diagnosed as suffering from migraine, 38% had received no information about this condition, only 17% took triptans for symptomatic relief and 23% had followed some kind of preventive treatment. One notable finding was the importance of episodic and chronic migraine in a general neurology service, on applying the recent IHS criteria. A high percentage of patients with chronic migraine who were referred to the neurology service have not been diagnosed or given any information or proper treatment; an elevated degree of self-medication and medication abuse also exists. Preventive treatment and triptans in cases of intense migraines are still not commonly used in primary care.

Ethics education: a priority for general practitioners in occupational medicine.

Science.gov (United States)

Alavi, S Shohreh; Makarem, Jalil; Mehrdad, Ramin

2015-01-01

General practitioners (GPs) who work in occupational medicine (OM) should be trained continuously. However, it seems that ethical issues have been neglected. This cross-sectional study aimed to determine educational priorities for GPs working in OM. A total of 410 GPs who participated in OM seminars were asked to answer a number of questions related to items that they usually come across in their work. The respondents were given scores on 15 items, which pertained to their frequency of experience in OM, their felt needs regarding education in the field, and their knowledge and skills. Ethical issues were the most frequently utilised item and the area in which the felt need for education was the greatest. The knowledge of and skills in ethical issues and matters were the poorest. Ethical principles and confidentiality had the highest calculated educational priority scores. It is necessary to consider ethical issues as an educational priority for GPs working in the field of OM.

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,…

Radiation protection office at the general direction of health

International Nuclear Information System (INIS)

Piechowski, J.

1996-01-01

The radiation protection office at the general direction of health has the following functions: organisation and relations with decentralized services, legal aspects, relations with the direction of nuclear installation safety, nuclear medicine with licensing, radioactive wastes in relation with ANDRA, environment, trusteeship of OPRI in matter of measurements, dosimetry and epidemiology in relation with the Minister of work and training in radiation protection. (N.C.)

Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general medical service.

Science.gov (United States)

Lord, Kito; Parwani, Vivek; Ulrich, Andrew; Finn, Emily B; Rothenberg, Craig; Emerson, Beth; Rosenberg, Alana; Venkatesh, Arjun K

2018-03-20

Overcrowding in the emergency department (ED) has been associated with patient harm, yet little is known about the association between ED boarding and adverse hospitalization outcomes. We sought to examine the association between ED boarding and three common adverse hospitalization outcomes: rapid response team activation (RRT), escalation in care, and mortality. We conducted an observational analysis of consecutive patient encounters admitted from the ED to the general medical service between February 2013 and June 2015. This study was conducted in an urban, academic hospital with an annual adult ED census over 90,000. We defined boarding as patients with greater than 4h from ED bed order to ED departure to hospital ward. The primary outcome was a composite of adverse outcomes in the first 24h of admission, including RRT activation, care escalation to intensive care, or in-hospital mortality. A total of 31,426 patient encounters were included of which 3978 (12.7%) boarded in the ED for 4h or more. Adverse outcomes occurred in 1.92% of all encounters. Comparing boarded vs. non-boarded patients, 41 (1.03%) vs. 244 (0.90%) patients experienced a RRT activation, 53 (1.33%) vs. 387 (1.42%) experienced a care escalation, and 1 (0.03%) vs.12 (0.04%) experienced unanticipated in-hospital death, within 24h of ED admission. In unadjusted analysis, there was no difference in the composite outcome between boarding and non-boarding patients (1.91% vs. 1.91%, p=0.994). Regression analysis adjusted for patient demographics, acuity, and comorbidities also showed no association between boarding and the primary outcome. A sensitivity analysis showed an association between ED boarding and the composite outcome inclusive of the entire inpatient hospital stay (5.8% vs. 4.7%, p=0.003). Within the first 24h of hospital admission to a general medicine service, adverse hospitalization outcomes are rare and not associated with ED boarding. Copyright © 2018 Elsevier Inc. All rights

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.

Widening access to medicine may improve general practitioner recruitment in deprived and rural communities: survey of GP origins and current place of work.

Science.gov (United States)

Dowell, J; Norbury, M; Steven, K; Guthrie, B

2015-10-01

Widening access to medicine in the UK is a recalcitrant problem of increasing political importance, with associated strong social justice arguments but without clear evidence of impact on service delivery. Evidence from the United States suggests that widening access may enhance care to underserved communities. Additionally, rural origin has been demonstrated to be the factor most strongly associated with rural practice. However the evidence regarding socio-economic and rural background and subsequent practice locations in the UK has not been explored. The aim of this study was to investigate the association between general practitioners' (GPs) socio-economic and rural background at application to medical school and demographic characteristics of their current practice. The study design was a cross-sectional email survey of general practitioners practising in Scotland. Socio-economic status of GPs at application to medical school was assessed using the self-coded National Statistics Socio-Economic Classification. UK postcode at application was used to define urban-rural location. Current practice deprivation and remoteness was measured using NHS Scotland defined measures based on registered patients' postcodes. A survey was sent to 2050 Scottish GPs with a valid accessible email address, with 801 (41.5 %) responding. GPs whose parents had semi-routine or routine occupations had 4.3 times the odds of working in a deprived practice compared to those with parents from managerial and professional occupations (95 % CI 1.8-10.2, p = 0.001). GPs from remote and rural Scottish backgrounds were more likely to work in remote Scottish practices, as were GPs originating from other UK countries. This study showed that childhood background is associated with the population GPs subsequently serve, implying that widening access may positively affect service delivery in addition to any social justice rationale. Longitudinal research is needed to explore this association and the

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.

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

Comparison of activity measurements of 131I and 99mTc radionuclides administered in nuclear medicine services of Porto Alegre

International Nuclear Information System (INIS)

Alabarse, Frederico Gil.; Santos, Carlos Eduardo Lima dos

2005-01-01

A programme for the comparison of activity measurements of radionuclides administered to patients in Nuclear Medicine Services, for the purpose of diagnosis or therapy, is being conducted under the coordination of the Radioprotection and Dosimetry Institute of the Brazilian Nuclear Energy Commission, IRD/CNEN. In the present work, measurements of the activity of samples of 131 I and 99 mTc were conducted in the dose calibrators of the Nuclear Medicine Services of the city of Porto Alegre, in the period from June to September 2004. The results were analysed to evaluate the compliance with the Brazilian regulation and were also compared to data available in the literature for the cities of Rio de Janeiro and Brasilia. The performance of the activity meters in Porto Alegre is shown to be very good, which contributes to the radiological protection of patients submitted to diagnosis or therapy with radiopharmaceuticals. (author)

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.

76 FR 78010 - General Services Administration Acquisition Regulation; Information Collection; Contract...

Science.gov (United States)

2011-12-15

... collection of information is accurate and based on valid assumptions and methodology; and ways to enhance the...: February 13, 2012. FOR FURTHER INFORMATION CONTACT: Ms. Dana Munson, Procurement Analyst, General Services.../or business confidential information provided. SUPPLEMENTARY INFORMATION: A. Purpose Under certain...

Extremity dosimetry in nuclear medicine services using thermoluminescent detectors

International Nuclear Information System (INIS)

Mebhah, D.; Djeffal, S.; Badreddine, A.; Medjahed, M.

1993-01-01

The Radiation Protection and Safety Centre in Algiers provides two types of dosemeters, one for monitoring doses to the whole body and skin and the other one for monitoring doses to the extremities of the body. In nuclear medicine services and radiopharmaceutical laboratories, hands and arms are often closer to a given radiation source than the main part of the body and therefore receive greater doses. In this context, extremity doses have been measured by a ring dosemeter and by a fingertip ultra-thin dosemeter. The ring dosemeter consists of a metallic ring with a circular indentation to hold a LiF chip which is covered with a 10 mg.cm -2 shrinkable black polyamide layer. The ultra-thin dosemeter contains a 5 mg.cm -2 LiF element for measuring doses at a depth of 7 mg.cm -2 . These extremity dosemeters have been characterised before their use in the field. They have also been tested using radioisotopes of various energies. The doses received by the monitored workers were correlated with the amount of the handled activity. The doses obtained using the fingertip and the ring dosemeters are presented and discussed from a radiological point of view. (author)

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.

The Views of the Teachers Related to the Problems the Nursery Class Teachers Encounter in Personnel Services and General Services

Science.gov (United States)

Ertör, Eren; Akan, Durdagi

2016-01-01

In this study, it was aimed to analyze the problems that the nursery school teachers, who worked in primary schools of Ministry of National Education in Agri city center in 2014-2015 academic years, experience in personnel services and general services according to the views of the teachers. In the direction of this purpose, phenomenology design,…

General practice integration in Australia. Primary health services provider and consumer perceptions of barriers and solutions.

Science.gov (United States)

Appleby, N J; Dunt, D; Southern, D M; Young, D

1999-08-01

To identify practical examples of barriers and possible solutions to improve general practice integration with other health service providers. Twelve focus groups, including one conducted by teleconference, were held across Australia with GPs and non GP primary health service providers between May and September, 1996. Focus groups were embedded within concept mapping sessions, which were used to conceptually explore the meaning of integration in general practice. Data coding, organising and analysis were based on the techniques documented by Huberman and Miles. Barriers to integration were perceived to be principally due to the role and territory disputes between the different levels of government and their services, the manner in which the GP's role is currently defined, and the system of GP remuneration. Suggestions on ways to improve integration involved two types of strategies. The first involves initiatives implemented 'top down' through major government reform to service structures, including the expansion of the role of divisions of general practice, and structural changes to the GP remuneration systems. The second type of strategy suggested involves initiatives implemented from the 'bottom up' involving services such as hospitals (e.g. additional GP liaison positions) and the use of information technology to link services and share appropriate patient data. The findings support the need for further research and evaluation of initiatives aimed at achieving general practice integration at a systems level. There is little evidence to suggest which types of initiatives improve integration. However, general practice has been placed in the centre of the health care debate and is likely to remain central to the success of such initiatives. Clarification of the future role and authority of general practice will therefore be required if such integrative strategies are to be successful at a wider health system level.

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.

Use of medical services and medicines attributable to diabetes in Sub-Saharan Africa.

Science.gov (United States)

Brown, Jonathan Betz; Ramaiya, Kaushik; Besançon, Stéphane; Rheeder, Paul; Tassou, Clarisse Mapa; Mbanya, Jean-Claude; Kissimova-Skarbek, Katarzyna; Njenga, Eva Wangechi; Muchemi, Eva Wangui; Wanjiru, Harrison Kiambuthi; Schneider, Erin

2014-01-01

Although the large majority of persons with diabetes and other non-communicable diseases (NCDs) lives and dies in low- and middle-income countries, the prevention and treatment of diabetes and other NCDs is widely neglected in these areas. A contributing reason may be that, unlike the impacts of acute and communicable diseases, the demands on resources imposed by diabetes is not superficially obvious, and studies capable of detecting these impacts have not be done. To ascertain recent use of medical services and medicines and other information about the impact of ill-health, we in 2008-2009 conducted structured, personal interviews with 1,780 persons with diagnosed diabetes (DMs) and 1,770 matched comparison subjects (MCs) without diabetes in Cameroon, Mali, Tanzania and South Africa. We sampled DMs from diabetes registries and, in Cameroon and South Africa, from attendees at outpatient diabetes clinics. To recruit MCs, we asked subjects with diabetes to identify five persons living nearest to them who were of the same sex and approximate age. We estimated diabetes impact on medical services use by calculating ratios and differences between DMs and MCs, testing for statistical significance using two-stage multivariable hurdle models. DMs consumed 12.95 times more days of inpatient treatment, 7.54 times more outpatient visits, and 5.61 times more medications than MCs (all pSub-Saharan Africa, the relative incremental use of medical care and medicines associated with diagnosed diabetes is much greater than in industrialized countries and in China. Published calculations of the health-system impact of diabetes in Africa are dramatic underestimates. Although non-communicable diseases like diabetes are commonly thought to be minor problems for health systems and patients in Africa, our data demonstrate the opposite.

Technical issues and conservation conditions of medicines in the primary health care of the Brazilian Unified Health System

Science.gov (United States)

Costa, Ediná Alves; Araújo, Patrícia Sodré; Pereira, Marcelo Tavares; Souto, Ana Cristina; Souza, Gisélia Santana; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Alvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair

2017-01-01

ABSTRACT OBJECTIVE To characterize the technical issues and conditions of medicines conservation in Primary Health Care of Brazilian regions, responsible for pharmacy/dispensing unit profile; environmental, storage, and dose fractioning conditions; inventory control and waste management; fire and electrical failure safety items; transportation problems; advertising regulation; and pharmacovigilance. METHODS This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços (National Survey on Access, Use and Promotion of Rational Use of Medicines – Services)–, a cross-sectional and exploratory study, of evaluative nature, consisting of an information survey within a representative sample of municipalities, stratified by Brazilian regions, which constitute the study domains, and a sample of Primary Health Care services. Pharmaceutical services (PS) were directly observed with photographic record and face-to-face interviews with those responsible for the dispensing of medicines and over the telephone with those responsible for pharmaceutical services. Data were processed with the SPSS® software version 21. RESULTS The investigated dimensions showed relevant deficiencies and inequalities between the regions, generally more favorable in the Southeast and Midwest regions and weaker in the Northeast and North regions. We verified non-compliance with technical requirements and conditions essential to the conservation of medicines, which may interfere with the maintenance of stability and, thus, on their quality, efficacy, and safety. The regulation of advertising/promotion of medicines is still incipient and there is some progress in the structuring of mechanisms regarding pharmacovigilance. CONCLUSIONS The sanitary situation of medicines in Brazilian Primary Health Care is alarming due to the violation of the specific sanitary legislation for dispensing establishments and due to a wide range of

Retrospective analysis of the role and performance of family medicine versus emergency medical services in the pre-hospital management of patients with AMI in Banja Luka.

Science.gov (United States)

Lakić, Biljana; Račić, Maja; Vulić, Duško

2016-05-01

The aim of this study was to investigate the differences in pre-hospital care of patients with acute myocardial infarction between emergency medical services and family medicine. This retrospective descriptive study included patients treated for acute myocardial infarction at the University Clinical Centre of Banja Luka, in the period from 1st January to 31st December 2011. The patients were divided into two groups: patients who received a hospital referral from the family medicine service and those who received one from the emergency medical service. The majority of patients (54.8%) received pre-hospital care from emergency medical services, while in 24.8% of cases the care was provided by family medicine physicians. The analysis showed that the time that passed from the onset of symptoms to the visit to the health institution of first medical contact was shorter in the emergency medical service (pfamily practice was 24 hours, and to the emergency service 2 hours. The patients who established their first medical contact with the emergency service reported more severe symptoms than the ones who visited a family practice over the same period of time. The severity of symptoms affected the patients' decisions to seek help in a timely manner and to choose the facility of first medical contact. Interventions to decrease delay must focus on improving public awareness of acute myocardial infarction symptoms and increasing their knowledge of the benefits of early medical contact and treatment. Continuing education of family practitioners in this field is required. Copyright © 2016 by Academy of Sciences and Arts of Bosnia and Herzegovina.

Analysis on the Implementation of Nutrition Services in Tugurejo General Hospital Semarang

OpenAIRE

Dewi, Emy Shinta; Kartasurya, Martha Irene; Sriatmi, Ayun

2015-01-01

Nutrition was an important factor for patient care and cure. Results of an evaluation by nutritionalresearch and development unit of Tugurejo district general hospital (RSUD) in 2011 indicated thatfood remains of patient were still below the minimal standard of service. Objective of this study wasto analyze the implementation of nutritional service in the RSUD Tugurejo Semarang.This was a qualitative study with 4 nutritionists, 8 cook assistants, and 8 waitresses as maininformants. Triangulat...

77 FR 31016 - General Services Administration Acquisition Regulation; Submission for OMB Review; GSA Mentor...

Science.gov (United States)

2012-05-24

... Services Administration Acquisition Regulation; Submission for OMB Review; GSA Mentor-Prot[eacute]g[eacute... collection concerning the GSA Mentor-Prot[eacute]g[eacute] Program, General Service Administration... Collection 3090- 0286, GSA Mentor-Prot[eacute]g[eacute] Program by any of the following methods: Regulations...

Invisible Thread: Pre-Service Success Indicators Among Marine General Officers

Science.gov (United States)

2017-12-01

30 Table 12. Self -Perception About Pre-Service Success Indicators .............................34...then reviewed by an Officer Review Board, which according to Marine Corps Order is “used to determine which company grade officers will be offered the...Status 91 Place of Birth State 83 Quarter of Birth 64 Religion 91 Sex 91 9 1. Accession Type Accession type defines which program each general

Critical evaluation of the external occupational exposure in nuclear medicine services in Brazil

International Nuclear Information System (INIS)

Kubo, Ana Luiza Silva Lima

2016-01-01

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

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

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.

Central African Journal of Medicine

African Journals Online (AJOL)

The Central African Journal of Medicine is a quarterly refereed general medical journal which seeks to promote the practice and science of medicine in Africa. Emphasis is placed on general medical topics, reflecting common and important conditions in the region. The journal also covers related medical fields. Submissions ...

Questioning territorial cohesion: (Un)equal access to services of general interest

Czech Academy of Sciences Publication Activity Database

Malý, Jiří

-, August 2016 (2016), s. 1-21 ISSN 1056-8190 Institutional support: RVO:68145535 Keywords : territorial cohesion * services of general interest * accessibility * spatial justice * Czech Republic Subject RIV: DE - Earth Magnetism, Geodesy, Geography Impact factor: 1.272, year: 2016 http://onlinelibrary.wiley.com/doi/10.1111/pirs.12250/full

NON-MUSCULOSKELETAL SPORTS MEDICINE LEARNING IN FAMILY MEDICINE RESIDENCY PROGRAMS

Directory of Open Access Journals (Sweden)

Pasqualino Caputo

2008-06-01

that contained a sports medicine fellowship. In order to protect anonymity, we did not receive other identifying information about candidates, such as demographics or whether participants belonged to a specific or common program. Thus, we could not group examinees by such variables as race, sex, or specific residency program.Faculty and graduates of the Halifax Sports Medicine Fellowship program at the Halifax Medical Center in Daytona Beach, Florida were asked to sort each examination question into (a non-musculoskeletal sports medicine questions and (b general family medicine questions on the ABFM ITE. Examples of non-musculoskeletal sports medicine questions included topics such as concussion, female triad, altitude medicine, cardiovascular conditions, etc. All other questions (except musculoskeletal medicine items were categorized as general family medicine questions. A total of seven faculty and graduates of the sports medicine fellowship completed the sorting task. All evaluators held board certification by the ABFM with Certificate of Added Qualifications (CAQ in Sports Medicine at the time of evaluation. Only identified questions with unanimous agreement by all 7 evaluators were used for data analysis. Table 1 shows the number of agreed-upon questions of each type for each year. As can be seen from Table 1, data from five different examinations were available to examine the impact of the fellowship on exam performance. For each examinee, we computed two total correct scores, one for the non-musculoskeletal sports medicine items, and one for general family medicine items. The specific items change each year (1998 to 2003, so that each year had to be considered separately. Although each of the five examinations allowed for the assessment and creation of scales for both non-musculoskeletal sports medicine and general family medicine knowledge, the number and nature of questions differed across years. Different people were examined across years as well. Therefore

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,…

Substance and materiality? The archaeology of Talensi medicine shrines and medicinal practices.

Science.gov (United States)

Insoll, Timothy

2011-08-01

Talensi materia medica is varied, encompassing plant, mineral, and animal substances. Healing, medicines, and medicinal practices and knowledge can be shrine-based and linked with ritual practices. This is explored utilising ethnographic data and from an archaeological perspective with reference to future possibilities for research both on Talensi medicine and, by implication, more generally through considering the archaeology of Talensi medicine preparation, use, storage, spread, and disposal. It is suggested that configuring the archaeology of medicine shrines and practices more broadly in terms of health would increase archaeological visibility and research potential.

A way to motivate Danish GPs to implement a new national service.

Science.gov (United States)

Kristensen, Alice; Wengler, Bente

2012-01-01

The Common Medicine card (CMC) is a new national service in Denmark which aim is to ensure better patient care and minimize medication errors. All health professionals as well as authorities have to use this system. CMC requires changing the organization of work for both physicians and clinical staff in General Practice (GP). Commissioning of CMC in GP requires a significant effort beyond the technical installation of the solution. Finding the right way to implement a new service in a busy GP has been the main focus of the national project organization MedCom. MedCom has in collaboration with the five regions in Denmark, established a joint plan and has created an implementation model contraining various initiatives including "after hours" meetings for each service provider of EMR (Electronic Medicine Records) in order to disseminate and support the new CMC service. This paper shows the status of the "after hours" meetings effect in dissemination of CMC from August to November 2011.

[Aesthetic medicine and aspects related to liability, medical professional and social law].

Science.gov (United States)

Jansen, Christoph

2006-01-01

There are no special legal arrangements for the field of aesthetic medicine; rather, the general medico-legal regulations apply although they raise specific questions as far as aesthetic medicine is concerned. Legally, a contract exists between physician and patient which is also applicable to aesthetic medicine. This means that the physician owes the patient only the provision of a proper, non-defective service, but does not need to guarantee that it actually leads to the desired outcome. Before performing a medically non-indicated procedure the physician is obliged to provide the patient with particularly thorough information about this procedure. Various problems and issues are raised by the advertising limitations for medical professionals and the maintenance of the boundaries confining the special field of aesthetic medicine. Medically indicated procedures are suitable for statutory reimbursement if the patient suffers from "physical disfigurement" or somatic complaints that lead to considerable impairment and if there are no other, cheaper treatment options available.

Transfusion practice in anemic, non-bleeding patients: Cross-sectional survey of physicians working in general internal medicine teaching hospitals in Switzerland.

Science.gov (United States)

von Babo, Michelle; Chmiel, Corinne; Müggler, Simon Andreas; Rakusa, Julia; Schuppli, Caroline; Meier, Philipp; Fischler, Manuel; Urner, Martin

2018-01-01

Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland. In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed. 560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.

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

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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

Variation in Emergency Department vs Internal Medicine Excess Charges in the United States.

Science.gov (United States)

Xu, Tim; Park, Angela; Bai, Ge; Joo, Sarah; Hutfless, Susan M; Mehta, Ambar; Anderson, Gerard F; Makary, Martin A

2017-08-01

Uninsured and insured but out-of-network emergency department (ED) patients are often billed hospital chargemaster prices, which exceed amounts typically paid by insurers. To examine the variation in excess charges for services provided by emergency medicine and internal medicine physicians. Retrospective analysis was conducted of professional fee payment claims made by the Centers for Medicare & Medicaid Services for all services provided to Medicare Part B fee-for-service beneficiaries in calendar year 2013. Data analysis was conducted from January 1 to July 31, 2016. Markup ratios for ED and internal medicine professional services, defined as the charges submitted by the hospital divided by the Medicare allowable amount. Our analysis included 12 337 emergency medicine physicians from 2707 hospitals and 57 607 internal medicine physicians from 3669 hospitals in all 50 states. Services provided by emergency medicine physicians had an overall markup ratio of 4.4 (340% excess charges), which was greater than the markup ratio of 2.1 (110% excess charges) for all services performed by internal medicine physicians. Markup ratios for all ED services ranged by hospital from 1.0 to 12.6 (median, 4.2; interquartile range [IQR], 3.3-5.8); markup ratios for all internal medicine services ranged by hospital from 1.0 to 14.1 (median, 2.0; IQR, 1.7-2.5). The median markup ratio by hospital for ED evaluation and management procedure codes varied between 4.0 and 5.0. Among the most common ED services, laceration repair had the highest median markup ratio (7.0); emergency medicine physician review of a head computed tomographic scan had the greatest interhospital variation (range, 1.6-27.7). Across hospitals, markups in the ED were often substantially higher than those in the internal medicine department for the same services. Higher ED markup ratios were associated with hospital for-profit ownership (median, 5.7; IQR, 4.0-7.1), a greater percentage of uninsured patients seen

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

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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.

Value and Payment in Sleep Medicine.

Science.gov (United States)

Wickwire, Emerson M; Verma, Tilak

2018-05-15

Value, like beauty, exists in the eye of the beholder. This article places the value of clinical sleep medicine services in historical context and presents a vision for the value-based sleep of the future. First, the history of value and payment in sleep medicine is reviewed from the early days of the field, to innovative disruption, to the widespread adoption of home sleep apnea testing. Next, the importance of economic perspective is discussed, with emphasis on cost containment and cost-shifting between payers, employers, providers, and patients. Specific recommendations are made for sleep medicine providers and the field at large to maximize the perceived value of sleep. Finally, alternate payment models and value-based care are presented, with an eye toward the future for clinical service providers as well as integrated health delivery networks. © 2018 American Academy of Sleep Medicine.

A Lifestyle Medicine Clinic in a Community Pharmacy Setting

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Thomas L. Lenz

2010-06-01

Full Text Available Chronic diseases continue to be a significant burden to the health care system. Pharmacists have been able to show that drug therapy for patients with chronic diseases can be improved through medication therapy management (MTM services but have yet to become significantly involved in implementing lifestyle modification programs to further control and prevent chronic conditions. A novel and innovative lifestyle medicine program was started by pharmacists in a community pharmacy in 2008 to more comprehensively prevent and manage chronic conditions. The lifestyle medicine program consists of designing seven personalized programs for patients to address physical activity, nutrition, alcohol consumption, weight control, stress management, sleep success, and tobacco cessation (if needed. The lifestyle medicine program complements existing MTM services for patients with hypertension, dyslipidemia, and/or diabetes. This program is innovative because pharmacists have developed and implemented a method to combine lifestyle medicine with MTM services to not only manage chronic conditions, but prevent the progression of those conditions and others. Several innovative tools have also been developed to enhance the effectiveness of a lifestyle medicine program. This manuscript describes the program's pharmacy setting, pharmacy personnel, participants and program details as well as the tools used to integrate a lifestyle medicine program with MTM services. Type: Clinical Experience

How effective is the integration of Sport and Exercise Medicine in the English National Health Service for sport related injury treatment and health management?

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Pullen, Emma; Malcolm, Dominic; Wheeler, Patrick

2018-06-07

Regular participation in sport, exercise and physical activity is associated with positive health outcomes and form a mainstay of British public health policies. However, regular participation in sport and exercise can result in sport related injury (SRI) which, in turn, is a key cause of exercise cessation. The integration of Sport and Exercise Medicine (SEM) in the English National Health Service (NHS) aims to provide a specialist service for public populations and thus reduce the impact of SRI on exercise cessation and associated negative health outcomes. More broadly it aims to both support physical activity health promotion policies and improve healthcare organisations efficiencies through providing the most condition-appropriate treatment. This qualitative interview study examines patients' (n=19) experiences of accessing and receiving SEM treatment within the English NHS. The research demonstrates that referral pathways into SEM were often prolonged, characterised by multiple General Practitioner (GP) visits and referrals into other musculoskeletal services, demonstrating an inefficient use of healthcare resources. Prolonged pathways fostered only limited recovery back to previous physical activity levels and other negative health behaviours, yet on accessing the SEM clinic, patients experienced progressive rehabilitation back into sport and exercise participation. This study highlights the importance of more fully integrating SEM services into public healthcare as a way of improving the organisational capacity of healthcare in treating SRI and ensuring that citizens comply with state interventions which orchestrate health management through raising physical activity levels across the population.

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.

General practice, primary care, and health service psychology: concepts, competencies, and the Combined-Integrated model.

Science.gov (United States)

Schulte, Timothy J; Isley, Elayne; Link, Nancy; Shealy, Craig N; Winfrey, LaPearl Logan

2004-10-01

The profession of psychology is being impacted profoundly by broader changes within the national system of health care, as mental and behavioral health services are being recognized as essential components of a comprehensive, preventive, and cost-efficient primary care system. To fully define and embrace this role, the discipline of professional psychology must develop a shared disciplinary identity of health service psychology and a generalized competency-based model for doctoral education and training. This very framework has been adopted by Combined-Integrated (C-I) doctoral programs in professional psychology, which train across the practice areas (clinical, counseling, and school psychology) to provide a general and integrative foundation for their students. Because C-I programs produce general practitioners who are competent to function within a variety of health service settings, this innovative training approach has great potential to educate and train psychologists for a changing health care marketplace. Copyright 2004 Wiley Periodicals, Inc.

Blood banking and transfusion medicine for the nephrologist.

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Wehrli, Gay

2012-01-01

Therapeutic Apheresis Medicine Services work closely with Blood Banking and Transfusion Medicine Services (BBTMS). The BBTMS performs patient testing and provides blood components for patients undergoing therapeutic apheresis procedures. This article will provide an overview of blood component descriptions, patient testing, and blood component options and preparations for therapeutic apheresis procedures. © 2012 Wiley Periodicals, Inc.

21 CFR 868.5640 - Medicinal nonventilatory nebulizer (atomizer).

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medicinal nonventilatory nebulizer (atomizer). 868... SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5640 Medicinal nonventilatory nebulizer (atomizer). (a) Identification. A medicinal nonventilatory nebulizer (atomizer) is a...

American Internal Medicine in the 21st Century

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Huddle, Thomas S; Centor, Robert; Heudebert, Gustavo R

2003-01-01

American internal medicine suffers a confusion of identity as we enter the 21st century. The subspecialties prosper, although unevenly, and retain varying degrees of connection to their internal medicine roots. General internal medicine, identified with primary care since the 1970s, retains an affinity for its traditional consultant-generalist ideal even as primary care further displaces that ideal. We discuss the origins and importance of the consultant-generalist ideal of internal medicine as exemplified by Osler, and its continued appeal in spite of the predominant role played by clinical science and accompanying subspecialism in determining the academic leadership of American internal medicine since the 1920s. Organizing departmental clinical work along subspecialty lines diminished the importance of the consultant-generalist ideal in academic departments of medicine after 1950. General internists, when they joined the divisions of general internal medicine that appeared in departments of medicine in the 1970s, could sometimes emulate Osler in practicing a general medicine of complexity, but often found themselves in a more limited role doing primary care. As we enter the 21st century, managed care threatens what remains of the Oslerian ideal, both in departments of medicine and in clinical practice. Twenty-first century American internists will have to adjust their conditions of work should they continue to aspire to practice Oslerian internal medicine. PMID:12950486

Management in general practice: the challenge of the new General Medical Services contract.

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Checkland, Kath

2004-10-01

Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these. To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract. In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract. Three general practices in England, chosen using purposeful sampling. Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance. The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the

Hospitalist workload influences faculty evaluations by internal medicine clerkship students

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Robinson RL

2015-02-01

Full Text Available Robert L Robinson Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA Background: The last decade has brought significant changes to internal medicine clerkships through resident work-hour restrictions and the widespread adoption of hospitalists as medical educators. These key medical educators face competing demands for quality teaching and clinical service intensity. Objective: The study reported here was conducted to explore the relationship between clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students. Design: A retrospective correlation analysis of clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students during the 2009 to 2013 academic years at Southern Illinois University School of Medicine was conducted. Participants: Internal medicine hospitalists who supervise the third-year inpatient experience for medical students during the 2009 to 2013 academic years participated in the study. Measures: Clinical service intensity data in terms of work relative value units (RVUs, patient encounters, and days of inpatient duty were collected for all members of the hospitalist service. Medical students rated hospitalists in the areas of patient rapport, enthusiasm about the profession, clinical skills, sharing knowledge and skills, encouraging the students, probing student knowledge, stimulating independent learning, providing timely feedback, providing constructive criticism, and observing patient encounters with students. Results: Significant negative correlations between higher work RVU production, total patient encounters, duty days, and learner evaluation scores for enthusiasm about the profession, clinical skills, probing the student for knowledge and judgment, and observing a patient encounter with the student were identified. Higher duty days had a significant negative correlation

Quick-Reaction Report on the Audit of ReCoupment Actions on Medicine Payments to Uniformed Services Treatment Facilities.

Science.gov (United States)

1993-07-21

OFFICE OF THE INSPECTOR GENERAL QUICK-REACTION REPORT ON THE AUDIT OF RECOUPMENT ACTIONS ON MEDICARE PAYMENTS TO UNIFORMED SERVICES TREATMENT...Quick-Reaction Report on the Audit of Recoupment Actions on Medicare Payments to Uniformed Services Treatment Facilities (Report No. 93-150) We are...Inspectors General will provide a joint report to the congressional committees that requested the audit . The courtesies extended to the audit staff

Radiation physics in medicine and veterinary medicine studies

International Nuclear Information System (INIS)

Popovic, D.; Djuric, G.

2000-01-01

Medical and veterinary medicine staff and specialists represent an important decision making group in national administration and institutions dealing with radiation protection and environmental protection matters in general. Still, their education in physics, especially in radiation physics is fragmentary and loose, both from technical and theoretical point of view. Within medicine and veterinary medicine studies as well as within other biomedical sciences (biology, pharmacology, biotechnology) radiation physics is usually incorporated in the first year curricula as a part of general physics or biophysics course. Some segments of radiation physics mainly as a technical base for different instrumentation methods and techniques could be also found within different graduate and post-graduate courses of radiology, physical therapy, radiation hygiene, environmental protection, etc. But the traditional approach in presenting the matter and inflexibility of the educational system strongly confront the growing public concern for the environmental problems dealing with radiation and demands for better informing and technical education for those involved in informing and administration. This paper considers some of these problems presenting a new approach in education in radiation physics for medical and veterinary medicine students based on education through student projects and work in the field, as well as on the strong collaboration among administration, universities and professional societies on the national and international level. (author)

[Patient-centered medicine for tuberculosis medical services].

Science.gov (United States)

Fujita, Akira; Narita, Tomoyo

2012-12-01

The 2011 edition of Specific Guiding Principles for Tuberculosis Prevention calls for a streamlined medical services system capable of providing medical care that is customized to the patient's needs. The new 21st Century Japanese version of the Directly Observed Treatment Short Course (DOTS) expands the indication of DOTS to all tuberculosis (TB) patients in need of treatment. Hospital DOTS consists of comprehensive, patient-centered support provided by a DOTS care team. For DOTS in the field, health care providers should select optimal administration support based on patient profiles and local circumstances. In accordance with medical fee revisions for 2012, basic inpatient fees have been raised and new standards for TB hospitals have been established, the result of efforts made by the Japanese Society for Tuberculosis and other associated groups. It is important that the medical care system be improved so that patients can actively engage themselves as a member of the team, for the ultimate goal of practicing patient-centered medicine. We have organized this symposium to explore the best ways for practicing patient-centered medicine in treating TB. It is our sincere hope that this symposium will lead to improved medical treatment for TB patients. 1. Providing patient-centered TB service via utilization of collaborative care pathway: Akiko MATSUOKA (Hiroshima Prefectural Tobu Public Health Center) We have been using two types of collaborative care pathway as one of the means of providing patient-centered TB services since 2008. The first is the clinical pathway, which is mainly used by TB specialist doctors to communicate with local practitioners on future treatment plan (e.g. medication and treatment duration) of patients. The clinical pathway was first piloted in Onomichi district and its use was later expanded to the whole of Hiroshima prefecture. The second is the regional care pathway, which is used to share treatment progress, test results and other

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

The Willingness-to-Pay for General Practitioners in Contractual Service and Influencing Factors among Empty Nesters in Chongqing, China.

Science.gov (United States)

Chen, Fei; Xu, Xiang-Long; Yang, Zhan; Tan, Hua-Wei; Zhang, Liang

2015-08-10

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. 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. 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. The willingness-to-pay for general practitioners by contractual service is high among city empty nesters in Chongqing, thus, individual financing is feasible. However

The Willingness-to-Pay for General Practitioners in Contractual Service and Influencing Factors among Empty Nesters in Chongqing, China

Directory of Open Access Journals (Sweden)

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

Genetic gatekeepers: regulating direct-to-consumer genomic services in an era of participatory medicine.

Science.gov (United States)

Palmer, Jessica Elizabeth

2012-01-01

Should consumers be able to obtain information about their own bodies, even if it has no proven medical value? Direct-to-consumer ("DTC") genomic companies offer consumers two services: generation of the consumer's personal genetic sequence, and interpretation of that sequence in light of current research. Concerned that consumers will misunderstand genomic information and make ill-advised health decisions, regulators, legislators and scholars have advocated restricted access to DTC genomic services. The Food and Drug Administration, which has historically refrained from regulating most genetic tests, has announced its intent to treat DTC genomic services as medical devices because they make "medical claims." This Article argues that FDA regulation of genomic services as medical devices would be counterproductive. Clinical laboratories conducting genetic tests are already overseen by a federal regime administered by the Centers for Medicare and Medicaid Services. While consumers and clinicians would benefit from clearer communication of test results and their health implications, FDA's gatekeeping framework is ill-suited to weigh the safety and efficacy of genomic information that is not medically actionable in traditional ways. Playing gatekeeper would burden FDA's resources, conflict with the patient-empowering policies promoted by personalized medicine initiatives, impair individuals' access to information in which they have powerful autonomy interests, weaken novel participatory research infrastructures, and set a poor precedent for the future regulation of medical information. Rather than applying its risk-based regulatory framework to genetic information, FDA should ameliorate regulatory uncertainty by working with the Federal Trade Commission and Centers for Medicare and Medicaid Services to ensure that DTC genomic services deliver analytically valid data, market and implement their services in a truthful manner, and fully disclose the limitations of their

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)

Ethical Issues Surrounding Personalized Medicine: A Literature Review.

Science.gov (United States)

Salari, Pooneh; Larijani, Bagher

2017-03-01

More than a decade ago, personalized medicine was presented in modern medicine. Personalized medicine means that the right drug should be prescribed for the right patient based on genetic data. No doubt is developing medical sciences, and its shift into personalized medicine complicates ethical challenges more than before. In this review, we categorized all probable ethical considerations of personalized medicine in research and development and service provision. Based on our review, extensive changes in healthcare system including ethical changes are needed to overcome the ethical obstacles including knowledge gap and informed consent, privacy and confidentiality and availability of healthcare services. Furthermore social benefit versus science development and individual benefit should be balanced. Therefore guidelines and regulations should be compiled to represent the ethical framework; also ethical decision making should be day-to-day and individualized.

Inspector General, DOD, Oversight of the Naval Audit Service Audit of the Navy General Fund Financial Statements for FY 1998

National Research Council Canada - National Science Library

1999-01-01

.... The audit objective was to determine the accuracy and completeness of the Naval Audit Service audit of the Navy General Fund Financial Statements for Fiscal Year 1998. See Appendix A for a discussion of the audit Process.

Solid radioactive waste: evaluation of residual activity in nuclear medicine services

International Nuclear Information System (INIS)

Alabarse, Frederico G.; Xavier, Ana M.; Magalhaes, Maisa H.; Guerrero, Jesus S.P.

2009-01-01

An experimental programme to estimate, with a better degree of accuracy, the activity that remains adsorbed in flasks and syringes used in Nuclear Medicine Services for the administration of radionuclides to patients submitted to diagnostic or therapy is been conducted under the coordination of the Radioactive Waste Division of the Brazilian Nuclear Energy Commission, CNEN. The adopted recommendation in Brazil to allow an expedite solid waste management in nuclear medicine facilities, up to the present, is to consider that 2% of the initial activity remains adsorbed in the solid waste, which easily allows the calculation of the storage time to achieve regulatory clearance levels by decay. This research evaluates 17 different kinds of radiopharmaceuticals and three radioisotopes: 99m Tc, 67 Ga and 201 Tl. Results obtained by means of a weighting method to estimate the residual mass in flasks show that the ratio of the mass of the liquid that remains in the solid waste to the mass of the empty flask is constant. This suggests that the residual activity depends on the initial activity concentration of radiopharmaceutical contained in each flask, as assumed by the regulatory body. Additionally, results obtained by determining the remaining activity in flasks, shortly after the injection of its radionuclide contents in patients, indicate that an average value for the residual activity of the order of 10% of the initial activity contained in the flasks or syringes should be adopted to determine the decay storage time before the release of solid waste in the urban conventional land fill disposal system. The 'rule of thumb' of 10 half-lives for storage before clearance is also discussed in the present work. (author)

Causes of prolonged hospitalization among general internal medicine patients of a tertiary care center.

Science.gov (United States)

Ruangkriengsin, Darat; Phisalprapa, Pochamana

2014-03-01

Unnecessary days of prolonged hospitalization may lead to the increase in hospital-related complications and costs, especially in tertiary care center Currently, there have not been many studies about the causes of prolonged hospitalization. Some identified causes could, however, be prevented and improved. To identify the prevalence, causes, predictive factors, prognosis, and economic burden of prolonged hospitalization in patients who had been in general internal medicine wards of the tertiary care center for 7 days or more. Retrospective chart review study was conducted among all patients who were admitted for 7 days or more in general internal medicine wards of Siriraj Hospital, the largest tertiary care center in Thailand. The period of this study was from 1 August 2012 to 30 September 2012. Demographic data, principle diagnosis, comorbid diseases, complications, discharge status, total costs of admission and percentage of reimbursement were collected. The causes of prolonged hospitalization at day 7, 14, 30, and 90 were assessed. Five hundred and sixty-two charts were reviewed. The average length of stay was 25.9 days. The two most common causes of prolonged admission at day 7 were treatment of main diagnosed disease with stable condition (27.6%) and waiting for completion of intravenous antibiotics administration with stable condition (19.5%). The causes of prolonged hospitalization at day 14 were unstable condition from complications (22.6%) and those waiting for completion of intravenous antibiotics administration with stable condition (15.8%). The causes of prolonged admission at day 30 were unstable conditions from complications (25.6%), difficulty weaning or ventilator dependence (17.6%), and caregiver problems (15.2%). The causes of prolonged hospitalization at day 90 were unstable condition from complications (30.0%), caregiver problems (30.0%), and palliative care (25.0%). Poor outcomes were shown in the patients admitted more than 90 days. Percentage

Out of the Universities, into the Fields: New Community Service for Medicine Students in the Autonomous University of Mexico (1934-1940

Directory of Open Access Journals (Sweden)

Ivonne Meza Huacuja

2014-10-01

Full Text Available The creation of a community service for Medicine students can be understood as an important part of Cardenas' social policies seeking to expand basic services throughout the country. It also represents a struggle to strengthen the power of the president and of the National Revolutionary Party (PNR, specially regarding a group distinguished since the beginning of the Revolution for its conservatism: the University of Mexico students. This work goes through the history of how this medical community service was created and organized, including documents such as students' reports and results obtained by these young doctors in factories, mines, and rural areas.

Hospital structure and technical efficiency in the production of nuclear medicine. Doctoral thesis

International Nuclear Information System (INIS)

Wilson, G.W.

1976-01-01

The relationship of hospital structure to production efficiency is explored. The hospital subindustry on which this research centers is nuclear medicine. The hypotheses generated were that technical efficiency is reduced by increased competitive intensity, by a lack of profit incentive, by a broader service range, and by in-house training of technical personnel. Most data employed in the study were gathered from the American College of Radiology and the Energy Research and Development Administration Census of Nuclear Medicine. More specific information came from questionnaires sent to 2,050 short-term general hospitals known to have a nuclear medicine facility. Of the responses 1,362 were usable for the study. A major study finding was that over half of the variations observed in technical efficiency were attributable to the structural elements being studied. The research indicated that competition for staff physicians has a role in reducing technical efficiency; that the output effect of in-house manpower training was relatively unimportant; and that profit incentives do have a significant impact. It is suggested that increased technical efficiency could be achieved through reduced competitive intensity, stronger profit orientation, and reduced service range. A bibliography is included

Episodes of care: is emergency medicine ready?

Science.gov (United States)

Wiler, Jennifer L; Beck, Dennis; Asplin, Brent R; Granovsky, Michael; Moorhead, John; Pilgrim, Randy; Schuur, Jeremiah D

2012-05-01

Optimizing resource use, eliminating waste, aligning provider incentives, reducing overall costs, and coordinating the delivery of quality care while improving outcomes have been major themes of health care reform initiatives. Recent legislation contains several provisions designed to move away from the current fee-for-service payment mechanism toward a model that reimburses providers for caring for a population of patients over time while shifting more financial risk to providers. In this article, we review current approaches to episode of care development and reimbursement. We describe the challenges of incorporating emergency medicine into the episode of care approach and the uncertain influence this delivery model will have on emergency medicine care, including quality outcomes. We discuss the limitations of the episode of care payment model for emergency services and advocate retention of the current fee-for-service payment model, as well as identify research gaps that, if addressed, could be used to inform future policy decisions of emergency medicine health policy leaders. We then describe a meaningful role for emergency medicine in an episode of care setting. Copyright © 2011. Published by Mosby, Inc.

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.

A general equilibrium model of ecosystem services in a river basin

Science.gov (United States)

Travis Warziniack

2014-01-01

This study builds a general equilibrium model of ecosystem services, with sectors of the economy competing for use of the environment. The model recognizes that production processes in the real world require a combination of natural and human inputs, and understanding the value of these inputs and their competing uses is necessary when considering policies of resource...

Alternative Medicine and the Ethics Of Commerce.

Science.gov (United States)

Macdonald, Chris; Gavura, Scott

2016-02-01

Is it ethical to market complementary and alternative medicines? Complementary and alternative medicines (CAM) are medical products and services outside the mainstream of medical practice. But they are not just medicines (or supposed medicines) offered and provided for the prevention and treatment of illness. They are also products and services - things offered for sale in the marketplace. Most discussion of the ethics of CAM has focused on bioethical issues - issues having to do with therapeutic value, and the relationship between patients and those purveyors of CAM. This article aims instead to consider CAM from the perspective of commercial ethics. That is, we consider the ethics not of prescribing or administering CAM (activities most closely associated with health professionals) but the ethics of selling CAM. © 2016 John Wiley & Sons Ltd.

Evaluation of radiochemistry purity and p H of radiopharmaceuticals in nuclear medicine services at Pernambuco, Brazil

International Nuclear Information System (INIS)

Andrade, Wellington; Lima, Fabiana Farias de; Santos, Poliane A.L.; Lima, Fernando Roberto de Andrade; Lima, Fabiana Farias de

2011-01-01

Radiopharmaceuticals are cellular or molecular structures that have a radionuclide in its composition and they are used for diagnosing or treating diseases. The evaluation of the radiochemical purity of radiopharmaceuticals is essential to produce images with artifacts free, as well as avoid unnecessary absorbed dose to the patient. Since they are administered in humans is important and necessary that they undergo rigorous quality control. Due to this fact, the norm in ANVISA RDC 38/2008 declaring the mandatory completion of a minimum of tests in routine nuclear medicine services before human administration. (author)

Effect of an evidence-based answering service on GPs and their patients : a pilot study

NARCIS (Netherlands)

Verhoeven, A.A.; Schuling, J.

2004-01-01

OBJECTIVES: For general practitioners (GPs), an important obstacle to practising evidence-based medicine is lack of time. An evidence-based answering service was developed that took over searching and appraisal of medical evidence from the GPs. GPs sent in questions, and the informationist

Ethical quandaries in spiritual healing and herbal medicine: a critical analysis of the morality of traditional medicine advertising in southern African urban societies.

Science.gov (United States)

Munyaradzi, Mawere

2011-01-01

This paper critically examines the morality of advertising by practitioners in spiritual healing and herbal medicine heretofore referred to as traditional medicine, in southern African urban societies. While the subject of traditional medicine has been heavily contested in medical studies in the last few decades, the monumental studies on the subject have emphasised the place of traditional medicine in basic health services. Insignificant attention has been devoted to examine the ethical problems associated with traditional medicine advertising. Critical look at the worthiness of some advertising strategies used by practitioners in traditional medicine in launching their products and services on market thus has been largely ignored. Yet, though advertising is key to helping traditional medicine practitioners' products and services known by prospective customers, this research registers a number of morally negative effects that seem to outweigh the merits that the activity brings to prospective customers. The paper adopts southern African urban societies, and in particular Mozambique, South Africa and Zimbabwe as particular references. The choice of the trio is not accidental, but based on the fact that these countries have in the last few decades been flooded with traditional medicine practitioners/traditional healers from within the continent and from abroad. Most of these practitioners use immoral advertising strategies in communicating to the public the products and services they offer. It is against this background that this paper examines the morality of advertising strategies deployed by practitioners in launching their products and services. To examine the moral worthiness of the advertising strategies used by traditional medical practitioners, I used qualitative analysis of street adverts as well as electronic and print media. From the results obtained through thematic content analysis, the paper concludes that most of the practitioners in traditional

Indicators related to the rational use of medicines and its associated factors

Science.gov (United States)

Lima, Marina Guimarães; Álvares, Juliana; Guerra, Augusto Afonso; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Leite, Silvana Nair; Karnikowski, Margô Gomes de Oliveira; Costa, Karen Sarmento; Acurcio, Francisco de Assis

2017-01-01

ABSTRACT OBJECTIVE To evaluate indicators related to the rational use of medicines and its associated factors in Basic Health Units. METHOD This is a cross-sectional study carried out in a representative sample of Brazilian cities included in the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). The data were collected by interviews with users, medicine dispensing professionals, and prescribers; and described by prescription, dispensing, and health services indicators. We analyzed the association between human resources characteristics of pharmaceutical services and dispensing indicators. RESULTS At national level, the average number of medicines prescribed was 2.4. Among the users, 5.8% had antibiotic prescription, 74.8% received guidance on how to use the medicines at the pharmacy and, for 45.1% of users, all prescribed medicines were from the national list of essential medicines. All the indicators presented statistically significant differences between the regions of Brazil. The dispensing professionals that reported the presence of a pharmacist in the unit with a working load of 40 hours or more per week presented 1.82 more chance of transmitting information on the way of using the medicines in the dispensing process. CONCLUSION The analysis of prescription, dispensing, and health services indicators in the basic health units showed an unsatisfactory proportion of essential medicines prescription and limitations in the correct identification of the medicine, orientation to the patients on medicines, and availability of therapeutic protocols in the health services. PMID:29160461

Invisible thread: pre-service success indicators among Marine general officers

OpenAIRE

Munoz, Valerie; Common, Joseph; Lue, Kendra

2017-01-01

Approved for public release; distribution is unlimited The purpose of this study is to identify commonalities that may exist among general officers within the Unites States Marine Corps. This exploratory analysis focuses on pre-service indicators of success and assesses the existence of any competitive advantages. The data used in this analysis includes pre- and post-accession information obtained from the United States Marine Corps' Total Force Data Warehouse (TFDW), as well as semi-struc...

General sale of non-prescription medicinal products

DEFF Research Database (Denmark)

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

2016-01-01

BACKGROUND: The number of non-prescription medicines (NPMs) available for self-medication is increasing within the European Union (EU). This can enhance the autonomy of individuals but is also connected with risks. Under an existing EU Directive, Sweden has only recently deregulated and made NPMs...... market. There is a difference in the balance between confidence and control, as well as availability and safety when it comes to NPMs in non-pharmacy settings that needs to be further discussed....

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.

Characterization of the selection of medicines for the Brazilian primary health care

Directory of Open Access Journals (Sweden)

Margô Gomes de Oliveira Karnikowski

2017-11-01

Full Text Available ABSTRACT OBJECTIVE To characterize the process of selection of medicines for primary health care in the Brazilian regions. METHODS This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015, a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS (n = 506, professionals responsible for the dispensing of medicines (n = 1,139, and physicians (n = 1,558. To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05. RESULTS The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC (12.5%. They claimed to have an updated (80.4% list of Essential Medicines (85.3% and being active participants of this process (88.2%. However, in the perception of respondents, the list only partially (70.1% meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%, the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%. For 13.0% of them, the list meets the health demands. CONCLUSIONS As this is the first national survey of

Ethical Issues Surrounding Personalized Medicine: A Literature Review

Directory of Open Access Journals (Sweden)

Pooneh Salari

2017-03-01

Full Text Available More than a decade ago, personalized medicine was presented in modern medicine. Personalized medicine means that the right drug should be prescribed for the right patient based on genetic data. No doubt is developing medical sciences, and its shift into personalized medicine complicates ethical challenges more than before. In this review, we categorized all probable ethical considerations of personalized medicine in research and development and service provision. Based on our review, extensive changes in healthcare system including ethical changes are needed to overcome the ethical obstacles including knowledge gap and informed consent, privacy and confidentiality and availability of healthcare services. Furthermore social benefit versus science development and individual benefit should be balanced. Therefore guidelines and regulations should be compiled to represent the ethical framework; also ethical decision making should be day-to-day and individualized.

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

Science.gov (United States)

2010-10-01

... offered. (1) There must be a director who is a doctor of medicine or osteopathy qualified in nuclear... accordance with acceptable standards of practice. (1) In-house preparation of radiopharmaceuticals is by, or under, the direct supervision of an appropriately trained registered pharmacist or a doctor of medicine...

Customer satisfaction in medical service encounters -- a comparison between obstetrics and gynecology patients and general medical patients.

Science.gov (United States)

Chang, Ching-Sheng; Weng, Hui-Ching; Chang, Hsin-Hsin; Hsu, Tsuen-Ho

2006-03-01

This study is concerned with the "service encounter", and seeks to describe, by use of the Service Encounter Evaluation Model, how the processes involved in the service encounter affect customer satisfaction. Its findings have implications for management practice and research directions, and recommendations are made. With the implementation of a national health insurance scheme, an ever-prospering economy and continually improving educational levels in Taiwan, demand among citizens for good health and medical care is ever increasing. Obstetrics and gynecology patients often differ greatly from general patients, in terms of their moods and emotions. This research involved an empirical study, whose subjects were 590 customers of general clinics and 339 customers of gynecology clinics, in various medical centers in southern Taiwan. By factor analysis, the study established four influencing factors, which were "Medical professionals", "Nursing professionals", "Service personnel" and "Space and facilities". Using the Linear Structural Relation Model (LISREL), it found that medical professionals, nursing professionals, service personnel and space and facilities were effective predictors of medical treatment satisfaction. We also found that the greatest positive impact on overall medical treatment satisfaction resulted from rises in satisfaction with medical professionals, but that the least impact was achieved in relation to service personnel in the general and gynecology clinics.

Counterfeit medicines in Peru: a retrospective review (1997-2014).

Science.gov (United States)

Medina, Edwin; Bel, Elvira; Suñé, Josep María

2016-04-04

To consolidate and assess information on counterfeit medicines subject to pharmaceutical alerts issued by the Peruvian Medicines Regulatory Authority over 18 years (1997-2014) of health monitoring and enforcement. A retrospective review of drug alerts. A search of the website of the General Directorate of Medicines, Supplies and Drugs (DIGEMID) of the Ministry of Health of Peru for drug alerts issued between 1997 and 2014. Drug alerts related to counterfeit medicines. A total of 669 DIGEMID alerts were issued during the study period, 354 (52.91%) of which cover 1738 cases of counterfeit medicines (many alerts deal with several cases at a time). 1010 cases (58.11%) involved pharmaceutical establishments and 349 (20.08%) involved non-pharmaceutical commercial outlets. In 126 cases (7.25%), counterfeit medicines were seized in an unauthorised trade (without any marketing authorisation); in 253 cases (14.56%) the type of establishment or business associated with the seized product was not identified. Counterfeit medicines are a serious public health problem in Peru. A review of the data cannot determine whether counterfeit medicines in Peru increased during the study period, or if monitoring by different government health agencies highlighted the magnitude of the problem by providing more evidence. The problem is clearly structural, since the majority of cases (58.11% of the total) were detected in legitimate supply chains. Most counterfeit medicines involve staple pharmaceutical products and common dosage forms. Considerable work remains to be done to control the serious problem of counterfeit medicines in Peru. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The Present Status of Nuclear Medicine in Korea

International Nuclear Information System (INIS)

Lee, Mun Ho

1968-01-01

It is my privilege to give you a brief history on the status of nuclear medicine in Korea. There is nothing much to mention, as the history of the peaceful use of atomic energy is rather short and the RI facilities are limited in the number. It is my sincere hope, however, that you may understand what steps nuclear medicine in the developing countries did take and how it has been developed, seeing the present status of nuclear medicine in Korea, as one of the models. In our country, the peaceful use of atomic energy was actualized since the Law of Atomic Energy had been enacted in March 1959, and the Office of Atomic Energy and the Atomic Energy Research Institute had been established. The Korea Society of Nuclear Medicine was organized in 1961, which i think is one of the older in the Far East area. The Society now held about 170 members and the annual meetings in addition to the quarterly meeting have been held. The 6th general scientific meeting for 1967 is scheduled to be held in 25 November. The society publishes the Korean Journal of Nuclear Medicine twice a year, and the second issue appeared Oct. 1967. The instruments used in nuclear medicine are mostly expensive, therefore, the hospitals equipped with such instruments are inevitably limited in number and the after-service or repair of such instruments are technically not easy. Some of these difficulties, i hope, shall be overcome in the near future.

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.

[General survey and protection of intangible cultural heritage in traditional medicine in Zhejiang Province].

Science.gov (United States)

Zhu, D M

2017-07-28

From January 2003 to October 2008, the Zhejiang Provincial Department of Culture, together with the Intangible Cultural Heritage Management Department of 11 cities and counties, including Hangzhou, Ningbo, Wenzhou, Huzhou, Jiaxing, Shaoxing, Jinhua, Quzhou, Zhoushan, Taizhou, Lishui, surveyed the Province's intangible cultural heritage in traditional medicine, with a total of 7849 items, including 7 kinds of traditional medicine in 8 major categories: living Chinese medicine culture, ethnic medicine, acu-moxibustion, osteopathic therapy, unique therapies, and Chinese crude drugs, herbal medicine and traditional Chinese medicine preparation, TCM processing.Among them, 9 items have been included in the Representative Project List of National Traditional Medicine Intangible Cultural Heritage, 18 items were listed in Representative Project Directory of Zhejiang Traditional Medicine Intangible Cultural Heritage.Theprotection and inheritance of traditional of the intangible heritage of traditional medicine in Zhejiang province are mainly through the 4 batches of master guidance apprentices.In addition, protection is carried out through organizational support, literature systematization and other measures.

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.

The role of traditional healers in the provision of health care and family planning services: Sinseh.

Science.gov (United States)

Kuek, K; Liow, T S

1985-01-01

The Chinese traditional medical system and pharmacology have a 1000-year history, and practitioners of Chinese traditional medicine play an important role in providing health care and family planning services in China. Vast numbers of patients from all walks of life and of all races benefit from Chinese traditional medicine. Although there are no official government records on the activities of practitioners of traditional medicine, the Chinese charitable medical organizations have some data on the nature of available services and their use. In China, in the context of significant government investment in health care facilities throughout the country and the proliferation of private hospitals, specialist centers, and general practitioners providing modern health care, the number of Chinese traditional charity medical aid departments, instead of falling by the wayside, has increased. The Chinese Traditional Medicine and Physician and Medicine Dealers Association of Malaysia was established 27 years ago. There are now officially 719 Chinese physicians and 1869 medical halls and Chinese physician infirmaries in Malaysia. The authors describe the status of Chinese physicians and medical halls in Malaysia, charitable organizations, and applications of Chinese traditional medicine.

Research projects in family medicine funded by the European Union.

Science.gov (United States)

Pavličević, Ivančica; Barać, Lana

2014-01-01

This study aimed at synthesizing funding opportunities in the field of family medicine by determining the number of family medicine projects, as well as number of project leaderships and/ or participations by each country. This was done in order to encourage inclusion of physicians in countries with underdeveloped research networks in successful research networks or to encourage them to form new ones. We searched the Community Research and Development Information Service project database in February 2013. Study covered the period from years 1992 - 2012, selecting the projects within the field of general/family medicine. The search was conducted in February 2013. First search conducted in the CORDIS database came up with a total of 466 projects. After excluding 241 projects with insufficient data, we analysed 225 remaining projects; out of those, 22 (9.8%) were in the field of family medicine and 203 (90.2%) were from other fields of medicine. Sorted by the number of projects per country, Dutch institutions had the highest involvement in family medicine projects and were partners or coordinators in 18 out of 22 selected projects (81.8%), followed by British institutions with 15 (68.8%), and Spanish with 10 projects (45.5%). Croatia was a partner in a single FP7 Health project. Research projects in family medicine funded by the European Union show significant differences between countries. Constant and high-quality international cooperation in family medicine is the prerequisite for improvement and development of scientific research and the profession. Copyright © 2014 by Academy of Sciences and Arts of Bosnia and Herzegovina.

Patients' willingness to pay for cognitive pharmacist services in community pharmacies.

Science.gov (United States)

Lakić, Dragana; Stević, Ivana; Odalović, Marina; Vezmar-Kovačević, Sandra; Tadić, Ivana

2017-10-31

To determine the general population willingness to pay for cognitive pharmacist service in community pharmacy, describe the behavior of participants regarding health care issues, and evaluate correlation between participants' sociodemographic characteristics or attitudes and their willingness to pay. A questionnaire-based survey was conducted among general population visiting community pharmacies. The participants were asked about receiving cognitive pharmacist services to identify and resolve potential medication therapy problems after the initiation of a new medicine to optimize health outcomes of the patients. A univariate and multivariate analysis were used to analyze associations between different variables and willingness to pay for pharmacy service. Of 444 respondents, 167 (38%) reported that they were willing to pay for a medication management service provided in the community pharmacy. Univariate analysis showed significant association between the willingness to pay for pharmacist-provided service and respondents' socio-demographic factors, health-related characteristics, and behavior, dilemmas, or need for certain pharmacist-provided service. The logistic regression model was statistically significant (χ2=4.599, Ppay for cognitive pharmacist services, which has not been fully recognized within the health care system. In future, pharmacists should focus on practical implementation of the service and models of funding.

Performance evaluation of the activity meters of the Brazilian Nuclear Medicine Services in the country during 16 years

International Nuclear Information System (INIS)

Toledo, B.C. de; Oliveira, A.E. de; Iwahara, A.; Tauhata, L.; Delgado, J.U.

2017-01-01

Measurements of radionuclide activity are a very intense routine in the Nuclear Medicine Services (NMS) of Brazil. In order to guarantee the quality of these measurements, the Institute of Radioprotection and Dosimetry (IRD) has developed an activity measurement comparison program aiming at the improvement of these services. The evaluation methodology was the criterion of accuracy of the CNEN NN 3.05 standard. The reference value was established by the National Laboratory of Ionizing Radiation Metrology (LNMR) of the IRD, RJ, Brazil. The results showed that 77% of the NMS reached a performance within the range of acceptance, whereas values obtained for the activity in the activity meters with Geiger-Müller (GM) type detectors, presented insufficient performance, supporting the prohibition of these calibrators

Comparison of Sasang Constitutional Medicine, Traditional Chinese Medicine and Ayurveda

Science.gov (United States)

Kim, Jong Yeol; Pham, Duong Duc; Koh, Byung Hee

2011-01-01

Sasang constitutional medicine (SCM), traditional Chinese medicine (TCM) and Ayurveda are three different forms of Asian traditional medicine. Although these traditions share a lot in common as holistic medicines, the different philosophical foundations found in each confer distinguishing attributes and unique qualities. SCM is based on a constitution-based approach, and is in this way relatively more similar to the Ayurvedic tradition than to the TCM, although many of the basic SCM theories were originally derived from TCM, a syndrome-based medicine. SCM and TCM use the same botanical materials that are distributed mainly in the East Asian region, but the basic principles of usage and the underlying rationale are completely different from each other. Meanwhile, the principles of the Ayurvedic use of botanical resources are very similar to those seen in SCM, but the medicinal herbs used in Ayurveda generally originate from the West Asian region which displays a different spectrum of flora. PMID:21949669

Comparison of Sasang Constitutional Medicine, Traditional Chinese Medicine and Ayurveda

Directory of Open Access Journals (Sweden)

Jong Yeol Kim

2011-01-01

Full Text Available Sasang constitutional medicine (SCM, traditional Chinese medicine (TCM and Ayurveda are three different forms of Asian traditional medicine. Although these traditions share a lot in common as holistic medicines, the different philosophical foundations found in each confer distinguishing attributes and unique qualities. SCM is based on a constitution-based approach, and is in this way relatively more similar to the Ayurvedic tradition than to the TCM, although many of the basic SCM theories were originally derived from TCM, a syndrome-based medicine. SCM and TCM use the same botanical materials that are distributed mainly in the East Asian region, but the basic principles of usage and the underlying rationale are completely different from each other. Meanwhile, the principles of the Ayurvedic use of botanical resources are very similar to those seen in SCM, but the medicinal herbs used in Ayurveda generally originate from the West Asian region which displays a different spectrum of flora.

75 FR 69686 - Advisory Committee on Training in Primary Care Medicine and Dentistry

Science.gov (United States)

2010-11-15

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Advisory Committee on Training in Primary Care Medicine and Dentistry AGENCY: Health Resources and Services... of the Advisory Committee on Training in Primary Care Medicine and Dentistry, November 15, 2010, 8:30...

Inequalities in utilisation of general practitioner and specialist services in 9 European countries

Directory of Open Access Journals (Sweden)

Mielck Andreas

2011-10-01

Full Text Available Abstract Background The aim of this study is to describe the magnitude of educational inequalities in utilisation of general practitioner (GP and specialist services in 9 European countries. In addition to West European countries, we have included 3 Eastern European countries: Hungary, Estonia and Latvia. To cover the gap in knowledge we pay a special attention to the magnitude of inequalities among patients with chronic conditions. Methods Data on the use of GP and specialist services were derived from national health surveys of Belgium, Estonia, France, Germany, Hungary, Ireland, Latvia, the Netherlands and Norway. For each country and education level we calculated the absolute prevalence and relative inequalities in utilisation of GP and specialist services. In order to account for the need for care, the results were adjusted by the measure of self-assessed health. Results People with lower education used GP services equally often in most countries (except Belgium and Germany compared with those with a higher level of education. At the same time people with a higher education used specialist care services significantly more often in all countries, except in the Netherlands. The general pattern of educational inequalities in utilisation of specialist care was similar for both men and women. Inequalities in utilisation of specialist care were equally large in Eastern European and in Western European countries, except for Latvia where the inequalities were somewhat larger. Similarly, large inequalities were found in the utilisation of specialist care among patients with chronic diseases, diabetes, and hypertension. Conclusions We found large inequalities in the utilisation of specialist care. These inequalities were not compensated by utilisation of GP services. Of particular concern is the presence of inequalities among patients with a high need for specialist care, such as those with chronic diseases.

Inequalities in utilisation of general practitioner and specialist services in 9 European countries.

Science.gov (United States)

Stirbu, Irina; Kunst, Anton E; Mielck, Andreas; Mackenbach, Johan P

2011-10-31

The aim of this study is to describe the magnitude of educational inequalities in utilisation of general practitioner (GP) and specialist services in 9 European countries. In addition to West European countries, we have included 3 Eastern European countries: Hungary, Estonia and Latvia. To cover the gap in knowledge we pay a special attention to the magnitude of inequalities among patients with chronic conditions. Data on the use of GP and specialist services were derived from national health surveys of Belgium, Estonia, France, Germany, Hungary, Ireland, Latvia, the Netherlands and Norway. For each country and education level we calculated the absolute prevalence and relative inequalities in utilisation of GP and specialist services. In order to account for the need for care, the results were adjusted by the measure of self-assessed health. People with lower education used GP services equally often in most countries (except Belgium and Germany) compared with those with a higher level of education. At the same time people with a higher education used specialist care services significantly more often in all countries, except in the Netherlands. The general pattern of educational inequalities in utilisation of specialist care was similar for both men and women. Inequalities in utilisation of specialist care were equally large in Eastern European and in Western European countries, except for Latvia where the inequalities were somewhat larger. Similarly, large inequalities were found in the utilisation of specialist care among patients with chronic diseases, diabetes, and hypertension. We found large inequalities in the utilisation of specialist care. These inequalities were not compensated by utilisation of GP services. Of particular concern is the presence of inequalities among patients with a high need for specialist care, such as those with chronic diseases. © 2011 Stirbu et al; licensee BioMed Central Ltd.

Handbooks in radiology: Nuclear medicine

International Nuclear Information System (INIS)

Datz, F.L.

1988-01-01

This series of handbooks covers the basic facts, major concepts and highlights in seven radiological subspecialties. ''Nuclear Medicine'' is a review of the principles, procedures and clinical applications that every radiology resident and practicing general radiologist should know about nuclear medicine. Presented in an outline format it covers all of the organ systems that are imaged by nuclear medicine

Disparities in availability of essential medicines to treat non-communicable diseases in Uganda: A Poisson analysis using the Service Availability and Readiness Assessment.

Science.gov (United States)

Armstrong-Hough, Mari; Kishore, Sandeep P; Byakika, Sarah; Mutungi, Gerald; Nunez-Smith, Marcella; Schwartz, Jeremy I

2018-01-01

Although the WHO-developed Service Availability and Readiness Assessment (SARA) tool is a comprehensive and widely applied survey of health facility preparedness, SARA data have not previously been used to model predictors of readiness. We sought to demonstrate that SARA data can be used to model availability of essential medicines for treating non-communicable diseases (EM-NCD). We fit a Poisson regression model using 2013 SARA data from 196 Ugandan health facilities. The outcome was total number of different EM-NCD available. Basic amenities, equipment, region, health facility type, managing authority, NCD diagnostic capacity, and range of HIV services were tested as predictor variables. In multivariate models, we found significant associations between EM-NCD availability and region, managing authority, facility type, and range of HIV services. For-profit facilities' EM-NCD counts were 98% higher than public facilities (p < .001). General hospitals and referral health centers had 98% (p = .004) and 105% (p = .002) higher counts compared to primary health centers. Facilities in the North and East had significantly lower counts than those in the capital region (p = 0.015; p = 0.003). Offering HIV care was associated with 35% lower EM-NCD counts (p = 0.006). Offering HIV counseling and testing was associated with 57% higher counts (p = 0.048). We identified multiple within-country disparities in availability of EM-NCD in Uganda. Our findings can be used to identify gaps and guide distribution of limited resources. While the primary purpose of SARA is to assess and monitor health services readiness, we show that it can also be an important resource for answering complex research and policy questions requiring multivariate analysis.

Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety

Directory of Open Access Journals (Sweden)

Blum AB

2011-06-01

Full Text Available Alexander B Blum1, Sandra Shea2, Charles A Czeisler3,4, Christopher P Landrigan3-5, Lucian Leape61Department of Health and Evidence Policy, Mount Sinai School of Medicine, New York, NY, USA; 2Committee of Interns and Residents, SEIU Healthcare Division, Service Employees International Union, New York, NY, USA; 3Harvard Work Hours, Health and Safety Group, Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA; 4Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; 5Division of General Pediatrics, Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA; 6Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USAAbstract: Long working hours and sleep deprivation have been a facet of physician training in the US since the advent of the modern residency system. However, the scientific evidence linking fatigue with deficits in human performance, accidents and errors in industries from aeronautics to medicine, nuclear power, and transportation has mounted over the last 40 years. This evidence has also spawned regulations to help ensure public safety across safety-sensitive industries, with the notable exception of medicine.

Arizona TeleMedicine Network: Engineering Master Plan.

Science.gov (United States)

Atlantic Research Corp., Alexandria, VA.

As the planning document for establishing a statewide health communications system initially servicing the Papago, San Carlos and White Mountain Apache, Navajo, and Hopi reservations, this document prescribes the communications services to be provided by the Arizona TeleMedicine Network. Specifications include: (1) communications services for each…

Impact of Potential Accreditation and Certification in Family Medicine Maternity Care.

Science.gov (United States)

Eden, Aimee R; Peterson, Lars E

2017-01-01

Advanced maternity care training in family medicine is highly variable at both the residency and fellowship levels. Declining numbers of family physicians providing maternity care services may exacerbate disparities in access to maternal and child care, especially in rural and other underserved communities. Accreditation of maternity care fellowships and board certification may be one potential avenue to address this trend. This study sought to understand the perceptions and beliefs of key family medicine stakeholders in advanced maternity care regarding the formalization of maternity care training through fellowship accreditation and the creation of a certificate of added qualification (CAQ). In 2014 and 2015, the authors conducted semi-structured interviews with 51 key stakeholders in family medicine maternity care. Transcribed interviews were coded using an iterative process to identify themes and patterns until saturation was reached. Participants generally supported both maternity care fellowship accreditation and a CAQ and recognized multiple advantages such as legitimization of training. Many had concerns about potential negative unintended consequences such as a loss of curricular flexibility; however, most felt that these could be mediated. Only a few did not support one or both aspects of formalization. Most participants interviewed support formalizing maternity care fellowship training in family medicine through accreditation and a subsequent CAQ, if implemented with attention to minimizing the potential negative consequences. Such formalization would recognize the advanced skill and training of family physicians practicing advanced maternity care and could address some access issues to essential maternity care services for rural and other underserved populations.

The use of Skype in a community hospital inpatient palliative medicine consultation service.

Science.gov (United States)

Brecher, David B

2013-01-01

Skype™, an Internet-based communication tool, has enhanced communication under numerous circumstances. As telemedicine continues to be an increasing part of medical practice, there will be more opportunities to use Skype and similar tools. Numerous scenarios in the lay literature have helped to highlight the potential uses. Although most commonly used to enhance physician-to-patient communication, there has been limited reported use of Skype for patient-to-family communication, especially in end of life and palliative care. Our inpatient Palliative Medicine Consultation Service has offered and used this technology to enhance our patients' quality of life. The objective was to provide another tool for our patients to use to communicate with family and/or friends, especially under circumstances in which clinical symptoms, functional status, financial concerns, or geographic limitations preclude in-person face-to face communication.

Evaluation of internal occupational exposure of workers from nuclear medicine services by aerosol analysis containing 131I

International Nuclear Information System (INIS)

Carneiro, Luana Gomes; Sampaio, Camilla da Silva; Dantas, Ana Leticia Almeida; Lucena, Eder Augusto; Santos, Maristela Souza; Dantas, Bernardo Maranhao; Paula, Gustavo Affonso de

2014-01-01

This study evaluated the risk of internal occupational exposure associated with the incorporation of 131 I via inhalation, in Nuclear Medicine Services, using aerosol analysis techniques. Occupationally Exposed Individuals (IOE) involved in handling this radionuclide are subject to chronic exposure, which can lead to an increase in the committed effective dose. Results obtained in preliminary studies indicate the occurrence of incorporation of 131 I by workers involved in handling solutions for radioiodine therapy procedures. The evaluation was carried out in radiopharmacy lab (nuclear medicine service) of a public hospital located in the city of Rio de Janeiro. After confirmed the presence of the radioisotope, by a qualitative assessment, it was determined an experimental arrangement for sample collection and were detected and quantitated the presence of steam 131 I during routine work. The average concentration of activity obtained in this study was 3 Bq / m 3 . This value is below of Derived Concentration in Air (DCA) of 8.4 x 10 3 Bq of 131 I / m 3 corresponding to a committed effective dose of 1.76 x 10 -4 mSv. These results demonstrate that the studied area is safe in terms of internal exposure of workers. However, the presence of 131 I should be periodically reevaluated, since this type of exposure contributes to the increase of the individual effective doses. Based on the data obtained improvements were suggested in the exhaust system and the use of good work practices in order to optimize the exposures

Ethical quandaries in spiritual healing and herbal medicine: A critical analysis of the morality of traditional medicine advertising in southern African urban societies

Science.gov (United States)

Munyaradzi, Mawere

2011-01-01

This paper critically examines the morality of advertising by practitioners in spiritual healing and herbal medicine heretofore referred to as traditional medicine, in southern African urban societies. While the subject of traditional medicine has been heavily contested in medical studies in the last few decades, the monumental studies on the subject have emphasised the place of traditional medicine in basic health services. Insignificant attention has been devoted to examine the ethical problems associated with traditional medicine advertising. Critical look at the worthiness of some advertising strategies used by practitioners in traditional medicine in launching their products and services on market thus has been largely ignored. Yet, though advertising is key to helping traditional medicine practitioners’ products and services known by prospective customers, this research registers a number of morally negative effects that seem to outweigh the merits that the activity brings to prospective customers. The paper adopts southern African urban societies, and in particular Mozambique, South Africa and Zimbabwe as particular references. The choice of the trio is not accidental, but based on the fact that these countries have in the last few decades been flooded with traditional medicine practitioners/traditional healers from within the continent and from abroad. Most of these practitioners use immoral advertising strategies in communicating to the public the products and services they offer. It is against this background that this paper examines the morality of advertising strategies deployed by practitioners in launching their products and services. To examine the moral worthiness of the advertising strategies used by traditional medical practitioners, I used qualitative analysis of street adverts as well as electronic and print media. From the results obtained through thematic content analysis, the paper concludes that most of the practitioners in traditional

Role of laboratory medicine in collaborative healthcare.

Science.gov (United States)

Watson, Ian D; Wilkie, Patricia; Hannan, Amir; Beastall, Graham H

2018-04-09

Healthcare delivery and responsibility is changing. Patient-centered care is gaining international acceptance with the patient taking greater responsibility for his/her health and sharing decision making for the diagnosis and management of illness. Laboratory medicine must embrace this change and work in a tripartite collaboration with patients and with the clinicians who use clinical laboratory services. Improved communication is the key to participation, including the provision of educational information and support. Knowledge management should be targeted to each stakeholder group. As part of collaborative healthcare clinical laboratory service provision needs to be more flexible and available, with implications for managers who oversee the structure and governance of the service. Increased use of managed point of care testing will be essential. The curriculum content of laboratory medicine training programs will require trainees to undertake practice-based learning that facilitates interaction with patients, clinicians and managers. Continuing professional development for specialists in laboratory medicine should also embrace new sources of information and opportunities for collaborative healthcare.

Home medicines reviews following acute coronary syndrome: study protocol for a randomized controlled trial

Directory of Open Access Journals (Sweden)

Bernal Daniel DL

2012-04-01

Full Text Available Abstract Background Despite continual improvements in the management of acute coronary syndromes, adherence to guideline-based medications remains suboptimal. We aim to improve adherence with guideline-based therapy following acute coronary syndrome using an existing service that is provided by specifically trained pharmacists, called a Home Medicines Review. We have made two minor adjustments to target the focus of the existing service including an acute coronary syndrome specific referral letter and a training package for the pharmacists providing the service. Methods/Design We will be conducting a randomized controlled trial to compare the directed home medicines review service to usual care following acute coronary syndromes. All patients aged 18 to 80 years and with a working diagnosis of acute coronary syndrome, who are admitted to two public, acute care hospitals, will be screened for enrolment into the trial. Exclusion criteria will include: not being discharged home, documented cognitive decline, non-Medicare eligibility, and presence of a terminal malignancy. Randomization concealment and sequence generation will occur through a centrally-monitored computer program. Patients randomized to the control group will receive usual post-discharge care. Patients randomized to receive the intervention will be offered usual post-discharge care and a directed home medicines review at two months post-discharge. The study endpoints will be six and twelve months post-discharge. The primary outcome will be the proportion of patients who are adherent to a complete, guideline-based medication regimen. Secondary outcomes will include hospital readmission rates, length of hospital stays, changes in quality of life, smoking cessation rates, cardiac rehabilitation completion rates, and mortality. Discussion As the trial is closely based on an existing service, any improvements observed should be highly translatable into regular practice. Possible

Individual monitoring of internal exposure of 131I of workers from the nuclear medicine service FUESMEN, Argentina

International Nuclear Information System (INIS)

Arenas, G.; Acosta, N.; Venier, V.; Bedoya Toboo, C.

2013-01-01

It is presented the FUESMEN experience in routine monitoring of thyroid internal doses due to inhalation of 131 I in workers of the Nuclear Medicine Service in normal operation or accidental exposure. It is used a surface contamination monitor, type Geiger Mueller, calibrated with a acrylic phantom based on specifications of the simulator of thyroid of ICRU 48 with 131 I reference activity. Through the obtained measurements is achieved to validate the use of Portable Monitor to carry out preliminary exploration on the monitoring scenarios of incidental situations

Inequalities in utilisation of general practitioner and specialist services in 9 European countries

NARCIS (Netherlands)

Stirbu, I.; Kunst, A.E.; Mielck, A.; Mackenbach, J.P.

2011-01-01

ABSTRACT: BACKGROUND: The aim of this study is to describe the magnitude of educational inequalities in utilisation of general practitioner (GP) and specialist services in 9 European countries. In addition to West European countries, we have included 3 Eastern European countries: Hungary, Estonia

Psychopathology of adolescents with an intellectual disability who present to general hospital services.

Science.gov (United States)

Theodoratos, Oreste; McPherson, Lyn; Franklin, Catherine; Tonge, Bruce; Einfeld, Stewart; Lennox, Nicholas; Ware, Robert S

2017-10-01

Adolescents with intellectual disability have increased rates of psychopathology compared with their typically developing peers and present to hospital more frequently for ambulant conditions. The aim of this study is to describe the psychopathology and related characteristics of a sample of adolescents with intellectual disability who presented to general hospital services. We investigated a cohort of adolescents with intellectual disability in South East Queensland, Australia between January 2006 and June 2010. Demographic and clinical data were obtained via mailed questionnaires and from general practice notes. Psychopathology was measured with the Short Form of the Developmental Behaviour Checklist. Of 98 individuals presenting to hospital, 71 (72.5%) had significant levels of psychopathology. Unknown aetiology for the intellectual disability was associated with presence of problem behaviours. Adolescents with more severe intellectual disability were more likely to have major problem behaviours. Co-morbid physical health issues were not associated with psychopathology. Only 12 (12.1%) adolescents had undergone specialized mental health intervention. The general hospital environment may offer opportunities for liaison psychiatry services to screen and provide management expertise for adolescent individuals with intellectual disability presenting for physical health issues.

Hospitalist workload influences faculty evaluations by internal medicine clerkship students.

Science.gov (United States)

Robinson, Robert L

2015-01-01

The last decade has brought significant changes to internal medicine clerkships through resident work-hour restrictions and the widespread adoption of hospitalists as medical educators. These key medical educators face competing demands for quality teaching and clinical service intensity. The study reported here was conducted to explore the relationship between clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students. A retrospective correlation analysis of clinical service intensity and teaching evaluations of hospitalists by internal medicine clerkship students during the 2009 to 2013 academic years at Southern Illinois University School of Medicine was conducted. Internal medicine hospitalists who supervise the third-year inpatient experience for medical students during the 2009 to 2013 academic years participated in the study. Clinical service intensity data in terms of work relative value units (RVUs), patient encounters, and days of inpatient duty were collected for all members of the hospitalist service. Medical students rated hospitalists in the areas of patient rapport, enthusiasm about the profession, clinical skills, sharing knowledge and skills, encouraging the students, probing student knowledge, stimulating independent learning, providing timely feedback, providing constructive criticism, and observing patient encounters with students. Significant negative correlations between higher work RVU production, total patient encounters, duty days, and learner evaluation scores for enthusiasm about the profession, clinical skills, probing the student for knowledge and judgment, and observing a patient encounter with the student were identified. Higher duty days had a significant negative correlation with sharing knowledge/skills and encouraging student initiative. Higher work RVUs and total patient encounters were negatively correlated with timely feedback and constructive criticism. The results suggest that

The Effectiveness of the Community Medicine Undergraduate Program in Medical Schools on Enabling Medical Graduates to Work in the Health Systems

Directory of Open Access Journals (Sweden)

Hossein Jabbari Bayrami

2013-05-01

Full Text Available Introduction: The main mission of medical schools is to train competent medical trainees for providing primary health care services, management of health care team and improving the health status of the population. The aim of this study was to determine the effectiveness of the undergraduate program of community medicine department among the graduates as general (family physicians in health system of East Azerbaijan, North-West of` Iran. Methods: In this cross- sectional study all family physicians of East Azerbaijan province were included. A questionnaire on the views of graduates about the effectiveness of community medicine undergraduate program was used for gathering data. Data were analyzed by T-test, ANOVA, and Pearson correlation. Results: Performance of community medicine department in creating competency for providing effective health services among physicians was 2.13 and management competency was 1.96 out of 4. To teach the necessary skills to meet the professional needs in Primary Health Care (PHC, Tabriz Community Medicine Department was better compared to Azad and other medical schools (p<0.001. Conclusions: The results of the study showed that the community medicine program in undergraduate medical education was effective for future career of physicians in the health system. There is a need to revise the health management courses in community medicine program.

Consumers' views on generic medicines: a review of the literature.

Science.gov (United States)

Hassali, Mohamed A A; Shafie, Asrul A; Jamshed, Shazia; Ibrahim, Mohamed I M; Awaisu, Ahmed

2009-04-01

To review the literature on consumers' knowledge, attitudes and opinions of the use of generic medicines. A narrative review of studies conducted from 1970 to 2008 on consumers perceptions and views towards generic medicines was performed. An extensive literature search was undertaken using indexing services available at the authors' institution library. The following keywords were used for the search: brand, generic, multisource, medications, medicines, drugs, pharmaceuticals and consumers, customers, and patients. Electronic databases searched were Medline, Inside Web, ISI Web of Knowledge, Science Direct, Springer Link, JSTOR, Proquest, Ebsco Host and Google Scholar. These electronic databases were searched for full text papers published in English from 1970 to October 2008. Twenty studies were identified. Eleven were from the USA, four were from Europe, two were from Canada and one each was from Australia, Brazil and Malaysia. In general, consumers showed mixed reactions towards the use of generic medicines. This was evident from the divergence of views observed by country development level, consumers' socioeconomic characteristics, drug product characteristics, pharmaceutical reimbursement system, policy environment, contact with health care professionals, past experience with medications, and knowledge of the seriousness of a medical condition. Patient confidence and knowledge pertaining to generic medicines use have increased over the past four decades, especially in developed countries. Mass educational efforts, financial incentives, and greater communication among patients and health care professionals were seen as major drivers to the uptake of generic medicines among consumers.

41 CFR 102-118.420 - Can the Administrator of General Services waive the postpayment auditing provisions of this subpart?

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Can the Administrator of General Services waive the postpayment auditing provisions of this subpart? 102-118.420 Section 102-118... Transportation Audits § 102-118.420 Can the Administrator of General Services waive the postpayment auditing...

Impact of consumer copayments for subsidised medicines on health services use and outcomes: a protocol using linked administrative data from Western Australia.

Science.gov (United States)

Seaman, Karla L; Sanfilippo, Frank M; Roughead, Elizabeth E; Bulsara, Max K; Kemp-Casey, Anna; Bulsara, Caroline; Watts, Gerald F; Preen, David

2017-06-21

Across the world, health systems are adopting approaches to manage rising healthcare costs. One common strategy is a medication copayments scheme where consumers make a contribution (copayment) towards the cost of their dispensed medicines, with remaining costs subsidised by the health insurance service, which in Australia is the Federal Government.In Australia, copayments have tended to increase in proportion to inflation, but in January 2005, the copayment increased substantially more than inflation. Results from aggregated dispensing data showed that this increase led to a significant decrease in the use of several medicines. The aim of this study is to determine the demographic and clinical characteristics of individuals ceasing or reducing statin medication use following the January 2005 Pharmaceutical Benefit Scheme (PBS) copayment increase and the effects on their health outcomes. This whole-of-population study comprises a series of retrospective, observational investigations using linked administrative health data on a cohort of West Australians (WA) who had at least one statin dispensed between 1 May 2002 and 30 June 2010. Individual-level data on the use of pharmaceuticals, general practitioner (GP) visits, hospitalisations and death are used.This study will identify patients who were stable users of statin medication in 2004 with follow-up commencing from 2005 onwards. Subgroups determined by change in adherence levels of statin medication from 2004 to 2005 will be classified as continuation, reduction or cessation of statin therapy and explored for differences in health outcomes and health service utilisation after the 2005 copayment change. Ethics approvals have been obtained from the Western Australian Department of Health (#2007/33), University of Western Australia (RA/4/1/1775) and University of Notre Dame (0 14 167F). Outputs from the findings will be published in peer reviewed journals designed for a policy audience and presented at state

Office of Inspector General audit report on aircraft and air service management programs

Energy Technology Data Exchange (ETDEWEB)

NONE

1999-01-01

The Department of Energy`s (DOE) Albuquerque Operations Office (Albuquerque) owns seven aircraft that support defense programs, research and development efforts, emergency response programs, and official travel of Government and contractor employees. An Office of Inspector General (OIG) report, issued in 1994, identified concerns with Albuquerque`s cost for air service. Since that report, there have been reductions in cost and personnel indicating changes in air service requirements. This audit was conducted to determine (1) whether costs to operate Albuquerque`s aircraft were excessive and (2) if individual aircraft in the fleet were justified.

Professionalism, responsibility, and service in academic medicine.

Science.gov (United States)

Souba, W W

1996-01-01

Academic medical centers have responded to health care reform initiatives by launching a series of strategic plans designed to maintain patient flow and reduce hospital expenditures. Thought is also being given to processes by which the faculty can individually and collectively adjust to these changes and maintain morale at a time when reductions in the labor force and pay cuts are virtually certain. Physicians are concerned because managed care threatens their autonomy and jeopardizes the traditional ways in which they have carried out their multiple missions. Some doctors believe that it will become increasingly difficult to obtain genuine satisfaction from their job. The strategies that academic medical centers have begun to use to address the numerous challenges posed by a system of health care based on managed competition are reviewed. Potential mechanisms by which academic departments can continue to find fulfillment in an environment that threatens their traditional missions and values are discussed. A study of the social and historical origins of medicine in the United States reveals that the introduction of corporate medicine in the United States was destined to happen. Strategies implemented by academic medical centers in response to managed care include building an integrated delivery network, the acquisition of primary care practices, increasing cost-effectiveness, and creating physician-hospital organizations. Emphasis must be placed on integrating traditional core values (excellence, leadership, and innovation) with newer values such as patient focus, accountability, and diversity. A shift from rugged individualism to entrepreneurial teamwork is crucial. These reforms, although frightening at the onset, can serve to reaffirm our commitment to academic medicine and preserve our mission. The evolving managed care environment offers unique opportunities for academic medical centers to shape and positively impact health care delivery in the twenty

78 FR 57156 - General Services Administration Acquisition Regulation; Submission for OMB Review; Modifications...

Science.gov (United States)

2013-09-17

... GENERAL SERVICES ADMINISTRATION [OMB Control No. 3090-0302; Docket No. 2013-0001; Sequence 9... (GSAR) to add clause 552.243-81 Modifications (Federal Supply Schedule) and an Alternate I version of..., Modifications (Federal Supply Schedule). The alternate version of the clause implements and mandates electronic...

77 FR 58380 - General Services Administration Acquisition Regulation; Submission for OMB Review; Price...

Science.gov (United States)

2012-09-20

...] General Services Administration Acquisition Regulation; Submission for OMB Review; Price Reductions Clause... requirement regarding the GSAR Price Reductions Clause. A notice was published in the Federal Register at 76... identified by Information Collection 3090- 0235, Price Reduction Clause, by any of the following methods...

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

Science.gov (United States)

2012-10-01

... and Forms. This final rule is part of the General Services Administration Acquisition Manual (GSAM... the prescription for inclusion of the clause at 552.204-9, Personal Identity Verification Requirements... the ``National Industrial Security Program Operating Manual (NISPOM)'', and link to the web address...

77 FR 38848 - Library of Medicine Notice of Meeting

Science.gov (United States)

2012-06-29

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Library of Medicine Notice... National Library of Medicine will be closed to the public in accordance with the provisions set forth in... potential titles to be indexed by the National Library of Medicine, the discussions, and the presence of...

[French training program for medical students in transfusion medicine. Transfusion Medicine Teachers' College].

Science.gov (United States)

Wautier, J-L; Cabaud, J-J; Cazenave, J-P; Fialon, P; Fruchart, M-F; Joussemet, M; Leblond, V; Muller, J-Y; Rouger, P; Vignon, D; Waller, C; Lefrère, J-J; Worms, B; Vileyn, F

2005-02-01

In France, transfusion medicine training program has been updated. A national committee of professors in transfusion medicine propose a series of 13 items which represent the minimum knowledge that general practitioners should possess. This overview of transfusion medicine is far below the level that specialists should reach and they will need an additional specialized training. Several French universities have set up their own training program which is quite similar to the work of the committee of professors. The following recommendations are not strict guidelines but is a common basis which will be improved in 2005 according to new evidence based transfusion medicine.

Introduction to mathematical and informatics methods in Nuclear Medicine

International Nuclear Information System (INIS)

Martin, J.; Monot, C.; Legras, B.

1975-01-01

Mathematical and statistical methods are widely used in nuclear medicine because of the abundance and precision of the data obtained during morphological and dynamic explorations, and the number and complexity of the calculations involved has led to the use of informatics. Very elaborate techniques may be employed with the help of the computer. In spite of its cost it is closely associated with exploration techniques, especially in conjunction with the scintillation camera. To keep the machine in full-time use and ensure its profitability it is employed in other capacities, for an service management in particular. Each subject is dealt with from its fundamental aspect: nuclear medicine and biomathematics, statistics, informatics; compartment models in nuclear medicine (interpretation of dynamic examinations); quantitive image processing; special computer services (connections with apparatus, service and records management problems) [fr

The Future of Family Medicine: a collaborative project of the family medicine community.

Science.gov (United States)

Martin, James C; Avant, Robert F; Bowman, Marjorie A; Bucholtz, John R; Dickinson, John R; Evans, Kenneth L; Green, Larry A; Henley, Douglas E; Jones, Warren A; Matheny, Samuel C; Nevin, Janice E; Panther, Sandra L; Puffer, James C; Roberts, Richard G; Rodgers, Denise V; Sherwood, Roger A; Stange, Kurt C; Weber, Cynthia W

2004-01-01

Recognizing fundamental flaws in the fragmented US health care systems and the potential of an integrative, generalist approach, the leadership of 7 national family medicine organizations initiated the Future of Family Medicine (FFM) project in 2002. The goal of the project was to develop a strategy to transform and renew the discipline of family medicine to meet the needs of patients in a changing health care environment. A national research study was conducted by independent research firms. Interviews and focus groups identified key issues for diverse constituencies, including patients, payers, residents, students, family physicians, and other clinicians. Subsequently, interviews were conducted with nationally representative samples of 9 key constituencies. Based in part on these data, 5 task forces addressed key issues to meet the project goal. A Project Leadership Committee synthesized the task force reports into the report presented here. The project identified core values, a New Model of practice, and a process for development, research, education, partnership, and change with great potential to transform the ability of family medicine to improve the health and health care of the nation. The proposed New Model of practice has the following characteristics: a patient-centered team approach; elimination of barriers to access; advanced information systems, including an electronic health record; redesigned, more functional offices; a focus on quality and outcomes; and enhanced practice finance. A unified communications strategy will be developed to promote the New Model of family medicine to multiple audiences. The study concluded that the discipline needs to oversee the training of family physicians who are committed to excellence, steeped in the core values of the discipline, competent to provide family medicine's basket of services within the New Model, and capable of adapting to varying patient needs and changing care technologies. Family medicine education

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.

Investigating Knowledge and Attitude of Nursing Students Towards Iranian Traditional Medicine

Science.gov (United States)

Khorasgani, Sahar Rabani; Moghtadaie, Leila

2014-01-01

The present study aimed at Investigating the knowledge and attitude of Nursing Students towards Iranian Traditional Medicine in universities of Tehran in 2012-2013. 300 students of nursing studying at different universities in Tehran participated in this descriptive, cross-sectional study. The data was collected through a standard questionnaire with an acceptable validity and reliability. The questionnaire was made of five sections including demographic, general knowledge of the Iranian traditional medicine, general attitude towards it, resources of the Iranian traditional medicine and the barriers to it. The results revealed that general knowledge of the students about Iranian traditional medicine and complementary medicine is low. The attitude of the students towards including Iranian traditional medicine and complementary medicine in their curriculum is positive. General attitude of students towards Iranian traditional medicine is positive too. The majority of the participants had not passed any course on Iranian traditional medicine. There was no relationship between participants’ attitude towards Iranian traditional medicine and the number of semesters they had passed. Considering the participants’ positive attitude and their low level of knowledge, it seems necessary for the university policy makers to provide nursing students with different training courses on Iranian traditional medicine and complementary medicine in order to increase their knowledge. PMID:25363119

Acquisition Services Reorganization at the General Services Administration

National Research Council Canada - National Science Library

Smith, Stephanie

2005-01-01

Congress enacted the Federal Property and Administrative Services Act in 1949 to provide for an "economical and efficient system" for the Federal Government's management of real property, procurement...

General Practitioners' Attitudes Toward a Web-Based Mental Health Service for Adolescents: Implications for Service Design and Delivery.

Science.gov (United States)

Subotic-Kerry, Mirjana; King, Catherine; O'Moore, Kathleen; Achilles, Melinda; O'Dea, Bridianne

2018-03-23

Anxiety disorders and depression are prevalent among youth. General practitioners (GPs) are often the first point of professional contact for treating health problems in young people. A Web-based mental health service delivered in partnership with schools may facilitate increased access to psychological care among adolescents. However, for such a model to be implemented successfully, GPs' views need to be measured. This study aimed to examine the needs and attitudes of GPs toward a Web-based mental health service for adolescents, and to identify the factors that may affect the provision of this type of service and likelihood of integration. Findings will inform the content and overall service design. GPs were interviewed individually about the proposed Web-based service. Qualitative analysis of transcripts was performed using thematic coding. A short follow-up questionnaire was delivered to assess background characteristics, level of acceptability, and likelihood of integration of the Web-based mental health service. A total of 13 GPs participated in the interview and 11 completed a follow-up online questionnaire. Findings suggest strong support for the proposed Web-based mental health service. A wide range of factors were found to influence the likelihood of GPs integrating a Web-based service into their clinical practice. Coordinated collaboration with parents, students, school counselors, and other mental health care professionals were considered important by nearly all GPs. Confidence in Web-based care, noncompliance of adolescents and GPs, accessibility, privacy, and confidentiality were identified as potential barriers to adopting the proposed Web-based service. GPs were open to a proposed Web-based service for the monitoring and management of anxiety and depression in adolescents, provided that a collaborative approach to care is used, the feedback regarding the client is clear, and privacy and security provisions are assured. ©Mirjana Subotic

Inequalities in utilisation of general practitioner and specialist services in 9 European countries

NARCIS (Netherlands)

Stirbu, Irina; Kunst, Anton E.; Mielck, Andreas; Mackenbach, Johan P.

2011-01-01

The aim of this study is to describe the magnitude of educational inequalities in utilisation of general practitioner (GP) and specialist services in 9 European countries. In addition to West European countries, we have included 3 Eastern European countries: Hungary, Estonia and Latvia. To cover the

Use and Acceptance of Complementary and Alternative Medicine Among the General Population and Medical Personnel: A Systematic Review

Science.gov (United States)

Frass, Michael; Strassl, Robert Paul; Friehs, Helmut; Müllner, Michael; Kundi, Michael; Kaye, Alan D.

2012-01-01

Background The interest in complementary and alternative medicine (CAM) has increased during the past decade and the attitude of the general public is mainly positive, but the debate about the clinical effectiveness of these therapies remains controversial among many medical professionals. Methods We conducted a systematic search of the existing literature utilizing different databases, including PubMed/Medline, PSYNDEX, and PsycLit, to research the use and acceptance of CAM among the general population and medical personnel. A special focus on CAM-referring literature was set by limiting the PubMed search to “Complementary Medicine” and adding two other search engines: CAMbase (www.cambase.de) and CAMRESEARCH (www.camresearch.net). These engines were used to reveal publications that at the time of the review were not indexed in PubMed. Results A total of 16 papers met the scope criteria. Prevalence rates of CAM in each of the included studies were between 5% and 74.8%. We found a higher utilization of homeopathy and acupuncture in German-speaking countries. Excluding any form of spiritual prayer, the data demonstrate that chiropractic manipulation, herbal medicine, massage, and homeopathy were the therapies most commonly used by the general population. We identified sex, age, and education as predictors of CAM utilization: More users were women, middle aged, and more educated. The ailments most often associated with CAM utilization included back pain or pathology, depression, insomnia, severe headache or migraine, and stomach or intestinal illnesses. Medical students were the most critical toward CAM. Compared to students of other professions (ie, nursing students: 44.7%, pharmacy students: 18.2%), medical students reported the least consultation with a CAM practitioner (10%). Conclusions The present data demonstrate an increase of CAM usage from 1990 through 2006 in all countries investigated. We found geographical differences, as well as differences between

Interprofessional collaboration between general physicians and emergency department services in Belgium: a qualitative study

OpenAIRE

Karam, Marlène; Tricas, Sandra Maria; Darras, Elisabeth; Macq, Jean

2016-01-01

Introduction: The use of emergency department (ED) services has known a significant rise in the past decade. Organizational factors, such as the models of after-hours primary medical care services, and the shortage of general practitioners (GPs) could explain this phenomena. But also demographic and societal elements combined with the problem of patient’s ‘inappropriate visits to the ED. In order to ensure continuity of care for patients, collaboration between GPs and EDs becomes increasingly...

International VLBI Service for Geodesy and Astrometry: 2000 General Meeting Proceedings

Science.gov (United States)

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

2000-01-01

This volume is the proceedings of the first General Meeting of the International Very Long Base Interferometry (VLBI) Service for Geodesy and Astrometry (IVS), held in Koetzting, Germany, February 21-24, 2000. The content of this volume also appears on the IVS web site at: http://ivscc.gsfc.nasa.gov/publications/gm2000. The goal of the program committee for the General Meeting was to provide an interesting and informative program for a wide cross section of IVS members, including station operators, program managers, and analysts. The program included reports, tutorials, invited and contributed papers, and poster presentations. The tutorial papers should be particularly useful references because each one provides an overview and introduction to a topic relevant to VLBI.

78 FR 36555 - National Library of Medicine; Notice of Meetings

Science.gov (United States)

2013-06-18

... performance, and competence of individual investigators. Place: National Library of Medicine, Building 38, 2nd... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Library of Medicine... evaluation of individual intramural programs and projects conducted by the NATIONAL LIBRARY OF MEDICINE...

Provision of hormonal and long-acting reversible contraceptive services by general practices in Scotland, UK (2004-2009).

Science.gov (United States)

Reddy, Anusha; Watson, Margaret; Hannaford, Philip; Lefevre, Karen; Ayansina, Dolapo

2014-01-01

In the UK, a large proportion of contraceptive services are provided from general practice. However, little is known about which contraceptive services are provided and to whom. Descriptive serial cross-sectional study of women aged 12-55 years, registered with 191 general practices in Scotland, UK between 2004 and 2009. Annual incidence of provision of hormonal and long-acting reversible contraceptives (LARCs) increased from 27.7% in 2004 to 30.1% in 2009. Amongst those women registered with a general practice for the full 5-year period the provision of LARCs increased from 8.8% to 12.5% (pemergency hormonal contraception (EHC) decreased from 5.2% to 2.6% (pcontraceptives and LARCs from general practices. It is important that a full range of contraceptive options remains easily available to women.

General service and child immunization-specific readiness assessment of healthcare facilities in two selected divisions in Bangladesh.

Science.gov (United States)

Shawon, Md Shajedur Rahman; Adhikary, Gourab; Ali, Md Wazed; Shamsuzzaman, Md; Ahmed, Shahabuddin; Alam, Nurul; Shackelford, Katya A; Woldeab, Alexander; Lim, Stephen S; Levine, Aubrey; Gakidou, Emmanuela; Uddin, Md Jasim

2018-01-25

Service readiness of health facilities is an integral part of providing comprehensive quality healthcare to the community. Comprehensive assessment of general and service-specific (i.e. child immunization) readiness will help to identify the bottlenecks in healthcare service delivery and gaps in equitable service provision. Assessing healthcare facilities readiness also helps in optimal policymaking and resource allocation. A health facility survey was conducted between March 2015 and December 2015 in two purposively selected divisions in Bangladesh; i.e. Rajshahi division (high performing) and Sylhet division (low performing). A total of 123 health facilities were randomly selected from different levels of service, both public and private, with variation in sizes and patient loads from the list of facilities. Data on various aspects of healthcare facility were collected by interviewing key personnel. General service and child immunization specific service readiness were assessed using the Service Availability and Readiness Assessment (SARA) manual developed by World Health Organization (WHO). The analyses were stratified by division and level of healthcare facilities. The general service readiness index for pharmacies, community clinics, primary care facilities and higher care facilities were 40.6%, 60.5%, 59.8% and 69.5%, respectively in Rajshahi division and 44.3%, 57.8%, 57.5% and 73.4%, respectively in Sylhet division. Facilities at all levels had the highest scores for basic equipment (ranged between 51.7% and 93.7%) and the lowest scores for diagnostic capacity (ranged between 0.0% and 53.7%). Though facilities with vaccine storage capacity had very high levels of service readiness for child immunization, facilities without vaccine storage capacity lacked availability of many tracer items. Regarding readiness for newly introduced pneumococcal conjugate vaccine (PCV) and inactivated polio vaccine (IPV), most of the surveyed facilities reported lack of

Regulatory problems in nuclear medicine

International Nuclear Information System (INIS)

Vandergrift, J.F.

1987-01-01

Governmental involvement in the practice of medicine has increased sharply within the past few years. The impact on health care has, for the most part, been in terms of financial interactions between health care facilities and federally funded health services programs. One might say that this type of governmental involvement has indirect impact on the medical and/or technical decisions in the practice of nuclear medicine. In other areas, however, governmental policies and regulations have had a more direct and fundamental impact on nuclear medicine than on any other medical specialty. Without an understanding and acceptance of this situation, the practice of nuclear medicine can be very frustrating. This chapter is thus written in the hope that potential frustration can be reduced or eliminated

Nuclear radiation and its role in general nuclear medicine

International Nuclear Information System (INIS)

Kempaiah, A.; Ravi, C.

2012-01-01

Radiation is really nothing more than the emission of energy through space, as well as through physical objects. Nuclear radiations are emitted due to decay of nuclei of radioactive materials and damage cells and the DNA inside them through its ionizing effect. That causes melanoma and other cancers. Nuclear radiation has a number of beneficial uses especially in medical field with low levels of radioactive compounds, better than X-rays. There are some 440 nuclear reactors worldwide, people around will be under the effect of radiation. In nuclear medicine (medical imaging) small amount of radioactive materials were used to diagnose and determine the severity of or treat a variety of disease, including many types of cancers, heart disease, gastrointestinal, endocrine, neurological disorders and other abnormalities within the body it is painless and cost-effective techniques and provides information about both structure and function. Nuclear medicine diagnostic procedures called Gamma camera, single photon emission computed tomography (SPECT) and positron emission tomography (PET) were discussed in this paper. (author)

How and when to get rid of unused medicines

Science.gov (United States)

... location for disposal. Contact your local trash and recycling service to find out when the next event ... if: Someone consumes expired medicines accidentally or on purpose You have an allergic reaction to a medicine

Experiences of military CRNAs with service personnel who are emerging from general anesthesia.

Science.gov (United States)

Wilson, John Tyler; Pokorny, Marie E

2012-08-01

We conducted this qualitative study to understand the experiences of military Certified Registered Nurse Anesthetists (CRNAs) working with service personnel who have traumatic brain injury (TBI) and/or posttraumatic stress disorder (PTSD) and are emerging from general anesthesia. This study is important because there are no studies in the literature that describe the experiences of anesthetists working with patients with these specific problems. The leading questions were: "Out of all the anesthesia cases both abroad and stateside (post 9/11/2001), have you noticed service members wake from general anesthesia (not utilizing total intravenous anesthesia (TIVA), in a state of delirium? If so, can you tell me your experiences and thought processes as to why it was occurring?" Five themes emerged: (1) Emergence delirium (ED) exists and to a much higher degree in the military than in the general population. (2) ED was much more prevalent in the younger military population. (3) TIVA was a superior anesthetic for patients thought to have TBI and/or PTSD. (4) Talking to all patients suspected of having TBI and/or PTSD before surgery and on emergence was vital for a smooth emergence. (5) There is something profound happening in regard to ketamine and PTSD and TBI.

Analysis of Smartphone Interruptions on Academic General Internal Medicine Wards. Frequent Interruptions may cause a 'Crisis Mode' Work Climate.

Science.gov (United States)

Vaisman, Alon; Wu, Robert C

2017-01-04

Hospital-based medical services are increasingly utilizing team-based pagers and smartphones to streamline communications. However, an unintended consequence may be higher volumes of interruptions potentially leading to medical error. There is likely a level at which interruptions are excessive and cause a 'crisis mode' climate. We retrospectively collected phone, text messaging, and email interruptions directed to hospital-assigned smartphones on eight General Internal Medicine (GIM) teams at two tertiary care centres in Toronto, Ontario from April 2013 to September 2014. We also calculated the number of times these interruptions exceeded a pre-specified threshold per hour, termed 'crisis mode', defined as at least five interruptions in 30 minutes. We analyzed the correlation between interruptions and date, site, and patient volumes. A total of 187,049 interruptions were collected over an 18-month period. Daily weekday interruptions rose sharply in the morning, peaking between 11 AM to 12 PM and measuring 4.8 and 3.7 mean interruptions/hour at each site, respectively. Mean daily interruptions per team totaled 46.2 ± 3.6 at Site 1 and 39.2 ± 4.2 at Site 2. The 'crisis mode' threshold was exceeded, on average, 2.3 times/day per GIM team during weekdays. In a multivariable linear regression analysis, site (β6.43 CI95% 5.44 - 7.42, ptime.

Teaching emergency medicine with workshops improved medical student satisfaction in emergency medicine education

Directory of Open Access Journals (Sweden)

Sricharoen P

2015-02-01

Full Text Available Pungkava Sricharoen,1 Chaiyaporn Yuksen,1 Yuwares Sittichanbuncha,1 Kittisak Sawanyawisuth2,3 1Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 3The Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH, Khon Kaen University, Khon Kaen, Thailand Background: There are different teaching methods; such as traditional lectures, bedside teaching, and workshops for clinical medical clerkships. Each method has advantages and disadvantages in different situations. Emergency Medicine (EM focuses on emergency medical conditions and deals with several emergency procedures. This study aimed to compare traditional teaching methods with teaching methods involving workshops in the EM setting for medical students. Methods: Fifth year medical students (academic year of 2010 at Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand participated in the study. Half of students received traditional teaching, including lectures and bedside teaching, while the other half received traditional teaching plus three workshops, namely, airway workshop, trauma workshop, and emergency medical services workshop. Student evaluations at the end of the clerkship were recorded. The evaluation form included overall satisfaction, satisfaction in overall teaching methods, and satisfaction in each teaching method. Results: During the academic year 2010, there were 189 students who attended the EM rotation. Of those, 77 students (40.74% were in the traditional EM curriculum, while 112 students were in the new EM curriculum. The average satisfaction score in teaching method of the new EM curriculum group was higher than the traditional EM curriculum group (4.54 versus 4.07, P-value <0.001. The top three highest average satisfaction scores in the new EM curriculum group were trauma

Ethics in the marketing of medical services.

Science.gov (United States)

Latham, Stephen R

2004-09-01

This paper deals with the ethics of marketing medical services by physicians, medical groups, hospitals and other mainstream medical caregivers in the United States. It does not deal with pharmaceutical marketing, since that raises a number of special issues, some of them legal and some having to do with the unique culture of pharmaceutical marketing, which really ought to be dealt with separately. Nor does it touch on the little-explored field of marketing alternative and complementary medicine. It begins with a general description of what is included in "the marketing process." It then briefly tours some of the difficulties faced by those who would market medical services ethically, and ends with some comments on the relevance of professionalism to ethical marketing.

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.

[Exploration of microcosmic Chinese medicine used by western medicine].

Science.gov (United States)

Zheng, Zhi-jing

2015-02-01

"Microcosmic syndrome", "treatment based on syndrome differentiation", and "combination of disease identification and syndrome differentiation" generally refer to a mode: following the syndrome if with no disease identified, following the disease if with no syndrome type differentiated. For example, Chinese medical treatment of hypertension, high blood lipids, increased transaminase, and so on candirectly use Chinese recipes, but no longer with syndrome differentiation. Clinical application of Chinese patent medicine can also obtain favorable clinical. Western doctors need not follow syndrome differentiation. The invention of artemisinin was screened from more than 40 000 kinds of compounds and herbs, but with no reference of any traditional Chinese medical theory. A lot of folk remedy and empirical recipes have obtained effective efficacy but unnecessarily with profound Chinese medical theories. Various evidences showed that disease can also be cured without syndrome differentiation. I held that it might be associated with the same mechanism of Chinese medicine and Western medicine. Any disease can be cured or alleviated by Chinese medicine is a result from its modern pharmacological effect, which is achieved by improving etiologies, and pathogeneses. I was inspired by whether we can directly use traditional Chinese medicine with modern pharmacological effects to treat symptomatic disease. So I raised an idea of microcosmic Chinese medicine used by Western medicine, i.e., we find and use Chinese herbs with relatively effective modern pharmacological effect to treat diseases targeting at patients' clinical symptoms and signs, as well as various positive laboratory results (collectively called as microscopic dialectical indicators). More Western doctors would use it to treat disease due to omission of complicated and mysterious syndrome differentiation. This will promote extensive application and expansion of Chi- nese medicine and pharmacy, enlarge the team of

[Ambulance in emergency medicine].

Science.gov (United States)

Aksoy, Fikret; Ergun, Alper

2002-07-01

The ambulance service is very important in emergency medicine. The aim of this study was to investigate the new governing statuate of private ambulance service and to propose some new ideas. We examinated the new governing statuate of private ambulance service, rules of patient transporte between the hospitals and reports written by SSK Goztepe Educational Hospital ambulance drivers. We concluded that SSK Goztepe Educational Hospital ambulance drivers have a iot of problems especially at the rules of patient transport between the hospitals and there are some defiencies at the new governing statuate of private ambulance service. We concluded that it is necesssary to manage all the ambulance services in one center; all the private ambulance services have to have a specialist and all these must be determinated by the special rules. Key words: Regulation ofprivate ambulance, emergency head maintanence, ambulance services