Insanity and Cinema: Keys to understand a complicated affair

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Beatriz Vera Poseck

2008-10-01

Full Text Available Psychopathology and mental disturbances have always been prevalent in cinema because they add an element of drama and mystery. Films portraying mentally disturbed characters like Dr. Dippy´s Sanitarium (1906 or Das Kabinett des Dr. Caligari (1919 by Robert Wiener were released only a short time after the Lumière brothers had invented the cinematographer. Since then, there are a large number of films whose plot and intrigue are based on insanity and its manifestations. The list grows steadily every year.             This article is a review of some of the mental disturbances that have been portrayed in films. Its main purpose is to establish sensible choices and mistakes that have been committed while attempting to address the bottomless world of madness.

Grounded Theory in Medical Education Research.

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Tavakol, Mohsen; Torabi, Sima; Akbar Zeinaloo, Ali

2006-12-01

The grounded theory method provides a systematic way to generate theoretical constructs or concepts that illuminate psychosocial processes common to individual who have a similar experience of the phenomenon under investigation. There has been an increase in the number of published research reports that use the grounded theory method. However, there has been less medical education research, which is based on the grounded theory tradition. The purpose of this paper is to introduce basic tenants of qualitative research paradigm with specific reference to ground theory. The paper aims to encourage readers to think how they might possibly use the grounded theory method in medical education research and to apply such a method to their own areas of interest. The important features of a grounded theory as well as its implications for medical education research are explored. Data collection and analysis are also discussed. It seems to be reasonable to incorporate knowledge of this kind in medical education research.

Medical jurisprudence in the local context.

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Rajah, K S

1987-04-01

Medical jurisprudence in the local context would require the examination of a wide area. This paper focuses on liability producing conduct arising from the providing of medical services, other than liability for criminal negligent conduct. It examines the circumstances in which the physician-patient relationship emerges, in medical jurisprudence as against practice by medical practitioners. Tort law is the dominant legal theory, and reference is made to some intentional and miscellaneous torts. Implied contracts creating the relationship are touched upon, besides the reference to vicarious liability. Insanity and diminished responsibility in the criminal law, particularly the issue of whether the status quo is satisfactory and reliance on medical reports for purposes of treatment under drug laws are examined. Where abortion is performed, the question whether the husband has any right to prevent his wife from having a lawful abortion is discussed in the local context. Some thoughts on the medical (therapy, education and research) Act 1972 are expressed in relation to the living body, the corpse and the parts of the human body. The patient's right to determination and information in the light of the above legislation is also discussed.

Transformation of a metaphor: semantic shift in a Cantonese term 'Chi Sin' denoting insanity.

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Ng, J Y W; Chen, E Y H

2015-03-01

The historical evolution of the existing terms used to describe insanity may be able to shed light on the formation of stigma towards psychosis patients. In Hong Kong, a widely used Cantonese term for insanity 'Chi Sin' provides a unique example because of its neutral original sense, as it literally means misconnection in a network circuit. We attempt to trace the origin and subsequent evolution of the term 'Chi Sin' from its early use to the present day to understand how local Hong Kong people have attached increasingly negative connotations to this scientific term since the mid-20th century. We sampled as many newspapers and magazines published in Hong Kong from 1939 to June 2014 as possible, and sampled 7 popular local movies from the 1950s and 1960s. We also searched all the newspapers published in Hong Kong, Macau, Taiwan, and Mainland China from January 1998 to June 2014, and searched several other local historical resources. In one early use of 'Chi Sin' in 1939, the term was only used in a technical sense to describe 'short circuiting'. We found that the development of the telephone system, the Strowger system, in Hong Kong is closely related to the evolution of the semantics of the term 'Chi Sin'. The original meaning of short circuitry of the term 'Chi Sin' is no longer used, and it has become a dead metaphor through repeated use with negative emotional connotations. This illustrates some of the factors facilitating the emergence of a metaphor with subsequent semantic drift.

'Insane emigrants' in transit: Psychiatric patients' files as a source for the history of return migration, c. 1910

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Blok, G.

2015-01-01

This article highlights a source that can contribute to the history of migration and mental health: the case records of Eastern European emigrants who tried to enter America at the beginning of the twentieth century, but were refused entrance because of their alleged insanity. Some of these

"Idiots, infants, and the insane": mental illness and legal incompetence

OpenAIRE

Szasz, T

2005-01-01

Prior to the second world war, most persons confined in insane asylums were regarded as legally incompetent and had guardians appointed for them. Today, most persons confined in mental hospitals (or treated involuntarily, committed to outpatient treatment) are, in law, competent; nevertheless, in fact, they are treated as if they were incompetent. Should the goal of mental health policy be providing better psychiatric services to more and more people, or the reduction and ultimate elimination...

"Too stubborn to ever be governed by enforced insanity": Some therapeutic jurisprudence dilemmas in the representation of criminal defendants in incompetency and insanity cases.

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Perlin, Michael L

2010-01-01

Little attention has been paid to the importance of the relationship between therapeutic jurisprudence (TJ) and the role of criminal defense lawyers in insanity and incompetency-to-stand-trial (IST) cases. That inattention is especially noteworthy in light of the dismal track record of counsel providing services to defendants who are part of this cohort of incompetency-status-raisers and insanity-defense-pleaders. On one hand, this lack of attention is a surprise as TJ scholars have, in recent years, turned their attention to virtually every other aspect of the legal system. On the other hand, it is not a surprise, given the omnipresence of sanism, an irrational prejudice of the same quality and character of other irrational prejudices that cause (and are reflected in) prevailing social attitudes of racism, sexism, homophobia, and ethnic bigotry, that infects both our jurisprudence and our lawyering practices. Sanism is largely invisible and largely socially acceptable, and is based predominantly upon stereotype, myth, superstition, and deindividualization. It is sustained and perpetuated by our use of alleged "ordinary common sense" (OCS) and heuristic reasoning in an unconscious response to events both in everyday life and in the legal process. This paper examines the literature that seeks to apply TJ principles to the criminal law process in general, drawing mostly on the work of Professor David Wexler. It considers why the lack of attention that I have referred to already is surprising (given TJ's mandate and the fact that many TJ issues are inevitably raised in any insanity or IST case). The paper then considers why this lack of attention is not surprising, given the omnipresence of sanism. It will consider some of the actual counseling issues that might arise in these contexts, and offer some suggestions to lawyers representing clients in cases in which mental status issues may be raised. The paper concludes that we must rigorously apply therapeutic

The Epileptic Genius: The Use of Dostoevsky as Example in the Medical Debate over the Pathology of Genius.

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Dahlkvist, Tobias

2015-10-01

This paper examines how Fyodor Dostoevsky was used as an example in the debate over genius as a pathological phenomenon in nineteenth century medicine and criminal anthropology. When Dostoevsky's novels became known in Western Europe medical interest in the relation between genius and insanity reached its pinnacle. A known epileptic, Dostoevsky was exceptionally well suited to illustrate Cesare Lombroso's theory of genius as an epileptoid psychosis. Dostoevsky was also claimed as an example by the rivalling Lyon school, whose representatives argued that Dostoevsky's life and works demonstrate that genius is a higher form of health rather than a pathological deviation.

Coverage of Rosenhan's "On Being Sane in Insane Places" in Abnormal Psychology Textbooks

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Bartels, Jared M.; Peters, Daniel

2017-01-01

The present study examined 12 abnormal psychology textbooks to determine whether Rosenhan's classic study, "Being sane in insane places," was covered, and if so, the nature of that coverage. Only 50% covered the study, with all describing the study as demonstrating the biasing power of psychiatric labels. Two key aspects of the study…

Mental Insanity Assessment of Pedophilia: The Importance of the Trans-Disciplinary Approach. Reflections on Two Cases

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Cristina Scarpazza

2018-05-01

Full Text Available A 60 plus-year-old male was charged with pedophilia for forcing a child to touch him inappropriately near a primary school fence. In another case, a 70 plus-year-old male was charged with pedophilia for intimately touching a boy in a cinema. What led them to manifest this socially-inappropriate and legally-relevant behavior? Is there an explanation for the sexually-related behavioral changes emerging late in life of these two men? Indeed, a common point exists between the two men: both were found to suffer from highly-disabling neurological conditions, known to have a potential effect on social behavior. Specifically, a large right frontoparietal meningioma was found to have important influence on the first man's cognition and control inhibition, whereas frontotemporal dementia prevented the second man from understanding the moral disvalue of his sexually-inappropriate behavior and controlling his sexual impulses. In the current presentation, particular emphasis is placed on the logical reasoning supporting the conclusions that both the pedophiles should be considered not guilty by reason of insanity. Furthermore, experimental methods have been used to explore both cases, which rely on the existence of cognitive models for the phenomena under study, the integration of insights offered by different disciplines and the application of a variety of tools and approaches that follow the “convergence of evidence” principle, which could be safely used in court to support a mental insanity claim. Here, we describe how the use of the experimental method could become useful to reduce the uncertainty in mental insanity assessments. The use of a transdisciplinary, scientifically-grounded approach can help to change the way legal phenomena are interpreted. For instance, when assessing mental insanity, consultants should not only investigate the eventual existence of a diagnosis, but should assess the cognitive/affective abilities that are necessary to

"Idiots, infants, and the insane": mental illness and legal incompetence.

Science.gov (United States)

Szasz, T

2005-02-01

Prior to the second world war, most persons confined in insane asylums were regarded as legally incompetent and had guardians appointed for them. Today, most persons confined in mental hospitals (or treated involuntarily, committed to outpatient treatment) are, in law, competent; nevertheless, in fact, they are treated as if they were incompetent. Should the goal of mental health policy be providing better psychiatric services to more and more people, or the reduction and ultimate elimination of the number of persons in the population treated as mentally ill?

Making sense of grounded theory in medical education.

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Kennedy, Tara J T; Lingard, Lorelei A

2006-02-01

Grounded theory is a research methodology designed to develop, through collection and analysis of data that is primarily (but not exclusively) qualitative, a well-integrated set of concepts that provide a theoretical explanation of a social phenomenon. This paper aims to provide an introduction to key features of grounded theory methodology within the context of medical education research. In this paper we include a discussion of the origins of grounded theory, a description of key methodological processes, a comment on pitfalls encountered commonly in the application of grounded theory research, and a summary of the strengths of grounded theory methodology with illustrations from the medical education domain. The significant strengths of grounded theory that have resulted in its enduring prominence in qualitative research include its clearly articulated analytical process and its emphasis on the generation of pragmatic theory that is grounded in the data of experience. When applied properly and thoughtfully, grounded theory can address research questions of significant relevance to the domain of medical education.

Medical ethics research between theory and practice.

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ten Have, H A; Lelie, A

1998-06-01

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illness of contemporary medical ethics focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us.

Theory-based practice in a major medical centre.

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Alligood, Martha Raile

2011-11-01

This project was designed to improve care quality and nursing staff satisfaction. Nursing theory structures thought and action as demonstrated by evidence of improvement in complex health-care settings. Nursing administrators selected Modelling and Role-Modelling (MRM) for the theory-based practice goal in their strategic plan. An action research approach structured implementation of MRM in a 1-year consultation project in 2001-2002. Quality of health care improved according to national quality assessment ratings, as well as patient satisfaction and nurse satisfaction. Modelling and Role-Modelling demonstrated capacity to structure nursing thought and action in patient care in a major medical centre. Uniformity of patient care language was valued by nurses as well as by allied health providers who wished to learn the holistic MRM style of practice. The processes of MRM and action research contributed to project success. A positive health-care change project was carried out in a large medical centre with action research. Introducing MRM theory-based practice was a beneficial decision by nursing administration that improved care and nurse satisfaction. Attention to nursing practice stimulated career development among the nurses to pursue bachelors, masters, and doctoral degrees. © 2011 Blackwell Publishing Ltd.

Toward a social capital theory of competitive advantage in medical groups.

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Hoelscher, Mark L; Hoffman, James J; Dawley, David

2005-01-01

Social capital can have a positive impact on medical group performance. We forward our theory based on the integration of theories in social capital, resource advantage, and the resource-based view of the firm. Further, we suggest specific ways in which medical groups can increase their levels of social capital. First, medical groups should design or redesign the workplace so that there is ample interaction among employees. Second, employee participation within the community should be encouraged. Third, medical groups should recognize that social capital becomes ingrained in organizational culture. Therefore, medical groups should take steps to ensure a culture that supports its social capital. Fourth, hiring procedures should be designed (or redesigned) to ensure that new employees add social capital to the organization. Finally, trust must be fostered at the employee level.

Avoiding evasion: medical ethics education and emotion theory.

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Leget, C

2004-10-01

Beginning with an exemplary case study, this paper diagnoses and analyses some important strategies of evasion and factors of hindrance that are met in the teaching of medical ethics to undergraduate medical students. Some of these inhibitions are inherent to ethical theories; others are connected with the nature of medicine or cultural trends. It is argued that in order to avoid an attitude of evasion in medical ethics teaching, a philosophical theory of emotions is needed that is able to clarify on a conceptual level the ethical importance of emotions. An approach is proposed with the help of the emotion theory Martha Nussbaum works out in her book Upheavals of thought. The paper ends with some practical recommendations.

Therapeutic landscapes and postcolonial theory: a theoretical approach to medical tourism.

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Buzinde, Christine N; Yarnal, Careen

2012-03-01

This paper draws on two conceptual frameworks, therapeutic landscapes and postcolonial theory, to discuss aspects of medical tourism not addressed in extant literature. Building on the intersection between postcolonial and therapeutic landscapes scholarship, it highlights inequalities related to the production of national therapeutic landscapes located in postcolonial regions as well as their discursive (re)positioning as medical tourism destinations. As a framework, therapeutic landscapes can facilitate an understanding of medical tourism sites as curative spaces which combine modern and alternative forms of medicine with travel and leisure. Postcolonial theory critiques the economic, moral and cultural tensions emerging from the intersection between corporations that provide cheaper and more attractive medical services, and the nations on the periphery struggling to offer high medical standards that may not be accessible to their own local populations. In an effort to enhance scholarship on medical tourism, these conceptual frameworks are offered as points of departure, rather than sites of arrival, through which critical dialog on medical tourism can be sustained and broadened. Copyright © 2012 Elsevier Ltd. All rights reserved.

Grounded Theory in Medical Education Research

OpenAIRE

Tavakol, Mohsen; Torabi, Sima; Akbar Zeinaloo, Ali

2009-01-01

The grounded theory method provides a systematic way to generate theoretical constructs or concepts that illuminate psychosocial processes common to individual who have a similar expe­rience of the phenomenon under investigation. There has been an increase in the number of pub­lished research reports that use the grounded theory method. However, there has been less medical education research, which is based on the grounded theory tradition. The purpose of this paper is to introduce basic tena...

Evaluating conditional release in not guilty by reason of insanity acquittees: a prospective follow-up study in Virginia.

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Vitacco, Michael J; Vauter, Rebecca; Erickson, Steven K; Ragatz, Laurie

2014-08-01

Detailed research on treatment and risk management approaches with not guilty by reason of insanity acquittees (NGRI) during their conditional release is needed as states increasingly use community-based services for these individuals. Grounded in case law, and supported by follow-up studies demonstrating low recidivism rates, states have been encouraged in their efforts to conditionally release NGRI acquittees. The authors evaluated a state-wide sample of 127 NGRI acquittees released into the community after spending a mean of 61.63 months (SD = 76.54) in the hospital. One hundred individuals were committed to the hospital for lengthier treatment (M hospital time = 77.23 months, SD = 79.84), but 27 individuals were released to the community after a relatively short hospital stay (M hospital time = 5.60 months, SD = 3.01). Regarding release, 96 individuals (75.6%) maintained their conditional release. After evaluating a host of demographic and standardized risk data, the following variables predicted revocation on conditional release: previous failure on conditional release, nonadherence with hospital treatment, dangerousness to others, and previous violent charges. A multivariate survival analysis determined criminal behavior and previous failure on conditional release predicted time to revocation. The results of this study demonstrate the importance of considering standardized risk variables in the community-based management of forensic patients. In addition, the data are supportive of continued attempts at moving insanity acquittees from the hospital to the community via conditional release.

A Social Accountable Model for Medical Education System in Iran: A Grounded-Theory

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Mohammadreza Abdolmaleki

2017-10-01

Full Text Available Social accountability has been increasingly discussed over the past three decades in various fields providing service to the community and has been expressed as a goal for various areas. In medical education system, like other social accountability areas, it is considered as one of the main objectives globally. The aim of this study was to seek a social accountability theory in the medical education system that is capable of identifying all the standards, norms, and conditions within the country related to the study subject and recognize their relationship. In this study, a total of eight experts in the field of social accountability in medical education system with executive or study experience were interviewedpersonally. After analysis of interviews, 379 codes, 59 secondary categories, 16 subcategories, and 9 main categories were obtained. The resulting data was collected and analyzed at three levels of open coding, axial coding, and selective coding in the form of grounded theory study of “Accountability model of medical education in Iran”, which can be used in education system’s policies and planning for social accountability, given that almost all effective components of social accountability in highereducation health system with causal and facilitator associations were determined.Keywords: SOCIAL ACCOUNTABILITY, COMMUNITY–ORIENTED MEDICINE, COMMUNITY MEDICINE, EDUCATION SYSTEM, GROUNDED THEORY

INSAN KAMIL DALAM PEMIKIRAN MUHAMMAD NAFIS AL-BANJARI DAN ABDUSH-SHAMAD AL-FALIMBÂNÎ DALAM KITAB AD-DURR AN-NAFIS DAN SIYAR AS-SÂLIKÎN (SEBUAH STUDI PERBANDINGAN

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Rodiah Rodiah

2015-10-01

Full Text Available This paper tries to explore the concept of Insan Kamil through two books of Sufism, ad-Durr an-Nafis by Muhammad Nafis al-Banjari and Siyar as-Salikin by Abdush-Shamad al-Falimbânî. The method used in this paper comparative descriptive approach, because the studies referred to in this study aims to look at the similarities and differences of the concept of Insan Kamil contained in both books. These results indicate that the thought of Muhammad Nafis al-Banjari in the book ad-Durr an-Nafis and Abdush-Samad al-Falimbânî in the book Siyar al-Salikin against the concept of Insan Kamil has the same basic concept, in addition to the typical thinking its own distinct between the two.

Ecological theories of systems and contextual change in medical education.

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Ellaway, Rachel H; Bates, Joanna; Teunissen, Pim W

2017-12-01

Contemporary medical practice is subject to many kinds of change, to which both individuals and systems have to respond and adapt. Many medical education programmes have their learners rotating through different training contexts, which means that they too must learn to adapt to contextual change. Contextual change presents many challenges to medical education scholars and practitioners, not least because of a somewhat fractured and contested theoretical basis for responding to these challenges. There is a need for robust concepts to articulate and connect the various debates on contextual change in medical education. Ecological theories of systems encompass a range of concepts of how and why systems change and how and why they respond to change. The use of these concepts has the potential to help medical education scholars explore the nature of change and understand the role it plays in affording as well as limiting teaching and learning. This paper, aimed at health professional education scholars and policy makers, explores a number of key concepts from ecological theories of systems to present a comprehensive model of contextual change in medical education to inform theory and practice in all areas of medical education. The paper considers a range of concepts drawn from ecological theories of systems, including biotic and abiotic factors, panarchy, attractors and repellers, basins of attraction, homeostasis, resilience, adaptability, transformability and hysteresis. Each concept is grounded in practical examples from medical education. Ecological theories of systems consider change and response in terms of adaptive cycles functioning at different scales and speeds. This can afford opportunities for systematic consideration of responses to contextual change in medical education, which in turn can inform the design of education programmes, activities, evaluations, assessments and research that accommodates the dynamics and consequences of contextual change. �

Meta-analyses of Theory use in Medication Adherence Intervention Research

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Conn, Vicki S.; Enriquez, Maithe; Ruppar, Todd M.; Chan, Keith C.

2016-01-01

Objective This systematic review applied meta-analytic procedures to integrate primary research that examined theory- or model-linked medication adherence interventions. Methods Extensive literature searching strategies were used to locate trials testing interventions with medication adherence behavior outcomes measured by electronic event monitoring, pharmacy refills, pill counts, and self-reports. Random-effects model analysis was used to calculate standardized mean difference effect sizes for medication adherence outcomes. Results Codable data were extracted from 146 comparisons with 19,348 participants. The most common theories and models were social cognitive theory and motivational interviewing. The overall weighted effect size for all interventions comparing treatment and control participants was 0.294. The effect size for interventions based on single-theories was 0.323 and for multiple-theory interventions was 0.214. Effect sizes for individual theories and models ranged from 0.041 to 0.447. The largest effect sizes were for interventions based on the health belief model (0.477) and adult learning theory (0.443). The smallest effect sizes were for interventions based on PRECEDE (0.041) and self-regulation (0.118). Conclusion These findings suggest that theory- and model-linked interventions have a significant but modest effect on medication adherence outcomes. PMID:26931748

Insane defendants and forensic convicts: before and after the onset of the new forensic psychiatry network and the criminal justice system reform in Chile.

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Cid, Rodrigo D

2010-09-01

Like other Latin American democratic societies, Chile is supposed to respect legal rights of mentally ill people who are in trouble with the law, and provide them protection, treatment and welfare. Therefore, in this decade, the Chilean Criminal Justice and Mental Health System has undergone significant changes. Because this article is related to the recent social features that involve different areas such as justice, mental health assistance and forensic psychiatry systems, and thereby the nonexistence of current literature that reviews this matter from a global perspective and its implications for the mental health population involved in the justice system, its review and analysis seems to be interesting. The 'New Forensic Psychiatry Network' (NFPN) has been putting in relevant efforts to offer proper treatment and forensic assessment taking into account the civil rights of mentally insane people, and the 'Criminal Justice System Reform' (CJSR) is making possible legal conditions for better justice ensuring a more just resolution of insane defendants' and mentally ill convicts' lawsuits. From the author's viewpoint, all these changes are leading to a deep cultural impact on a Chilean's mind, changing their vision of justice and how society should respect insane defendants' and mentally ill convicts' legal rights.

The importance of the patients deemed not guilty by reason of insanity for the psychiatric reform.

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Douzenis, Athanasios

2016-01-01

developing community psychiatry services and closure/transformation of the big psychiatric hospitals (asylums). It is impossible to close hospitals where "NGRIs" are kept. The decision to move them into the community is not a medical-psychiatric but a legal one. In this respect it is imperative to establish a Forensic Psychiatric Unit for these patients. In our country as the "Psychargos" external evaluation highlighted, there are great gaps in the provision of Forensic psychiatric services.3 It must be emphasised that these gaps affect negatively psychiatric reform and social reintegration not only for the forensic psychiatric patients but for the whole of mentally ill individuals. Given that forensic Psychiatric services are developed in Athens and Thessaloniki and that training in Forensic Psychiatry has moved forward, it is imperative that the state should build upon the existing knowledge and experience and create specialist forensic units aiming to treat and rehabilitate this special and important group of patients.4 Only when the patients found "not guilty by reasons of insanity" have their own (safe for the society and them) therapeutic and rehabilitative services the aim of de-institutionalisation will be visible and realistic to implement.

Grounded theory in medical education research: AMEE Guide No. 70.

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Watling, Christopher J; Lingard, Lorelei

2012-01-01

Qualitative research in general and the grounded theory approach in particular, have become increasingly prominent in medical education research in recent years. In this Guide, we first provide a historical perspective on the origin and evolution of grounded theory. We then outline the principles underlying the grounded theory approach and the procedures for doing a grounded theory study, illustrating these elements with real examples. Next, we address key critiques of grounded theory, which continue to shape how the method is perceived and used. Finally, pitfalls and controversies in grounded theory research are examined to provide a balanced view of both the potential and the challenges of this approach. This Guide aims to assist researchers new to grounded theory to approach their studies in a disciplined and rigorous fashion, to challenge experienced researchers to reflect on their assumptions, and to arm readers of medical education research with an approach to critically appraising the quality of grounded theory studies.

[The medical theory of Lee Je-ma and its character].

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Lee, Kyung-Lock

2005-12-01

Lee Je-ma 1837-1900) was a prominent scholar as well as an Korean physician. classified every people into four distinctive types: greater yang [tai yang] person, lesser yin [shao yin] person, greater yin [tai yin] person, lesser yin [shao yin] person. This theory would dictate proper treatment for each type in accordance with individual differences of physical and temperament features. Using these four types he created The Medical Science of Four Types. This article is intended to look into the connection between Lee Je-Ma's 'The Medical Science of Four Types' and 'The Modern' with organizing his ideas about the human body and the human being. Through The Modern, the theory of human being underwent a complete change. Human being in The Premodern, which was determined by sex, age and social status has been changed to the individual human being, which is featured by equality. Lee Je-Ma's medical theory of The Medical Science of Four Types would be analyzed as follow. His concept of human body is oriented toward observable objectivity. But on the other hand, it still remains transcendent status of medical science, which is subordinated by philosophy. According to Lee Je-Ma's theory of human being, human is an equal individual in a modern way of thinking, not as a part of hierarchical group. But on the other hand, it still remains incomplete from getting rid of morality aspect that includes virtue and vice in the concept of human body. The common factors in Lee Je-Ma's ideas about the human body and the human being is 'Dualism of mind and body that means all kinds of status and results depends on each individual. As is stated above, Lee Je-Ma's medical theory has many aspects of The Modern and it proves that Korean traditional medicine could be modernized by itself.

Using attachment theory in medical settings: implications for primary care physicians.

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Hooper, Lisa M; Tomek, Sara; Newman, Caroline R

2012-02-01

Mental health researchers, clinicians and clinical psychologists have long considered a good provider-patient relationship to be an important factor for positive treatment outcomes in a range of therapeutic settings. However, primary care physicians have been slow to consider how attachment theory may be used in the context of patient care in medical settings. In the current article, John Bowlby's attachment theory and proposed attachment styles are proffered as a framework to better understand patient behaviors, patient communication styles with physicians and the physician-patient relationship in medical settings. The authors recommend how primary care physicians and other health care providers can translate attachment theory to enhance practice behaviors and health-related communications in medical settings.

Game theory and strategy in medical training.

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Blake, Amy; Carroll, Bryan T

2016-11-01

This paper analyses how game theory can provide a framework for understanding the strategic decision-making that occurs in everyday scenarios in medical training and practice, and ultimately serves as a tool for improving the work environment and patient care. Game theory has been applied to a variety of fields outside of its native economics, but has not been thoroughly studied in the context of health care provision. The paper discusses four of the most common 'games' and applies each to a scenario in medicine to provide new insight on the incentives and drivers for certain types of behaviour and a deeper understanding of why certain results are valued more strongly than others. Using game theory as an integrative tool, in conjunction with good judgement and a sound knowledge base, trainees and physicians can work to better recognise where competing priorities exist, understand the motivations and interactions of the various players, and learn to adjust their approaches in order to 'change the game' when their preferred outcome is not the most likely one. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Avoiding evasion: medical ethics education and emotion theory.

NARCIS (Netherlands)

Leget, C.J.W.

2004-01-01

Beginning with an exemplary case study, this paper diagnoses and analyses some important strategies of evasion and factors of hindrance that are met in the teaching of medical ethics to undergraduate medical students. Some of these inhibitions are inherent to ethical theories; others are connected

Medical student selection and society: Lessons we learned from sociological theories.

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Yaghmaei, Minoo; Yazdani, Shahram; Ahmady, Soleiman

2016-01-01

The aim of this study was to show the interaction between the society, applicants and medical schools in terms of medical student selection. In this study, the trends to implement social factors in the selection process were highlighted. These social factors were explored through functionalism and conflict theories, each focusing on different categories of social factors. While functionalist theorists pay attention to diversity in the selection process, conflict theorists highlight the importance of socio-economic class. Although both theories believe in sorting, their different views are reflected in their sorting strategies. Both theories emphasize the importance of the person-society relationship in motivation to enter university. Furthermore, the impacts of social goals on the selection policies are derived from both theories. Theories in the sociology of education offer an approach to student selection that acknowledges and supports complexity, plurality of approaches and innovative means of selection. Medical student selection does not solely focus on the individual assessment and qualification, but it focuses on a social and collective process, which includes all the influences and interactions between the medical schools and the society. Sociological perspective of medical student selection proposes a model that envelops the individual and the society. In this model, the selection methods should meet the criteria of merit at the individual level, while the selection policies should aim at the society goals at the institutional level.

The theoretical basis for practice-relevant medication use research: patient-centered/behavioral theories.

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Blalock, Susan J

2011-12-01

There is an urgent need for research to improve the quality of medication use among those who require pharmacotherapy. To describe how behavioral science theories can help to achieve this goal. We begin by describing what a theory is and the functions that theories serve. We then provide 8 guiding principles that are crucial for investigators to understand if they are to use theory appropriately. We conclude by discussing the need for a new model of patient medication self-management that incorporates information concerning factors operating at all levels of the ecological framework, ranging from patient-level to societal-level factors. The 8 guiding principles discussed are the following: (1) There is no single theory that is appropriate for guiding all medication use research; (2) Behavioral science theories are probabilistic, not deterministic; (3) When trying to influence a health behavior, the health behavior of interest must be defined precisely; (4) Many factors outside of patient control influence patient medication use; (5) Every patient is unique; (6) Patient motivation is a fundamental ingredient required to optimize medication use, especially when maintenance of long term behavior is the goal; (7) Health care providers can have a profound effect on patient medication use, and this effect can operate through several possible causal pathways; and (8) When planning an intervention to optimize medication use, it is important to develop a conceptual model that links intervention inputs to the ultimate outcomes that are desired. Medication use can be influenced by a wide variety of factors acting at different levels of the ecological model. The quality of research on medication use could be improved by development of an ecological model specific to medication self-management. Copyright © 2011 Elsevier Inc. All rights reserved.

The medical theory of Lee Je-ma and its character

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LEE Kyung-Lock

2005-12-01

Full Text Available Lee Je-ma(李濟馬, 1837-1900 was a prominent scholar as well as an Korean physician He classified every people into four distinctive types: greater yang[tai yang] person, lesser yin[shao yin] person greater yin[tai yin] person, lesser yin[shao yin] person. This theory would dictate proper treatment for each type in accordance with individual differences of physical and temperament features Using these four types he created The Medical Science of Four Types(四象體質論.This article is intended to look into the connection between Lee Je-Ma's 'The Medical Science of Four Types' and 'The Modern' with organizing his ideas about the human body and the human being. Through The Modern, the theory of human being(人間觀 underwent a complete change. Human being in The Premodern, which was determined by sex, age and social status has been changed to the individual human being, which is featured by equality. Lee Je-Ma's medical theory of The Medical Science of Four Types would be analyzed as follow. His concept of human body(人體論 is oriented toward observable objectivity. But on the other hand, it still remains transcendent status of medical science, which is subordinated by philosophy According to Lee Je-Ma's theory of human being human is an equal individual in a modern way of thinking not as a part of hierarchical group. But on the other hand, it still remains incomplete from getting rid of morality aspect that includes virtue and vice in the concept of human body.The common factors in Lee Je-Ma's ideas about the human body and the human being is 'Dualism of mind and body(心身二元論' that means all kinds of status and results depends on each individual. As is stated above, Lee Je-Ma's medical theory has many aspects of The Modern and it proves that Korean traditional medicine could be modernized by itself.

Learning theory and its application to the use of social media in medical education.

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Flynn, Leslie; Jalali, Alireza; Moreau, Katherine A

2015-10-01

There is rapidly increasing pressure to employ social media in medical education, but a review of the literature demonstrates that its value and role are uncertain. To determine if medical educators have a conceptual framework that informs their use of social media and whether this framework can be mapped to learning theory. Thirty-six participants engaged in an iterative, consensus building process that identified their conceptual framework and determined if it aligned with one or more learning theories. The results show that the use of social media by the participants could be traced to two dominant theories-Connectivism and Constructivism. They also suggest that many medical educators may not be fully informed of these theories. Medical educators' use of social media can be traced to learning theories, but these theories may not be explicitly utilised in instructional design. It is recommended that formal education (faculty development) around learning theory would further enhance the use of social media in medical education. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Pediatric psychotropic medication initiation and adherence: a literature review based on social exchange theory.

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Hamrin, Vanya; McCarthy, Erin M; Tyson, Veda

2010-08-01

Psychotropic medication initiation and adherence is an identified problem. This literature review explores factors that determine families' decisions to initiate, sustain, or discontinue use of psychotropic medication in children and adolescents. Social exchange theory is used as a framework to explore decisions to initiate and adhere to psychotropic medications. Contributing factors related to psychotropic medication initiation, adherence, and discontinuation are explored. Themes in the literature encompassing costs and benefits of psychotropic medication adherence include family experiences with adverse effects, previous psychotropic medication experience, medication psychoeducation, stigma, societal views about psychotropic medication, particular diagnosis, the effect of comorbid diagnosis on adherence, attitudes and beliefs about medication by both children and parents, and relationships with the provider. The impact of family demographics including parent gender, age of the child, ethnicity, and parent educational level on psychotropic medication adherence is evaluated. International and U.S. studies from Medline, Cumulative Index for Nursing and Allied Health Literature and PsychInfo evaluating medication initiation and adherence in the pediatric psychiatric population and social exchange theory was incorporated from relevant textbook resources. Rewards experienced from medication treatment include improvement in symptoms, school performance and family relationships, and reduced level of parenting stress. Identified costs include impact of adverse side effects, social stigma, lack of response, fears of addiction, and changing the child's personality. Acceptance of the diagnosis influences adherence while medication education has varying effects. Families' attitudes, beliefs and perceptions about psychiatric illness and treatment play a large role in medication treatment decisions. A trusting provider relationship has a positive effect on adherence

No Time for Nostalgia!: Asylum-Making, Medicalized Colonialism in British Columbia (1859-97) and Artistic Praxis for Social Transformation

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Roman, Leslie G.; Brown, Sheena; Noble, Steven; Wainer, Rafael; Young, Alannah Earl

2009-01-01

This article asks: How have disability, indigenous arts and cultural praxis transformed and challenged the historical sociological archival research into relationships among asylum-making, medicalized colonialism and eugenics in the Woodlands School, formerly the Victoria Lunatic Asylum, the Provincial Asylum for the Insane in Victoria, BC 1859-72…

The importance of educational theories for facilitating learning when using technology in medical education.

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Sandars, John; Patel, Rakesh S; Goh, Poh Sun; Kokatailo, Patricia K; Lafferty, Natalie

2015-01-01

There is an increasing use of technology for teaching and learning in medical education but often the use of educational theory to inform the design is not made explicit. The educational theories, both normative and descriptive, used by medical educators determine how the technology is intended to facilitate learning and may explain why some interventions with technology may be less effective compared with others. The aim of this study is to highlight the importance of medical educators making explicit the educational theories that inform their design of interventions using technology. The use of illustrative examples of the main educational theories to demonstrate the importance of theories informing the design of interventions using technology. Highlights the use of educational theories for theory-based and realistic evaluations of the use of technology in medical education. An explicit description of the educational theories used to inform the design of an intervention with technology can provide potentially useful insights into why some interventions with technology are more effective than others. An explicit description is also an important aspect of the scholarship of using technology in medical education.

[Medical theories and urban management: Fortaleza's 1877-79 drought].

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Costa, Maria Clélia Lustosa

2004-01-01

Down through the nineteenth century, new medical theories on the origin of disease influenced the norms and regulations that controlled the population's behavior and the urban space. The present study discusses the ideas, medical practices , and administrative initiatives adopted during the 1877-79 drought in Fortaleza, capital of Ceará province. The drought was accompanied by a smallpox epidemic, along with the increased migration of sertão dwellers to the capitol. The city lacked a public service network capable of meeting the needs of this new population, which took up lodgings on the city and periphery. The municipal administration endeavored to implement the recommendations of physicians based on modern principles of hygienization. Through an analysis of reports by the provincial presidents and by public health inspectors, the study intends to show how these medical theories influenced the practices of urban reorganization at a moment of public emergency.

[A non-classical approach to medical practices: Michel Foucault and Actor-Network Theory].

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Bińczyk, E

2001-01-01

The text presents an analysis of medical practices stemming from two sources: Michel Foucault's conception and the research of Annemarie Mol and John Law, representatives of a trend known as Actor-Network Theory. Both approaches reveal significant theoretical kinship: they can be successfully consigned to the framework of non-classical sociology of science. I initially refer to the cited conceptions as a version of non-classical sociology of medicine. The identity of non-classical sociology of medicine hinges on the fact that it undermines the possibility of objective definitions of disease, health and body. These are rather approached as variable social and historical phenomena, co-constituted by medical practices. To both Foucault and Mol the main object of interest was not medicine as such, but rather the network of medical practices. Mol and Law sketch a new theoretical perspective for the analysis of medical practices. They attempt to go beyond the dichotomous scheme of thinking about the human body as an object of medical research and the subject of private experience. Research on patients suffering blood-sugar deficiency provide the empirical background for the thesis of Actor-Network Theory representatives. Michel Foucault's conceptions are extremely critical of medical practices. The French researcher describes the processes of 'medicalising' Western society as the emergence of a new type of power. He attempts to sensitise the reader to the ethical dimension of the processes of medicalising society.

The shadow, the tyrant and the insane: the east and west dualism in the visual journalism

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Alberto Klein

2014-07-01

Full Text Available This paper explores the East and West dualism considering three images: the shadow, the tyrant and the insane, respectively linked to Osama Bin Laden, Saddam Hussein and Mahmoud Ahmadinejad. These representations, given their occurrence in the media, appear as stereotypes in the visual journalism, being in total opposition to western values, such as illuminism, democracy and reason. From the perspective of the concept of Orientalism, the text also analyzes semiotic procedures which constitute the process of demonization, according to the contribuitions of Ivan Bystrina, Gilbert Durand and Stuart Clark.

Experiences of antidepressant medication and cognitive-behavioural therapy for depression: a grounded theory study.

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Bayliss, Paul; Holttum, Sue

2015-09-01

To develop a preliminary model of the experiences of people undergoing combined treatment with antidepressant medication and cognitive-behavioural therapy (CBT) for depression. The study used a qualitative methodology informed by grounded theory. Participants were 12 adults who had received treatment with antidepressant medication and CBT for depression. Participants engaged in a semistructured interview about their experiences. Interviews were transcribed and analysed using components of grounded theory methodology. Medication was often seen as an initial aid to surviving a crisis. Staying on medication longer term resulted in some participants feeling caught in a 'drug loop'. Feeling that medication was unhelpful or actively harmful could contribute to participants seeking CBT. Medics also offered information on CBT and acted as gatekeepers, meaning that negotiation was sometimes necessary. CBT was described as a process of being guided towards skilled self-management. Occasionally, participants felt that medication had facilitated CBT at one or more stages. Conversely, developing skilled self-management through CBT could reduce feelings of dependency on medication and affect several of the other elements maintaining the 'drug loop'. Antidepressant medication and CBT are perceived and experienced differently, with CBT often being seen as an alternative to medication, or even as a means to discontinue medication. Service users' experiences and beliefs about medication may thus affect their engagement and goals in CBT, and it may be important for therapists to consider this. Practitioners who prescribe medication should ensure that they also provide information on the availability and appropriateness of CBT, and engage in an open dialogue about treatment options. CBT practitioners should explore aspects of clients' experiences and beliefs about medication. This would particularly include clients' experiences of the effects of medication, their beliefs about

The agency problem and medical acting: an example of applying economic theory to medical ethics.

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Langer, Andreas; Schröder-Bäck, Peter; Brink, Alexander; Eurich, Johannes

2009-03-01

In this article, the authors attempt to build a bridge between economic theory and medical ethics to offer a new perspective to tackle ethical challenges in the physician-patient encounter. They apply elements of new institutional economics to the ethically relevant dimensions of the physician-patient relationship in a descriptive heuristic sense. The principal-agent theory can be used to analytically grasp existing action problems in the physician-patient relationship and as a basis for shaping recommendations at the institutional level. Furthermore, the patients' increased self-determination and modern opportunities for the medical laity to inform themselves lead to a less asymmetrical distribution of information between physician and patient and therefore require new interaction models. Based on the analysis presented here, the authors recommend that, apart from the physician's necessary individual ethics, greater consideration should be given to approaches of institutional ethics and hence to incentive systems within medical ethics.

Medical ethics and more: ideal theories, non-ideal theories and conscientious objection.

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Luna, Florencia

2015-01-01

Doing 'good medical ethics' requires acknowledgment that it is often practised in non-ideal circumstances! In this article I present the distinction between ideal theory (IT) and non-ideal theory (NIT). I show how IT may not be the best solution to tackle problems in non-ideal contexts. I sketch a NIT framework as a useful tool for bioethics and medical ethics and explain how NITs can contribute to policy design in non-ideal circumstances. Different NITs can coexist and be evaluated vis-à-vis the IT. Additionally, I address what an individual doctor ought to do in this non-ideal context with the view that knowledge of NITs can facilitate the decision-making process. NITs help conceptualise problems faced in the context of non-compliance and scarcity in a better and more realistic way. Deciding which policy is optimal in such contexts may influence physicians' decisions regarding their patients. Thus, this analysis-usually identified only with policy making-may also be relevant to medical ethics. Finally, I recognise that this is merely a first step in an unexplored but fundamental theoretical area and that more work needs to be done. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The contribution of Kantian moral theory to contemporary medical ethics: a critical analysis.

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Heubel, Friedrich; Biller-Andorno, Nikola

2005-01-01

Kantian deontology is one of three classic moral theories, among virtue ethics and consequentialism. Issues in medical ethics are frequently addressed within a Kantian paradigm, at least --although not exclusively--in European medical ethics. At the same time, critical voices have pointed to deficits of Kantian moral philosophy which must be examined and discussed. It is argued that taking concrete situations and complex relationships into account is of paramount importance in medical ethics. Encounters between medical or nursing staff and patients are rarely symmetrical relationships between autonomous and rational agents. Kantian ethics, the criticism reads, builds on the lofty ideal of such a relationship. In addition to the charge of an individualist and rationalist focus on autonomy, Kantian ethics has been accused of excluding those not actually in possession of these properties or of its rigorism. It is said to be focussed on laws and imperatives to an extent that it cannot appreciate the complex nuances of real conflicts. As a more detailed analysis will show, these charges are inadequate in at least some regards. This will be demonstrated by drawing on the Kantian notion of autonomy, the role of maxims and judgment and the conception of duties, as well as the role of emotions. Nevertheless the objections brought forward against Kantian moral theory can help determine, with greater precision, its strengths and shortcomings as an approach to current problems in medical ethics.

Prevention of sexual harassment in the medical setting applying Inoculation Theory.

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Matusitz, Jonathan; Breen, Gerald Mark

2005-01-01

This paper is an examination of how Inoculation Theory can be applied in the prevention of sexual harassment in the medical setting. The basic tenet of the theory is the study of the processes through which we withstand and oppose attitude transformation during social interactions that may influence or change our attitudes. More importantly, this paper analyzes sexual harassment as a pervasive phenomenon in the medical setting. As such, it defines what sexual harassment is, explains the prevalence of sexual harassment between the physician and the patient, describes some of the general studies conducted in medical settings, provides a case scenario of doctor-patient sexual harassment, and identifies some key consequences to doctors, patients, and society.

Penggunaan Incoterms dalam Perjanjian Perdagangan Internasional (Studi Pada Pt. Insan Bonafide di Banjarmasin

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Adhitya Christanto Henry Dalim

2016-09-01

Full Text Available Tujuan penelitian ini untuk mengetahui dan menganalisis kedudukan incoterms selaku hukum kebiasaan internasional dalan perjanjian perdagangan internasional serta untuk mengetahui dan menganalisis hak dan kewajiban pengusaha eksportir dan importir sehubungan dengan penggunaan Incoterms dalam perjanjian perdagangan internasional (Studi pada PT. Insan Bonafide di Banjarmasin. Kegunaan yang di harapakan dari hasil penelitian Sebagai sumbangan pemikiran dalam bidang ilmu hukum khususnya terkait dengan hukum perdagangan internasional, bagi pelaku usaha di bidang perdagangan internasional dan bagi pemerintah dalam membuat peraturan perundang-undangan (legislasi berkenaan dengan perdagangan internasional. Metode penelitian ini menggunakan jenis penelitian hukum normatif,yaitu penelitian hukum yang dilakukan dengan cara meneliti bahan hukum(bahan hukum primer, bahan hukum sekunder, dan bahan hukum tersier, yang relevan dengan judul yang di angkat penulis. Ada pun tipe penelitianadalah penelitian dengan menitikberatkan permasalahan yang sering timbul berkaitan dengan kekaburan hukum (vage norm berkenaan dengan makna dan ruang lingkup dari Incoterms tersebut. Pendekatan penelitian menggunakan pendekatan analitis (analytical approach.Menurut hasil dari penelitian tesis ini menunjukan bahwa : Pertama, mengenai kekuatan hukum Incoterms dalam perjanjian perdagangan internasional, Incoterms yang lahir dari hukum kebiasaan dan sebagai suatu kebiasaan internasional yang berkedudukan hukum yang merupakan sumber hukum perdagangan internasional. namun demikian kekuatan hukum Incoterms selaku hukum kebiasaan internasional tidak sama dengan kekuatan hukum dari Perjanjian Internasional seperti Konvensi, Traktat, Piagam, Agreement, Covenant, Protocol, Pacta, dan lain-lain. Kedua, hak dan kewajiban pengusaha eksportir dan importir sehubungan dengan penggunaan Incoterms dalam perjanjian perdagangan internasional khususnya pada PT. Insan Bonafide dengan menggunakan

Remediation of at-risk medical students: theory in action

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Winston, K.A.; Vleuten, C.P.M. van der; Scherpbier, A.J.J.A.

2013-01-01

BACKGROUND: Previous work has shown that a programme that draws on a blend of theories makes a positive difference to outcomes for students who fail and repeat their first semester at medical school. Exploration of student and teacher perspectives revealed that remediation of struggling medical students can be achieved through a cognitive apprenticeship within a small community of inquiry. This community needs expert teachers capable of performing a unique combination of roles (facilitator, n...

Using activity theory to study cultural complexity in medical education.

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Frambach, Janneke M; Driessen, Erik W; van der Vleuten, Cees P M

2014-06-01

There is a growing need for research on culture, cultural differences and cultural effects of globalization in medical education, but these are complex phenomena to investigate. Socio-cultural activity theory seems a useful framework to study cultural complexity, because it matches current views on culture as a dynamic process situated in a social context, and has been valued in diverse fields for yielding rich understandings of complex issues and key factors involved. This paper explains how activity theory can be used in (cross-)cultural medical education research. We discuss activity theory's theoretical background and principles, and we show how these can be applied to the cultural research practice by discussing the steps involved in a cross-cultural study that we conducted, from formulating research questions to drawing conclusions. We describe how the activity system, the unit of analysis in activity theory, can serve as an organizing principle to grasp cultural complexity. We end with reflections on the theoretical and practical use of activity theory for cultural research and note that it is not a shortcut to capture cultural complexity: it is a challenge for researchers to determine the boundaries of their study and to analyze and interpret the dynamics of the activity system.

Guilt and Choice in Criminal Law Theory – A Critical Assessment

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Tatjana Hörnle

2016-08-01

Full Text Available The article discusses the Principle of Guilt and the Principle of Alternate Decisions, beginning with their central role in German law before moving on to the broader discussion. It argues that criminal law theory should not rely on the Principle of Alternate Decisions as it is not consistent with the most plausible, empirically founded model of how human beings make decisions. However, this does not lead to the conclusion that criminal punishment in the traditional sense, that is, as a practice involving blame, should be abandoned. Blame is compatible with a realistic view on decision-making. Compatibilism is not new to criminal law theory – several authors have developed such arguments. However, a simple version of compatibilism, arguing that substantive criminal law is not in need of major modifications, is insufficient. The main point in this paper is that several issues in criminal law doctrine, the place and scope of insanity defences, mitigations and intention as volition, need to be re-considered and re-conceptualized. 

Psychiatric monitoring of not guilty by reason of insanity outpatients.

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Almeida, Fernando; Moreira, Diana; Moura, Helena; Mota, Victor

2016-02-01

Individuals deemed Not Guilty by Reason of Insanity (NGRI) by the courts, under Article 20 of the Portuguese Criminal Code, have often committed very serious crimes. It is unreasonable to consider that these patients were usually kept without adequate supervision after the security measure had been declared extinct. They often decompensated after leaving the institution where they complied with the security measure, and/or relapsed to alcohol and drug abuse. Very often, severe repeated crime erupted again. Considering this, there was an urgent need to keep a follow-up assessment of these patients in order to prevent them from relapsing in crime. This work presents the results of a psychiatric follow-up project with NGRI outpatients. The main goals of the project were: ensuring follow-up and appropriate therapeutic responses for these patients, maintaining all individuals in a care network, and preventing them from decompensating. The team consisted of a psychiatrist, a nurse, and a psychologist. Seventy-two patients were monitored during two years. Results demonstrated the unequivocal need to follow up decompensated patients after the court order is extinguished. Suggestions are presented for a better framing and psychiatric follow-up of these patients. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

High theory/mass markets: Newsweek magazine and the circuits of medical culture.

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Lewis, Bradley

2007-01-01

Medicine is driven by much more than science and reason (ethics); it is also driven by the circuits of culture within which it operates. This article examines how postmodern theory deconstructs standard ideals of science and reason and allows medical humanities scholars to better contextualize the world of medicine. As such, postmodern theory provides an invaluable tool for understanding the circuits of popular culture and medicine's place within these circuits. Using a recent issue of Newsweek magazine devoted to health and technology to illustrate the main points, this essay argues that contemporary popular influences on medicine are deeply problematic, and that through an appreciation of the dynamics of culture, medical humanities scholars can join the struggle over medical culture. This perspective allows medical humanities to make important contributions toward alternative circuits of medical representation, consumption, and identification.

Self-regulation theory: applications to medical education: AMEE Guide No. 58.

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Sandars, John; Cleary, Timothy J

2011-01-01

Self-regulation theory, as applied to medical education, describes the cyclical control of academic and clinical performance through several key processes that include goal-directed behaviour, use of specific strategies to attain goals, and the adaptation and modification to behaviours or strategies to optimise learning and performance. Extensive research across a variety of non-medical disciplines has highlighted differences in key self-regulation processes between high- and low-achieving learners and performers. Structured identification of key self-regulation processes can be used to develop specific remediation approaches that can improve performance in academic and complex psycho-motor skills. General teaching approaches that are guided by a self-regulation perspective can also enhance academic performance. Self-regulation theory offers an exciting potential for improving academic and clinical performance in medical education.

Food refusal and insanity: sitophobia and anorexia nervosa in Victorian asylums.

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van Deth, R; Vandereycken, W

2000-05-01

Although anorexia nervosa emerged as a new syndrome in the second half of the 19th century, this clinical picture seemed to be unknown in the psychiatric hospitals or asylums. In asylum medicine, the commonly used concept of sitophobia to designate food refusal in the insane covered a wide variety of mental disturbances and cannot be plainly equated with anorexia nervosa. A major difference is the occurrence of hallucinations and delusions specifically centered around religion and digestion. Most probably, anorectic patients were not treated in asylums, but at home, in the doctor's office, or in general hospitals. This pattern may be partly attributed to the fact that both patients and doctors were focusing on symptoms of self-starvation like emaciation, constipation, and amenorrhea, which were primarily interpreted as referring to somatic diseases. Additionally, wealthy families probably preferred private care in water-cure establishments, sanatoria, and rest homes to the stigmatizing referral of their anorectic daughter to an asylum. Hence, the fact that late 19th-century institutionalized psychiatry was only incidentally confronted with anorexia nervosa may explain its lack of interest in the emerging syndrome. Copyright 2000 by John Wiley & Sons, Inc.

Have motivation theories guided the development and reform of medical education curricula? A review of the literature.

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Kusurkar, Rashmi A; Croiset, Gerda; Mann, Karen V; Custers, Eugene; Ten Cate, Olle

2012-06-01

Educational psychology indicates that learning processes can be mapped on three dimensions: cognitive (what to learn), affective or motivational (why learn), and metacognitive regulation (how to learn). In a truly student-centered medical curriculum, all three dimensions should guide curriculum developers in constructing learning environments. The authors explored whether student motivation has guided medical education curriculum developments. The authors reviewed the literature on motivation theory related to education and on medical education curriculum development to identify major developments. Using the Learning-Oriented Teaching model as a framework, they evaluated the extent to which motivation theory has guided medical education curriculum developers. Major developments in the field of motivation theory indicate that motivation drives learning and influences students' academic performance, that gender differences exist in motivational mechanisms, and that the focus has shifted from quantity of motivation to quality of motivation and its determinants, and how they stimulate academic motivation. Major developments in medical curricula include the introduction of standardized and regulated medical education as well as problem-based, learner-centered, integrated teaching, outcome-based, and community-based approaches. These curricular changes have been based more on improving students' cognitive processing of content or metacognitive regulation than on stimulating motivation. Motivational processes may be a substantially undervalued factor in curriculum development. Building curricula to specifically stimulate motivation in students may powerfully influence the outcomes of curricula. The elements essential for stimulating intrinsic motivation in students, including autonomy support, adequate feedback, and emotional support, appear lacking as a primary aim in many curricular plans.

Effecting change through dialogue: Habermas' theory of communicative action as a tool in medical lifestyle interventions.

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Walseth, Liv Tveit; Schei, Edvin

2011-02-01

Adjustments of everyday life in order to prevent disease or treat illness afflict partly unconscious preferences and cultural expectations that are often difficult to change. How should one, in medical contexts, talk with patients about everyday life in ways that might penetrate this blurred complexity, and help people find goals and make decisions that are both compatible with a good life and possible to accomplish? In this article we pursue the question by discussing how Habermas' theory of communicative action can be implemented in decision-making processes in general practice. The theory of deliberative decision-making offers practical guidelines for what to talk about and how to do it. For a decision to be rooted in patients' everyday life it has to take into consideration the patient's practical circumstances, emotions and preferences, and what he or she perceives as ethically right behaviour towards other people. The aim is a balanced conversation, demonstrating respect, consistency and sincerity, as well as offering information and clarifying reasons. Verbalising reasons for one's preferences may increase awareness of values and norms, which can then be reflected upon, producing decisions rooted in what the patient perceives as good and right behaviour. The asymmetry of medical encounters is both a resource and a challenge, demanding patient-centred medical leadership, characterised by empathy and ability to take the patient's perspective. The implementation and adjustments of Habermas' theory in general practice is illustrated by a case story. Finally, applications of the theory are discussed.

Psychosomatic symptoms in medical outpatients: an investigation of self-handicapping theory.

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Organista, P B; Miranda, J

1991-01-01

Investigated self-handicapping theory as it relates to somatization in medical patients. We predicted that medical outpatients (N = 113) would report psychosomatic symptoms in response to events that threaten their self-esteem. As predicted, results of hierarchical multiple regression indicated that high-perfectionism patients reported somatic symptoms positively related to the number of events that jeopardize their sense of accomplishment, whereas low-perfectionism patients' somatic symptoms were not related to these events (p = .005). Contrary to prediction, high-dependency patients did not differ significantly from low-dependency patients in the relationship of somatic symptoms and events that threatened their interpersonal relationships (p = .115). Implications of these findings and the utility of self-handicapping theory for predicting somatization in medical patients are discussed.

Can achievement goal theory provide a useful motivational perspective for explaining psychosocial attributes of medical students?

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Madjar Nir

2012-01-01

Full Text Available Abstract Background Psychosocial competence and frustration tolerance are important characteristics of skilled medical professionals. In the present study we explored the usefulness of applying a comprehensive motivational theory (Goal orientations, for this purpose. According to goal orientation theory, learning motivation is defined as the general goals students pursue during learning (either mastery goals - gaining new knowledge; or performance goals - gaining a positive evaluation of competence or avoiding negative evaluation. Perceived psychosocial abilities are a desirable outcome, and low frustration tolerance (LFT, is a negative feature of student behavior. The hypothesis was that the mastery goal would be positively associated with psychosocial abilities while performance goals would be positively associated with LFT. Methods 143 first-year medical students completed at the end of an annual doctor-patient communication course a structured questionnaire that included measures of learning goal orientations (assessed by Pattern of Adaptive Learning Scale - PALS, psychosocial abilities (assessed by Psychological Medicine Inventory- student version -PMI-S and Low Frustration Tolerance (LFT. Results All study variables were found reliable (Cronbach's α ranged from .66 to .90 and normally distributed. Hierarchical multiple regression analysis revealed significant associations supporting the hypotheses. The mastery goal orientation was positively associated with perceived psychosocial abilities (PMI-S (β = .16, p Conclusions The results suggest that the goal orientations theory may be a useful theoretical framework for understanding and facilitating learning motivation among medical students. Limitations and suggestions for practice within medical education context are discussed.

Can achievement goal theory provide a useful motivational perspective for explaining psychosocial attributes of medical students?

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Madjar, Nir; Bachner, Yaacov G; Kushnir, Talma

2012-01-12

Psychosocial competence and frustration tolerance are important characteristics of skilled medical professionals. In the present study we explored the usefulness of applying a comprehensive motivational theory (Goal orientations), for this purpose. According to goal orientation theory, learning motivation is defined as the general goals students pursue during learning (either mastery goals - gaining new knowledge; or performance goals - gaining a positive evaluation of competence or avoiding negative evaluation). Perceived psychosocial abilities are a desirable outcome, and low frustration tolerance (LFT), is a negative feature of student behavior. The hypothesis was that the mastery goal would be positively associated with psychosocial abilities while performance goals would be positively associated with LFT. 143 first-year medical students completed at the end of an annual doctor-patient communication course a structured questionnaire that included measures of learning goal orientations (assessed by Pattern of Adaptive Learning Scale - PALS), psychosocial abilities (assessed by Psychological Medicine Inventory- student version -PMI-S) and Low Frustration Tolerance (LFT). All study variables were found reliable (Cronbach's α ranged from .66 to .90) and normally distributed. Hierarchical multiple regression analysis revealed significant associations supporting the hypotheses. The mastery goal orientation was positively associated with perceived psychosocial abilities (PMI-S) (β = .16, p frustration tolerance (β = -.22, p frustration tolerance (β = .36, p < .001). The results suggest that the goal orientations theory may be a useful theoretical framework for understanding and facilitating learning motivation among medical students. Limitations and suggestions for practice within medical education context are discussed.

From theory to practice: integrating instructional technology into veterinary medical education.

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Wang, Hong; Rush, Bonnie R; Wilkerson, Melinda; Herman, Cheryl; Miesner, Matt; Renter, David; Gehring, Ronette

2013-01-01

Technology has changed the landscape of teaching and learning. The integration of instructional technology into teaching for meaningful learning is an issue for all educators to consider. In this article, we introduce educational theories including constructivism, information-processing theory, and dual-coding theory, along with the seven principles of good practice in undergraduate education. We also discuss five practical instructional strategies and the relationship of these strategies to the educational theories. From theory to practice, the purpose of the article is to share our application of educational theory and practice to work toward more innovative teaching in veterinary medical education.

Defying the Definition of Insanity: Assessing the Robust Nature of University Outreach in the Community Using Carnegie Community Engagement Classification and Lynch Outreach Assessment Model (LOAM)

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Lynch-Alexander, Erin

2017-01-01

Duplicating processes and procedure with anticipation of deviating outcomes is the defining trait of insanity as attributed to a quote by Albert Einstein. It is the antithesis to innovation, which is what is needed in higher education to create impactful changes in the outreach we should be providing to the community. What is important for those…

Pavel Ivanovich Karpov (1873-1932?)--the Russian Prinzhorn: art of the insane in Russia.

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Lerner, Vladimir; Podolsky, Grigory; Witztum, Eliezer

2016-03-01

The complicated relationship between the discipline of mental health and the arts has barely been studied systematically. Mental hospitals, shelters and prisons--institutions that accommodate the mentally ill--sometimes promote but often discourage and disrupt the patients' artistic creativity and the images created. In psychiatric circles, the recognition of patient art was a long, slow and frustrating process. Among the Western psychiatrists who studied the creative activity of the mentally ill, researchers usually mention such names as C. Lombroso, M. Shearing, V. Morgentaller, H. Prinzhorn and others, but rarely refer to their Russian colleagues and contemporaries. Pavel Ivanovich Karpov (1873-1932?), a Russian psychiatrist, was one of the most extensive researchers in the field of the art of the insane, but unfortunately his name is little known among modern psychiatrists. For his clinical and scientific contributions, he deserves to be remembered in the history of psychiatry. © The Author(s) 2016.

Considering "Nonlinearity" Across the Continuum in Medical Education Assessment: Supporting Theory, Practice, and Future Research Directions.

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Durning, Steven J; Lubarsky, Stuart; Torre, Dario; Dory, Valérie; Holmboe, Eric

2015-01-01

The purpose of this article is to propose new approaches to assessment that are grounded in educational theory and the concept of "nonlinearity." The new approaches take into account related phenomena such as "uncertainty," "ambiguity," and "chaos." To illustrate these approaches, we will use the example of assessment of clinical reasoning, although the principles we outline may apply equally well to assessment of other constructs in medical education. Theoretical perspectives include a discussion of script theory, assimilation theory, self-regulated learning theory, and situated cognition. Assessment examples to include script concordance testing, concept maps, self-regulated learning microanalytic technique, and work-based assessment, which parallel the above-stated theories, respectively, are also highlighted. We conclude with some practical suggestions for approaching nonlinearity. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

How Do Physicians Become Medical Experts? A Test of Three Competing Theories: Distinct Domains, Independent Influence and Encapsulation Models

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Violato, Claudio; Gao, Hong; O'Brien, Mary Claire; Grier, David; Shen, E.

2018-01-01

The distinction between basic sciences and clinical knowledge which has led to a theoretical debate on how medical expertise is developed has implications for medical school and lifelong medical education. This longitudinal, population based observational study was conducted to test the fit of three theories--knowledge encapsulation, independent…

Using activity theory to study cultural complexity in medical education

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Frambach, J.M.; Driessen, E.W.; Vleuten, C.P.M. van der

2014-01-01

There is a growing need for research on culture, cultural differences and cultural effects of globalization in medical education, but these are complex phenomena to investigate. Socio-cultural activity theory seems a useful framework to study cultural complexity, because it matches current views on

Using activity theory to study cultural complexity in medical education

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Frambach, Janneke M; Driessen, Erik W; van der Vleuten, Cees P M

There is a growing need for research on culture, cultural differences and cultural effects of globalization in medical education, but these are complex phenomena to investigate. Socio-cultural activity theory seems a useful framework to study cultural complexity, because it matches current views on

On-the-Job Ethics – Proximity Morality Forming in Medical School: A grounded theory analysis using survey data

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Hans O. Thulesius, MD, Ph.D.

2009-03-01

Full Text Available On-the-job-ethics exist in all businesses and can also be called proximity morality forming. In this paper we propose that medical students take a proximity morality stance towards ethics education at medical school. This means that they want to form physician morality “on the job” instead of being taught ethics like any other subject. On-the-job-ethics for medical students involves learning ethics that is used when practicing ethics. Learning ethics includes comprehensive ethics courses in which quality lectures provide ethics grammar useful for the ethics practicing in attitude exercises and vignette reflections in tutored group discussions. On-the-job-ethics develops professional identity, handles diversity of religious and existential worldviews, trains students described as ethically naive, processes difficult clinical experiences, and desists negative role modeling from physicians in clinical or teaching situations. This grounded theory analysis was made from a questionnaire survey on attitudes to ethics education with 409 Swedish medical students participating. We analyzed over 8000 words of open-ended responses and multiplechoice questions using classic grounded theory procedures, but also compared questionnaire data using statistics such as multiple regression models. The paper gives an example of how grounded theory can be used with a limited amount of survey data.

Insanity and ethnicity in New Zealand: Māori encounters with the Auckland Mental Hospital, 1860-1900.

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Barry, Lorelle; Coleborne, Catharine

2011-09-01

This article examines Māori patients at the Auckland Mental Hospital between 1860 and 1900.We argue that the patient case notes reveal 'European' categories in which Māori were situated, and demonstrate the extent to which the authorities at the hospital grappled with their appearance, their language and their culture, all of which were elements of their ethnicity. We argue that the use of institutional case records is highly suggestive of some of the historical meanings of insanity for Māori, including the lack of detailed or sustained collection of information about patients' tribal affiliations, the interest shown in their rights to land in maintenance payment inquiries, the experiences of cultural alienation or mate Māori, and the sad outcomes for Māori.

Integrating transition theory and bioecological theory: a theoretical perspective for nurses supporting the transition to adulthood for young people with medical complexity.

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Joly, Elizabeth

2016-06-01

To present a discussion of a theoretical perspective developed through integrating Meleis' Transition Theory and Bronfenbrenner's Bioecological Theory of Human Development to inform nursing and advanced nursing practice supporting the transition to adulthood for young people with medical complexity. Theoretical perspectives to inform nursing practice in supporting successful transition are limited, yet nurses frequently encounter young people with medical complexity during the transition to adulthood. Discussion paper. A literature search of CINAHL and Medline was conducted in 2014 and included articles from 2003-2014; informal discussions with families; the author's experiences in a transition program. The integrated theoretical perspective described in this paper can inform nurses and advanced practice nurses on contextual influences, program and intervention development across spheres of influence and outcomes for the transition to adulthood for young people with medical complexity. Young people and their families require effective reciprocal interactions with individuals and services across sectors to successfully transition to adulthood and become situated in the adult world. Intervention must also extend beyond the young person to include providers, services and health and social policy. Nurses can take a leadership role in supporting the transition to adulthood for young people with medical complexity through direct care, case management, education and research. It is integral that nurses holistically consider developmental processes, complexity and contextual conditions that promote positive outcomes during and beyond the transition to adulthood. © 2016 John Wiley & Sons Ltd.

Application of Learning Theories on Medical Imaging Education

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Osama A. Mabrouk Kheiralla

2018-05-01

Full Text Available The main objective of the education process is that student must learn well rather than the educators to teach well. If radiologists get involved in the process of medical education, it is important for them to do it through sound knowledge of how students learn. Researches have proved that most of the teachers in the field of medical education including diagnostic imaging are actually doctors or technicians, who didn’t have an opportunity to study the basics of learning. Mostly they have gained their knowledge through watching other educators, and they mostly rely on their personal skills and experience in doing their job. This will hinder them from conveying knowledge in an effective and scientific way, and they will find themselves lagging away behind the latest advances in the field of medical education and educational research, which will lead to negative cognitive outcomes among learners. This article presents an overview of three of the most influential basic theories of learning, upon which many teachers rely in their practical applications, which must be considered by radiologist who act as medical educators.

A survey of mindset theories of intelligence and medical error self-reporting among pediatric housestaff and faculty.

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Jegathesan, Mithila; Vitberg, Yaffa M; Pusic, Martin V

2016-02-11

Intelligence theory research has illustrated that people hold either "fixed" (intelligence is immutable) or "growth" (intelligence can be improved) mindsets and that these views may affect how people learn throughout their lifetime. Little is known about the mindsets of physicians, and how mindset may affect their lifetime learning and integration of feedback. Our objective was to determine if pediatric physicians are of the "fixed" or "growth" mindset and whether individual mindset affects perception of medical error reporting.  We sent an anonymous electronic survey to pediatric residents and attending pediatricians at a tertiary care pediatric hospital. Respondents completed the "Theories of Intelligence Inventory" which classifies individuals on a 6-point scale ranging from 1 (Fixed Mindset) to 6 (Growth Mindset). Subsequent questions collected data on respondents' recall of medical errors by self or others. We received 176/349 responses (50 %). Participants were equally distributed between mindsets with 84 (49 %) classified as "fixed" and 86 (51 %) as "growth". Residents, fellows and attendings did not differ in terms of mindset. Mindset did not correlate with the small number of reported medical errors. There is no dominant theory of intelligence (mindset) amongst pediatric physicians. The distribution is similar to that seen in the general population. Mindset did not correlate with error reports.

Why assessment in medical education needs a solid foundation in modern test theory.

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Schauber, Stefan K; Hecht, Martin; Nouns, Zineb M

2018-03-01

Despite the frequent use of state-of-the-art psychometric models in the field of medical education, there is a growing body of literature that questions their usefulness in the assessment of medical competence. Essentially, a number of authors raised doubt about the appropriateness of psychometric models as a guiding framework to secure and refine current approaches to the assessment of medical competence. In addition, an intriguing phenomenon known as case specificity is specific to the controversy on the use of psychometric models for the assessment of medical competence. Broadly speaking, case specificity is the finding of instability of performances across clinical cases, tasks, or problems. As stability of performances is, generally speaking, a central assumption in psychometric models, case specificity may limit their applicability. This has probably fueled critiques of the field of psychometrics with a substantial amount of potential empirical evidence. This article aimed to explain the fundamental ideas employed in psychometric theory, and how they might be problematic in the context of assessing medical competence. We further aimed to show why and how some critiques do not hold for the field of psychometrics as a whole, but rather only for specific psychometric approaches. Hence, we highlight approaches that, from our perspective, seem to offer promising possibilities when applied in the assessment of medical competence. In conclusion, we advocate for a more differentiated view on psychometric models and their usage.

Approach to the notice of insanity. Symptom - mental health and clinical structures. Psychology and psychoanalysis

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Jorge Enrique Chacón-Afanador

2017-09-01

Full Text Available The present work of reflection proposes the approach of the concepts of clinical structures and mental health, starting from the position of psychoanalysis and the question is asked if it is possible to think the madness within them. To do this, it starts from an approach to training and symptom in psychoanalysis and psychology, pointing out the importance of differentiating the psychic from the organic, as well as the psychic from the mental. In this sense, the concept of mental health proposed by WHO is addressed and the place of psychology and psychoanalysis in this concept is questioned. In the same way a reflection is made around the questions: Is it possible to speak of madness in the XXI century, when psychiatry has tried to eradicate this term? To talk about crazy again is to return to a debate that has somehow been left out of the scientific debate? Is it possible to think nowadays the importance of elaborating a nosography that includes Insanity?

The theory of planned behaviour in medical education: a model for integrating professionalism training.

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Archer, Ray; Elder, William; Hustedde, Carol; Milam, Andrea; Joyce, Jennifer

2008-08-01

Teaching and evaluating professionalism remain important issues in medical education. However, two factors hinder attempts to integrate curricular elements addressing professionalism into medical school training: there is no common definition of medical professionalism used across medical education, and there is no commonly accepted theoretical model upon which to integrate professionalism into the curriculum. This paper proposes a definition of professionalism, examines this definition in the context of some of the previous definitions of professionalism and connects this definition to the attitudinal roots of professionalism. The problems described above bring uncertainty about the best content and methods with which to teach professionalism in medical education. Although various aspects of professionalism have been incorporated into medical school curricula, content, teaching and evaluation remain controversial. We suggest that intervening variables, which may augment or interfere with medical students' implementation of professionalism knowledge, skills and, therefore, attitudes, may go unaddressed. We offer a model based on the theory of planned behaviour (TPB), which describes the relationships of attitudes, social norms and perceived behavioural control with behaviour. It has been used to predict a wide range of behaviours, including doctor professional behaviours. Therefore, we propose an educational model that expands the TPB as an organisational framework that can integrate professionalism training into medical education. We conclude with a discussion about the implications of using this model to transform medical school curricula to develop positive professionalism attitudes, alter the professionalism social norms of the medical school and increase students' perceived control over their behaviours.

Using Social Cognitive Theory to Predict Medication Compliance Behavior in Patients with Depression in Southern United States in 2016 in a Cross-Sectional Study.

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Bennett, Britney; Sharma, Manoj; Bennett, Russell; Mawson, Anthony R; Buxbaum, Sarah G; Sung, Jung Hye

2018-03-01

Introduction: Depression is a major public health issue. One of the concerns in depression research and practice pertains to non-compliance to prescribed medications. The purpose of the study was to predict compliance with medication use for patients with depression using social cognitive theory (SCT). Based on this study it was envisaged that recommendations for interventions to enhance compliance for medication use could be developed for patients with depression. Methods: The study was conducted using cross sectional design (n=148) in southern United States with a convenience sample of clinic-based depression patients with a 37-item valid and reliable questionnaire. Sample size was calculated to be 148 using G*Power (five predictors with a 0.80 power at the 0.05 alpha level and an estimated effect size of 0.10 with an inflation by 10% for missing data). Social cognitive theory constructs of expectations, self-efficacy and self-efficacy in overcoming barriers, self-control, and environment were reified. Data were analyzed using multiple linear regression and multiple logistic regression analyses. Results: Self-control for taking medication for depression (P=0.04), expectations for taking medication for depression (P=0.025), age (P<0.0001) and race (P=0.04) were significantly related to intent for taking medication for depression (Adjusted R 2 = 0.183). In race, Blacks had lower intent to take medication for depression. Conclusion: Social cognitive theory is weakly predictive with low explained variance for taking medication for depression. It needs to be bolstered by newer theories like integrative model or multi-theory model of health behavior change for designing educational interventions aimed at enhancing compliance to medication for depression.

Using Social Cognitive Theory to Predict Medication Compliance Behavior in Patients with Depression in Southern United States in 2016 in a Cross-Sectional Study

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Britney Bennett

2018-03-01

Full Text Available Introduction: Depression is a major public health issue. One of the concerns in depression research and practice pertains to non-compliance to prescribed medications. The purpose of the study was to predict compliance with medication use for patients with depression using social cognitive theory (SCT. Based on this study it was envisaged that recommendations for interventions to enhance compliance for medication use could be developed for patients with depression. Methods: The study was conducted using cross sectional design (n=148 in southern United States with a convenience sample of clinic-based depression patients with a 37-item valid and reliable questionnaire. Sample size was calculated to be 148 using G*Power (five predictors with a 0.80 power at the 0.05 alpha level and an estimated effect size of 0.10 with an inflation by 10% for missing data. Social cognitive theory constructs of expectations, self-efficacy and self-efficacy in overcoming barriers, self-control, and environment were reified. Data were analyzed using multiple linear regression and multiple logistic regression analyses. Results: Self-control for taking medication for depression (P=0.04, expectations for taking medication for depression (P=0.025, age (P<0.0001 and race (P=0.04 were significantly related to intent for taking medication for depression (Adjusted R2 = 0.183. In race, Blacks had lower intent to take medication for depression. Conclusion: Social cognitive theory is weakly predictive with low explained variance for taking medication for depression. It needs to be bolstered by newer theories like integrative model or multi-theory model of health behavior change for designing educational interventions aimed at enhancing compliance to medication for depression.

'Shrouded in a dark fog': comparison of the diagnosis of pellagra in Venice and general paralysis of the insane in the United Kingdom, 1840-1900.

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Priani, Egidio

2017-06-01

The debate on the causes and the nature of pellagra in Italy during the nineteenth century resembles and evokes the similar debate on General Paralysis of the Insane (GPI) that was growing at the same time in the United Kingdom. Pellagra and GPI had a massive and virulent impact on the populations of Italy and the UK, respectively, and contributed to a great extent to the increase and overcrowding of the asylum populations in these countries. This article compares the two illnesses by examining the features of their nosographic positioning, aetiology and pathogenesis. It also documents how doctors arrived at the diagnoses of the two diseases and how this affected their treatment.

Establishment of medical education upon internalization of virtue ethics: bridging the gap between theory and practice.

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Madani, Mansoureh; Larijani, Bagher; Madani, Ensieh; Ghasemzadeh, Nazafarin

2017-01-01

During medical training, students obtain enough skills and knowledge. However, medical ethics accomplishes its goals when, together with training medical courses, it guides students behavior towards morality so that ethics-oriented medical practice is internalized. Medical ethics is a branch of applied ethics which tries to introduce ethics into physicians' practice and ethical decisions; thus, it necessitates the behavior to be ethical. Therefore, when students are being trained, they need to be supplied with those guidelines which turn ethical instructions into practice to the extent possible. The current text discusses the narrowing of the gap between ethical theory and practice, especially in the field of medical education. The current study was composed using analytical review procedures. Thus, classical ethics philosophy, psychology books, and related articles were used to select the relevant pieces of information about internalizing behavior and medical education. The aim of the present study was to propose a theory by analyzing the related articles and books. The attempt to fill the gap between medical theory and practice using external factors such as law has been faced with a great deal of limitations. Accordingly, the present article tries to investigate how and why medical training must take internalizing ethical instructions into consideration, and indicate the importance of influential internal factors. Virtue-centered education, education of moral emotions, changing and strengthening of attitudes through education, and the wise use of administrative regulations can be an effective way of teaching ethical practice in medicine.

The theory of planned behaviour explains intentions to use antiresorptive medication after a fragility fracture.

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Sale, Joanna E M; Cameron, Cathy; Thielke, Stephen; Meadows, Lynn; Senior, Kevin

2017-06-01

Our objective was to ascertain whether the Theory of Planned Behaviour (TPB) explains patient intentions to use antiresorptive medication after a fracture. A qualitative study was conducted with English-speaking members of the Canadian Osteoporosis Patient Network (COPN) who had sustained a fragility fracture at 50+ years of age and were not taking antiresorptive medication at the time of that fracture. Questions during a 1-h telephone interview were guided by the domains of the TPB: they addressed the antecedent constructs regarding antiresorptive medication (attitudes, subjective norms, and perceived behavioural control) as well as intentions regarding antiresorptive medication use. We created a coding template a priori based on the TPB domains and applied this template to the interview data. Twenty-six eligible participants (24 females, 2 males) aged 51-89 completed an interview. The TPB appeared to be predictive of intentions in 19 (73%) participants. In the majority of participants where the TPB did not appear to be predictive (57%), a positive attitude toward antiresorptive medication was the most important antecedent variable in determining intentions. The TPB appeared to be predictive of intentions to use antiresorptive medication among individuals who had experienced a fragility fracture. Attitudes towards medication were especially important.

Factors affecting nursing students' intention to report medication errors: An application of the theory of planned behavior.

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Ben Natan, Merav; Sharon, Ira; Mahajna, Marlen; Mahajna, Sara

2017-11-01

Medication errors are common among nursing students. Nonetheless, these errors are often underreported. To examine factors related to nursing students' intention to report medication errors, using the Theory of Planned Behavior, and to examine whether the theory is useful in predicting students' intention to report errors. This study has a descriptive cross-sectional design. Study population was recruited in a university and a large nursing school in central and northern Israel. A convenience sample of 250 nursing students took part in the study. The students completed a self-report questionnaire, based on the Theory of Planned Behavior. The findings indicate that students' intention to report medication errors was high. The Theory of Planned Behavior constructs explained 38% of variance in students' intention to report medication errors. The constructs of behavioral beliefs, subjective norms, and perceived behavioral control were found as affecting this intention, while the most significant factor was behavioral beliefs. The findings also reveal that students' fear of the reaction to disclosure of the error from superiors and colleagues may impede them from reporting the error. Understanding factors related to reporting medication errors is crucial to designing interventions that foster error reporting. Copyright © 2017 Elsevier Ltd. All rights reserved.

Combined evaluations of competency to stand trial and mental state at the time of the offense: An overlooked methodological consideration?

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Kois, Lauren; Wellbeloved-Stone, James M; Chauhan, Preeti; Warren, Janet I

2017-06-01

Combined evaluations of competency to stand trial (CST; competency) and mental state at the time of the offense (MSO; sanity) frequently co-occur. However, most research examines the 2 as discrete constructs without considering 4 potential combined evaluation outcomes: competent-sane, incompetent-sane, competent-insane, and incompetent-insane. External validity can be improved if research more closely mirrored practice. It may be incorrect to assume incompetent defendants are similar across CST-only and combined evaluations, and insane defendants are similar across MSO-only and combined evaluations. Using a sample of 2,751 combined evaluations, we examined demographic, clinical, offense, evaluation, and psycholegal characteristics associated with evaluators' combined evaluation opinions. Multinomial regression analyses revealed older defendants were more likely to be opined incompetent-insane. Defendants with psychotic disorders were more often opined insane, regardless of competency status. Affective diagnoses predicted competent-insane opinions. Developmental disorders were closely related to incompetence, regardless of sanity status. Defendants with organic disorders tended to have global psycholegal impairment, in that they were more often opined incompetent-insane, incompetent-sane, or competent-insane, relative to competent-sane. Prior hospitalization predicted competent-insane relative to competent-sane opinions. Defendants not under the influence of a substance during the offense or with no prior convictions were more likely to be opined insane, regardless of competency status. We interpret these findings in light of psycholegal theory and provide recommendations for research and practice. Collectively, results suggest incorporation of combined evaluations into CST and MSO research is an important methodological consideration not to be overlooked. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The irresistible fascination of medical theories about opposites.

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Angeletti, L R; Frati, L

1989-01-01

Theurgical medicine was a part of the eternal fight between good and evil and health was reconciliation with the gods. This duality characterized ancient medicine, i.e. Greek medicine after the Homeric age or Chinese traditional medicine. In the passage to medicine of observation due to the School of Cos duel between good and evil becomes substrate of new medicine and the balances between*opposites represented by elements and qualities were the fundaments of the humoralism. Fascination of opposites continues for centuries up to now, both in western and far eastern medicine: yin/yang, antibody/antigen, cAMP/cGMP, oncogene/antioncogene are examples of this attractive theory. Although fundaments of biological and medical observations are the basis of theories of opposites, the trend is to overcome reality and today represents, following idealism in the 19th century, an inconscious ancestral reminiscence of theurgical philosophy and medicine.

Kepler's theory of force and his medical sources.

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Regier, Jonathan

2014-01-01

Johannes Kepler (1571-1630) makes extensive use of souls and spiritus in his natural philosophy. Recent studies have highlighted their importance in his accounts of celestial generation and astrology. In this study, I would like to address two pressing issues. The first is Kepler's context. The biological side of his natural philosophy is not naively Aristotelian. Instead, he is up to date with contemporary discussions in medically flavored natural philosophy. I will examine his relationship to Melanchthon's anatomical-theological Liber de anima (1552) and to Jean Femel's very popular Physiologia (1567), two Galenic sources with a noticeable impact on how he understands the functions of life. The other issue that will direct my article is force at a distance. Medical ideas deeply inform Kepler's theories of light and solar force (virtus motrix). It will become clear that they are not a hindrance even to the hardcore of his celestial physics. Instead, he makes use of soul and spiritus in order to develop a fully mathematized dynamics.

Decision theory on the quality evaluation of medical images

International Nuclear Information System (INIS)

Lessa, Patricia Silva

2001-10-01

The problem of quality has been a constant issue in every organization.One is always seeking to produce more, to do it at a lower cost, and to do it with better quality. However, in this country, there is no radiographic film quality control system for radiographic services. The tittle that actually gets done is essentially ad hoc and superficial. The implications of this gap, along with some other shortcomings that exist in process as a whole (the state of the x-ray equipment, the adequate to use in order to obtain a radiography, the quality of the film, the processing of the film, the brightness and homogeneity of the viewing boxes, the ability of the radiologist), have a very negative impact on the quality of the medical image, and, as result, to the quality of the medical diagnosis and therapy. It frequently happens that many radiographs have to be repeated, which leads to an increase of the patient's exposure to radiation, as well as of the cost of the procedure for the patient. Low quality radiographs that are not repeated greatly increase the probability of a wrong diagnosis, and consequently, of inadequate therapeutical procedures, thus producing increased incidence of bad outcomes and higher costs. The paradigm proposed in order to establish a system for the measurement of the image's quality is Decision Theory. The problem of the assessment of the image is studied by proposing a Decision Theory approach. The review of the literature reveals a great concern with the quality of the image, along with an absence of an adequate paradigm and several essentially empirical procedures. Image parameters are developed in order to formalize the problem in terms of Decision Theory, and various aspects of image digitalisation are exposed. Finally, a solution is presented, including a protocol for quality control. (author)

The Theory of Action in the light of the schizo experience: an study of insane epistemology

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Gabriel Peters

2016-12-01

device that has proven fruitful in a variety of research domains, namely the plunge into the realm of the “pathological” as a pathway to illuminate “normal” modalities of action and experience. Resorting to this strategy on the plane of sociological characterizations of human conduct, the article harnesses phenomenological and existential descriptions of schizoid and schizophrenic experiences, not only to understand these in the light of the praxeological theory of action, but also to deepen the praxeological theory of action in the light of what such descriptions teach us about the multiplicity of ways of being-in-the-world displayed by the anthropos. The study defends that these transformations, despite their psychic costs, must not be conceived as mere functional deficits, but rather as complex existential attitudes which defy, in practice, certain postulates of the praxeological theory of action: the grounding upon tacit beliefs is replaced with a hyper-reflexive compulsion, the pragmatic relationship with material objects gives way to a quasi-philosophical perplexity in face of their mere reality, the inter-subjective agreements that offer familiarity and order to social reality in a given culture are perceived in their radical ontological arbitrariness, and the estrangement from one’s own body ceases to be a playful Cartesian skepticism so as to become a profound existential experience.

Fake insanes and fools: another way of playing (without disguise in Lope de Vega's theatre

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José Enrique López Martínez

2014-05-01

Full Text Available Abstract:In this work I study the theme of fake insanity and foolishness in Spanish Baroque Drama, starting with the work of Lope de Vega. In the first place, I consider some important sources in Italian Drama, specially Grazzini’s La Spiritata and Girolamo Bargagli’s La Pellegrina. Afterwards, I analyse in chronological order some of Lope’s plays that introduce this theme in Hispanic Theater, written at the turn of the XVIIth Century, such as Los locos de Valencia and El mármol de Felisardo; until many late plays by Lope and other playwrights that kept on reproducing the literary elements of those early comedias. In this survey, I examine the metatheatrical sense of fake insanity, the dramatic subgenres where it was featured, its importance for the plots, and its relation to other forms of dramatic deception, like the woman in male disguise and the nobleman as servant; as well as some dramatic and literary devices it relied on: the different kinds of simulated madness, its discoursive features, and the motif of the fake wedding. Resumen:En este trabajo se analiza el desarrollo del tema de la locura y la simpleza fingida en el teatro barroco español, a partir de la obra de Lope de Vega. Primero, se consideran algunos importantes antecedentes italianos, especialmente las obras La Spiritata, de Grazzini, y La Pellegrina, de Girolamo Bargagli. Después, se analizan con detalle y en orden cronológico algunas comedias del Fénix escritas en la última década del siglo XVI y primera del XVII en que introduce este tema en el teatro hispánico, como Los locos de Valencia o El mármol de Felisardo, hasta mencionar varias obras tardías del propio Lope y otros autores que continuaron reproduciendo los recursos de aquellas comedias tempranas. En este recorrido, se hace énfasis en el carácter metateatral de la locura fingida, los subgéneros dramáticos en la que fue incluida, importancia argumental, formas de caracterización y relación con

Ethnic Differences And Motivation Based On Maslow’s Theory At a MedicaL University

OpenAIRE

Jagmohni Kaur Sidhu

2007-01-01

Introduction: Motivation in Malaysia is to a largeextent influenced by the value system amongst allMalaysians. Being able to motivate employees is one ofthe important keys to the success of the organization.In this paper, an attempt was made to look into theneeds of employees in organizations and in particular,the needs based on Maslow’s theory on motivation. Subjects and Methods: Employees which consisted ofboth academic and administrative employees of theInternational Medical University (...

Peculiarities of medical sociology: application of social theories in analyzing health and medicine.

Science.gov (United States)

Kaminskas, Raimundas; Darulis, Zilvinas

2007-01-01

To reveal the peculiarities of medical sociology introducing the application of social theories in analyzing public health and medicine. Comparative and descriptive analysis of scientific references found and current situation. During the last decade of the 20th century, the discussions about the sociology of health and medicine as separate discipline and its practical applications became more active. Main factors determined the growing importance of discipline were institutionalization of medicine and health care, changing patterns in doctor-patient relationships, different health perceptions, understanding of the influence of social factors on health, cardinal changes in the area of health technologies, consumeristic attitude towards health, appearance of market relationships within health care, and other global phenomena. In sociology, usual social theories such as structural functionalism, conflict, symbolic interaction, poststructuralism, feminist often attempt to explain the changes within health care. There is a relation of medical sociology and other types of sociology having common areas with medicine and health being analyzed in the article; social theories and their application in the field of health and medicine are being introduced attempting to explain the ongoing social changes in both Lithuania and the world. More and more attention in various areas of medical activities is being paid to the social aspects (both individual and society levels) of these activities, and there is a shift from applied sociology towards medical one. Despite the cessations of the development of medical sociology as separate branch of sciences, the researches of recent years are demonstrating obvious approaching modern research issues and methods, which do exist in contemporary world. Such tendencies show the prompt approaching of the academic community of Lithuania the general scientific standards which are dominating in the globalization-effected world.

The relationship between the theory of planned behavior and medication adherence in patients with epilepsy.

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Lin, Chung-Ying; Updegraff, John A; Pakpour, Amir H

2016-08-01

The aim of this study was to apply the theory of planned behavior (TPB) with two other factors (action planning and coping planning) to the medication adherence of adults with epilepsy. We measured the elements of the theory of planned behavior (attitude, subjective norm, perceived behavioral control, and behavioral intention), action planning, and coping planning at baseline among adults with epilepsy (n=567, mean±SD age=38.37±6.71years, male=48.5%). Medication adherence was measured using the Medication Adherence Report Scale (MARS) and antiepileptic serum level at the 24-month follow-up. Structural equation modeling (SEM) examined three models relating TPB elements to medication adherence. Three SEM models all had satisfactory fit indices. Moreover, attitude, subjective norms, perceived behavioral control, and intention together explained more than 50% of the variance for medication adherence measured using MARS. The explained variance increased to 61.8% when coping planning and action planning were included in the model, with coping planning having greater association than action planning. In addition, MARS explained 3 to 5% of the objective serum level. The theory of planned behavior is useful in understanding medication adherence in adults with epilepsy, and future interventions may benefit by improving such beliefs as well as beliefs about coping planning. Copyright © 2016 Elsevier Inc. All rights reserved.

Theory of Change: a theory-driven approach to enhance the Medical Research Council's framework for complex interventions.

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De Silva, Mary J; Breuer, Erica; Lee, Lucy; Asher, Laura; Chowdhary, Neerja; Lund, Crick; Patel, Vikram

2014-07-05

The Medical Research Councils' framework for complex interventions has been criticized for not including theory-driven approaches to evaluation. Although the framework does include broad guidance on the use of theory, it contains little practical guidance for implementers and there have been calls to develop a more comprehensive approach. A prospective, theory-driven process of intervention design and evaluation is required to develop complex healthcare interventions which are more likely to be effective, sustainable and scalable. We propose a theory-driven approach to the design and evaluation of complex interventions by adapting and integrating a programmatic design and evaluation tool, Theory of Change (ToC), into the MRC framework for complex interventions. We provide a guide to what ToC is, how to construct one, and how to integrate its use into research projects seeking to design, implement and evaluate complex interventions using the MRC framework. We test this approach by using ToC within two randomized controlled trials and one non-randomized evaluation of complex interventions. Our application of ToC in three research projects has shown that ToC can strengthen key stages of the MRC framework. It can aid the development of interventions by providing a framework for enhanced stakeholder engagement and by explicitly designing an intervention that is embedded in the local context. For the feasibility and piloting stage, ToC enables the systematic identification of knowledge gaps to generate research questions that strengthen intervention design. ToC may improve the evaluation of interventions by providing a comprehensive set of indicators to evaluate all stages of the causal pathway through which an intervention achieves impact, combining evaluations of intervention effectiveness with detailed process evaluations into one theoretical framework. Incorporating a ToC approach into the MRC framework holds promise for improving the design and evaluation of complex

Theory of Change: a theory-driven approach to enhance the Medical Research Council's framework for complex interventions

Science.gov (United States)

2014-01-01

Background The Medical Research Councils’ framework for complex interventions has been criticized for not including theory-driven approaches to evaluation. Although the framework does include broad guidance on the use of theory, it contains little practical guidance for implementers and there have been calls to develop a more comprehensive approach. A prospective, theory-driven process of intervention design and evaluation is required to develop complex healthcare interventions which are more likely to be effective, sustainable and scalable. Methods We propose a theory-driven approach to the design and evaluation of complex interventions by adapting and integrating a programmatic design and evaluation tool, Theory of Change (ToC), into the MRC framework for complex interventions. We provide a guide to what ToC is, how to construct one, and how to integrate its use into research projects seeking to design, implement and evaluate complex interventions using the MRC framework. We test this approach by using ToC within two randomized controlled trials and one non-randomized evaluation of complex interventions. Results Our application of ToC in three research projects has shown that ToC can strengthen key stages of the MRC framework. It can aid the development of interventions by providing a framework for enhanced stakeholder engagement and by explicitly designing an intervention that is embedded in the local context. For the feasibility and piloting stage, ToC enables the systematic identification of knowledge gaps to generate research questions that strengthen intervention design. ToC may improve the evaluation of interventions by providing a comprehensive set of indicators to evaluate all stages of the causal pathway through which an intervention achieves impact, combining evaluations of intervention effectiveness with detailed process evaluations into one theoretical framework. Conclusions Incorporating a ToC approach into the MRC framework holds promise for

The Study of Electronic Medical Record Adoption in a Medicare Certified Home Health Agency Using a Grounded Theory Approach

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May, Joy L.

2013-01-01

The purpose of this qualitative grounded theory study was to examine the experiences of clinicians in the adoption of Electronic Medical Records in a Medicare certified Home Health Agency. An additional goal for this study was to triangulate qualitative research between describing, explaining, and exploring technology acceptance. The experiences…

Building bridges between theory and practice in medical education using a design-based research approach: AMEE Guide No. 60.

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Dolmans, Diana H J M; Tigelaar, D

2012-01-01

Medical education research has grown enormously over the past 20 years, but it does not sufficiently make use of theories, according to influential leaders and researchers in this field. In this AMEE Guide, it is argued that design-based research (DBR) studies should be conducted much more in medical education design research because these studies both advance the testing and refinement of theories and advance educational practice. In this Guide, the essential characteristics of DBR as well as how DBR differs from other approach such as formative evaluation are explained. It is also explained what the pitfalls and challenges of DBR are. The main challenges deal with how to insure that DBR studies reveal findings that are of a broader relevance than the local situation and how to insure that DBR contributes toward theory testing and refinement. An example of a series of DBR studies on the design of a teaching portfolio in higher education that is aimed at stimulating a teacher's professional development is described, to illustrate how DBR studies actually work in practice. Finally, it is argued that DBR-studies could play an important role in the advancement of theory and practice in the two broad domains of designing or redesigning work-based learning environments and assessment programs.

PENINGKATAN AKTIFITAS DAN HASIL BELAJAR DENGAN METODE PROBLEM BASIC LEARNING (PBL PADA MATA PELAJARAN TUNE UP MOTOR BENSIN SISWA KELAS XI DI SMK INSAN CENDEKIA TURI SLEMAN TAHUN AJARAN 2015/2016

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Hermawan Budi Santoso

2017-06-01

Full Text Available The aim of this research is to know the increase of learning activityand result using Problem Based Learning in motorbike gasoline Tune-up lesson for students in grade XI SMK Insan Cendekia Sleman. This research is a kind of action research, which in the process applying the PBL method. This research has 4 steps, which are planning, application, observation and reflection. The observation of students activity in applying PBL learning is done by going to the class directly while the learning process is still ongoing. While, the result of student learning is measured by first assessment and final assessment. The result shows that after PBL method which is given to the students there is an increase of learning activity in amount 60%, while the increase of learning result in time of observation is approximately getting 6,5 for average mark First cycle, the average mark is 6,5, while for the second cycle 6,8 and 7,3 for third cycle. These evidences show PBL method application can increase the learning activity and result using Problem Based Learning in motorbike gasoline Tune-up lesson for students in grade XI SMK Insan Cendekia Sleman

Curing "moral disability": brain trauma and self-control in Victorian science and fiction.

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Schillace, Brandy L

2013-12-01

While, historically, the disabled body has appeared in literature as "monstrous," burgeoning psychological theories of the Victorian period predicated an unusual shift. In a culture of sexual anxiety and fears of devolution and moral decay, the physically disabled and "weak" are portrayed as strangely free from moral corruption. Unlike the cultural link between deviance and disability witnessed in the medical literature and eugenic approach to generation, authors of narrative fiction-particularly Charles Dickens, but Wilkie Collins, Charlotte Yonge, and others as well-portray disabled characters as "purified," and trauma itself as potentially sanitizing. This present paper argues that such constructions were made possible by developments in the treatment of insanity. "Curing 'Moral Disability': Brain Trauma and Self-Control in Victorian Fiction," examines the concept of trauma-as-cure. Throughout the Victorian period, case studies on brain trauma appeared in widely circulated journals like the Lancet, concurrently with burgeoning theories about psychological disturbance and "moral insanity." While not widely practiced until the early twentieth century, attempts at surgical "cures" aroused curiosity and speculation-the traumatic event that could free sufferers from deviance. This work provides a unique perspective on representations of disability as cure in the nineteenth century as a means of giving voice to the marginalized, disabled, and disempowered.

Mental Health Professionals' Attitudes Toward Offenders With Mental Illness (Insanity Acquittees) in Ghana.

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Adjorlolo, Samuel; Abdul-Nasiru, Inusah; Chan, Heng Choon Oliver; Bambi, Laryea Efua

2018-02-01

Mental health professionals' attitudes toward offenders with mental illness have significant implications for the quality of care and treatment rendered, making it imperative for these professionals to be aware of their attitudes. Yet, this topical issue has received little research attention. Consequently, the present study investigates attitudes toward offenders with mental illness (insanity acquittees) in a sample of 113 registered mental health nurses in Ghana. Using a cross-sectional survey and self-report methodology, the participants respond to measures of attitudes toward offenders with mental illness, attitudes toward mental illness, conviction proneness, and criminal blameworthiness. The results show that mental health nurses who reportedly practiced for a longer duration (6 years and above) were more likely to be unsympathetic, while the male nurses who were aged 30 years and above were more likely to hold offenders with mental illness strictly liable for their offenses. Importantly, the nurses' scores in conviction proneness and criminal blameworthiness significantly predict negative attitudes toward the offenders even after controlling for their attitudes toward mental illness. Yet, when the nurses' conviction proneness and criminal blameworthiness were held constant, their attitudes toward mental illness failed to predict attitudes toward the offenders. This initial finding implies that the nurses' views regarding criminal blameworthiness and conviction may be more influential in understanding their attitudes toward offenders with mental illness relative to their attitudes toward mental illness.

Is expected utility theory normative for medical decision making?

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Cohen, B J

1996-01-01

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

“Dead Souls”: Gogol’s Interpretation of the State of Insanity

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Olha Chervinska

2013-12-01

Full Text Available Actual outline of creating the concept of literary insanity (in the aspect of poetics of dialogue, narrative, motif of duality, etc. is overviewed. The article states that in the fiction by Nicolai Gogol a graduated sequence of various states and degrees of madness is fully represented in “The Collected Petersburg Tales”. Here, this paradigm is considered to be the principle of graduation in all levels of manner as a key suggestive genre construct of “Dead Souls”. The mental isomorphism of the paradigm meaning content, associated with the peculiarities of the religious, as well as the verbal, consciousness is emphasized in the article. The author stresses that the anthropological vector of Gogol's attention is directed towards the ordinary “despicable and stupid in the life”. The ironic example of the discursive metaphor of a pendulum of history (the philosophical background of the text is the slip-in parable of Kif Mokievich and his son Mokii Kifovich. Both characters are at opposite sides of the proper. The world of human relations in “Dead Souls” is reflected in the most straightforward analogies with constant teeming world of different microscopic creatures. To give prominence to the human image Gogol refers to the colourful ontological metaphor, ultimately identifying and equating the person with ordinary fly, which in this text is a significant element of the whole hyper-realistic person-sphere. Conversion of large to small or small to large is the dimensioned game of the author’s strategy in the literal sense. In “Dead Souls” the denoted topic decisively grounds for the genre of the poem.

Direitos das pessoas com transtorno mental autoras de delitos The rights of criminally insane individuals

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Ludmila Cerqueira Correia

2007-09-01

Full Text Available O Movimento pela Reforma Psiquiátrica tem subsidiado propostas de reorientação do modelo assistencial hegemônico em saúde mental. Para a assistência às pessoas com transtorno mental autoras de delitos instituiu-se o manicômio judiciário, atualmente denominado Hospital de Custódia e Tratamento Psiquiátrico (HCTP. A manutenção dessa estrutura, reconhecida como instituição total, tem reforçado a exclusão individual, limitando a reinserção social dos internos. Este artigo discute o direito à saúde nos HCTP na perspectiva dos direitos humanos. Os avanços conferidos pela Política Nacional de Saúde Mental não têm contemplado a reorientação da prática assistencial desenvolvida no âmbito do HCTP. Essa instituição tem preservado o seu caráter asilar/segregacionista, evidenciando uma tradição fundada na negação dos direitos humanos. O avanço normativo não consolida, de per si, a materialização das recentes conquistas advindas a partir da Reforma Psiquiátrica, particularmente quanto ao segmento das pessoas com transtorno mental autoras de delitos. O Estado, em co-responsabilidade com a sociedade, deve promover a efetiva reorientação do modelo de atenção à saúde dessas pessoas, cuja responsabilidade penal deverá ser reconhecida ao tempo em que se propicie o tratamento especializado. O respeito aos direitos humanos não implica a inimputabilidade.The Psychiatric Reform Movement has supported proposals to reorient the hegemonic mental health care model. In Brazil, a facility for the criminally insane was created, called the Custody and Psychiatric Treatment Hospital (CPTH. The maintenance of such a structure, known as total institutionalization, has reinforced individual exclusion, limiting the patients' social rehabilitation. This article discusses the right to health in the CPTH from a human rights perspective. The advances achieved in Brazil under the National Mental Health Policy have failed to include

Using the Theory of Planned Behaviour to examine health professional students' behavioural intentions in relation to medication safety and collaborative practice.

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Lapkin, Samuel; Levett-Jones, Tracy; Gilligan, Conor

2015-08-01

Safe medication practices depend upon, not only on individual responsibilities, but also effective communication and collaboration between members of the medication team. However, measurement of these skills is fraught with conceptual and practical difficulties. The aims of this study were to explore the utility of a Theory of Planned Behaviour-based questionnaire to predict health professional students' behavioural intentions in relation to medication safety and collaborative practice; and to determine the contribution of attitudes, subjective norms, and perceived control to behavioural intentions. A descriptive cross-sectional survey based upon the Theory of Planned Behaviour was designed and tested. A convenience sample of 65 undergraduate pharmacy, nursing and medicine students from one semi-metropolitan Australian university were recruited for the study. Participants' behavioural intentions, attitudes, subjective norms, and perceived control to behavioural intentions in relation to medication safety were measured using an online version of the Theory of Planned Behaviour Medication Safety Questionnaire. The Questionnaire had good internal consistency with a Cronbach's alpha of 0.844. The three predictor variables of attitudes, subjective norms, and perceived control accounted for between 30 and 46% of the variance in behavioural intention; this is a strong prediction in comparison to previous studies using the Theory of Planned Behaviour. Data analysis also indicated that attitude was the most significant predictor of participants' intention to collaborate with other team members to improve medication safety. The results from this study provide preliminary support for the Theory of Planned Behaviour-Medication Safety Questionnaire as a valid instrument for examining health professional students' behavioural intentions in relation to medication safety and collaborative practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

Who Am I, and Who Do I Strive to Be? Applying a Theory of Self-Conscious Emotions to Medical Education.

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Bynum, William E; Artino, Anthony R

2018-06-01

The self-conscious emotions of shame, guilt, and pride are a distinct set of cognitively complex, powerful, and ubiquitous emotions that arise when an individual engages in self-evaluation. Currently, little is known about the influence or outcomes of self-conscious emotions in medical learners. In this article, the authors present a leading theory of self-conscious emotions that outlines the appraisals and attributions that give rise to and differentiate shame, guilt, and two forms of pride. The authors then apply the theory to three relevant topics in medical education: perfectionism, professional identity formation, and motivation. In doing so, the authors present novel ways of viewing these topics through the lens of self-conscious emotion, suggest areas of future research, and outline a framework for emotional resilience training. Ultimately, the goal of this article is to highlight the fundamental nature of shame, guilt, and pride, which the authors believe are underappreciated and understudied in medical education, and to inform future empirical study on the role that these emotions might play in medical education. Additionally, from a practical standpoint, this article aims to encourage educators and learners to recognize self-conscious emotions in themselves and their colleagues, and to begin developing more resilient approaches to learning-approaches that acknowledge and confront shame, guilt, and pride in medical education.

The evolution of cognitive load theory and its application to medical education

NARCIS (Netherlands)

Leppink, Jimmie; van den Heuvel, Angelique

Cognitive Load Theory (CLT) has started to find more applications in medical education research. Unfortunately, misconceptions such as lower cognitive load always being beneficial to learning and the continued use of dated concepts and methods can result in improper applications of CLT principles in

Complementary medicines in medicine: Conceptualising terminology among Australian medical students using a constructivist grounded theory approach.

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Templeman, Kate; Robinson, Anske; McKenna, Lisa

2015-02-01

Terminology around the use of complementary medicines (CM) within medical discourse is ambiguous. Clear collective discourse within the medical context is required. This study reports the findings of a Constructivist Grounded Theory Method study used to explore medical students' conceptualisation of terminology and associated value components around CMs as evidenced within their discourse community. The results show that terminology surrounding CMs within medicine is politically charged and fraught with value judgements. Terms used to describe CMs were considered, many of which were deemed problematic. Categorisation of specific medicines was also deemed inappropriate in certain contexts. Conceptualisation of CM terminology, categorisation and value implications, discriminated between levels of evidence for CMs and provided insights into the social change of medicine towards emergence of an evidence-based integrative approach. The results show that terminology surrounding CM is a social construct consistent with fluid conceptualisation and operationalisation in different social contexts. Copyright © 2015 Elsevier Ltd. All rights reserved.

The enforcement regulation for the law for radiation and x-ray technicians engaging in medical treatment

International Nuclear Information System (INIS)

1978-01-01

These provisions are established on the basis of and to enforce the ''Law for radiation and X-ray technicians engaging in medical treatment''. Applications for the license of radiation and X-ray technicians engaging in medical treatment shall be filed, attached with a copy or an abstract of the census register of the applicant and a medical certificate by a doctor of whether the applicant is an insane, a deaf, a dumb or a blind person or a person caught by an infectious disease or not. In the register of such technicians, the number and the date of registration, the names of the prefectures where the technicians are legally domiciled, their names and the date of birth, the year and month of passing the examination, the matters concerning withdrawal of the license or suspension of the practice must be written. The date and the place of the examination for such technicians shall be published beforehand on the official gazette. The examinations for such radiation and X-ray technicians are made on the subjects, such as physics, electrical engineering, chemistry, elementary medical science, radiology, photographing technique, medical treatment technique and control technique. (Okada, K.)

STRATEGI PENINGKATAN ASET PT BPR SYARIAH HARTA INSAN KARIMAH (HIK CILEDUG

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Fajri Ryan Isnandar

2016-01-01

Full Text Available The objectives of this study were 1 to analyze the conditions of the performance competition on the financial aspect of BPRS HIK Ciledug and the market leader in BPRS industry; 2 to identify the internal and external factors affecting the corporate development and strategic position of BPRS HIK Ciledug based on these factors; and 3 to formulate an accurate alternative strategy and a priority that can be recommended to the company in achieving its goals. Analysis of the evaluation of internal and external factors based on the components contained in the Shari'ah Maqashid and based on the components on The Porter's Five Forces. The analysis of the company's strategic position based on the market growth rate and relative market share on the internal strength was conducted by using BCG matrix (Boston Consulting Group, and the analysis on the alternative strategy formulation was conducted by using IE matrix (Internal-External Matrix, and the QSPM analysis served to determine the priority strategies to increase the assets of BPRS HIK Ciledug. The main weaknesses that should be handled is the lack of scoring systems of financing and the main opportunity is the great number of written requirements for obtaining the financing provided by its competitors. The prioritized strategies of SRB HIK Ciledug include: 1 product development strategy to create innovative products, 2 Market penetration strategy by changing the amount of share returns, 3 Market development strategy by opening new branches, and 4 Backward, forward and horizontal integration strategies by introducing products to various industries.Keywords:  strategies in increasing assets, sharia community financing bank, BPRS Harta Insan Karimah, QSPM

Applying the theory of constraints to the logistics service of medical records of a hospital

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Víctor-G. Aguilar-Escobar

2016-09-01

Full Text Available Management of patient records in a hospital is of major importance, for its impact both on the quality of care and on the associated costs. Since this process is circular, the prevention of the building up of bottlenecks is especially important. Thus, the objective of this paper was to analyze whether the Theory of Constraints (TOC can be useful to the logistics of medical records in hospitals. The paper is based on a case study conducted about the 2007-2011 period in the Medical Records Logistics Service at the Hospital Universitario Virgen Macarena in Seville (Spain. From April 2008, a set of actions in the clinical record logistics system were implemented based on the application of TOC principles. The results obtained show a significant increase in the level of service and employee productivity, as well as a reduction of cost and the number of patients’ complaints.

Four tenets of modern validity theory for medical education assessment and evaluation.

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Royal, Kenneth D

2017-01-01

Validity is considered by many to be the most important criterion for evaluating a set of scores, yet few agree on what exactly the term means. Since the mid-1800s, scholars have been concerned with the notion of validity, but over time, the term has developed a variety of meanings across academic disciplines and contexts. Accordingly, when scholars with different academic backgrounds, many of whom hold deeply entrenched perspectives about validity conceptualizations, converge in the field of medical education assessment, it is a recipe for confusion. Thus, it is important to work toward a consensus about validity in the context of medical education assessment. Thus, the purpose of this work was to present four fundamental tenets of modern validity theory in an effort to establish a framework for scholars in the field of medical education assessment to follow when conceptualizing validity, interpreting validity evidence, and reporting research findings.

Non-medical use of prescription stimulants for academic purposes among college students: a test of social learning theory.

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Ford, Jason A; Ong, Julianne

2014-11-01

The current research examines whether measures associated with Akers' social learning theory are related to non-medical use of prescription stimulants for academic reasons among college students. We examine data from a sample of 549 undergraduate students at one public university in the Southeastern United States. We estimate several logistic regression models to test our hypotheses. The findings indicated that roughly 17% of students reported non-medical use of prescription stimulants for academic reasons during the past year. In separate models, all four of the social learning measures were significantly correlated to non-medical use. In the complete model, the risk of non-medical prescription stimulant use for academic reasons was increased for respondents who reported more of their friends used and also for respondents who believed that prescription stimulants were an effective study aid. The current research fills an important gap in the literature regarding theoretical explanations for non-medical prescription stimulant use. Given the high prevalence of non-medical prescription stimulant use and the known risks associated with non-medical use this research can help inform intervention strategies for college populations. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Group processes in medical education: learning from social identity theory.

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Burford, Bryan

2012-02-01

The clinical workplace in which doctors learn involves many social groups, including representatives of different professions, clinical specialties and workplace teams. This paper suggests that medical education research does not currently take full account of the effects of group membership, and describes a theoretical approach from social psychology, the social identity approach, which allows those effects to be explored. The social identity approach has a long history in social psychology and provides an integrated account of group processes, from the adoption of group identity through a process of self-categorisation, to the biases and conflicts between groups. This paper outlines key elements of this theoretical approach and illustrates their relevance to medical education. The relevance of the social identity approach is illustrated with reference to a number of areas of medical education. The paper shows how research questions in medical education may be usefully reframed in terms of social identity in ways that allow a deeper exploration of the psychological processes involved. Professional identity and professionalism may be viewed in terms of self-categorisation rather than simply attainment; the salience of different identities may be considered as influences on teamwork and interprofessional learning, and issues in communication and assessment may be considered in terms of intergroup biases. Social identity theory provides a powerful framework with which to consider many areas of medical education. It allows disparate influences on, and consequences of, group membership to be considered as part of an integrated system, and allows assumptions, such as about the nature of professional identity and interprofessional tensions, to be made explicit in the design of research studies. This power to question assumptions and develop deeper and more meaningful research questions may be increasingly relevant as the nature and role of the medical profession change

Rethinking agency and medical adherence technology: applying Actor Network Theory to the case study of Digital Pills.

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Hurtado-de-Mendoza, Alejandra; Cabling, Mark L; Sheppard, Vanessa B

2015-12-01

Much literature surrounding medical technology and adherence posits that technology is a mechanism for social control. This assumes that the medical establishment can take away patients' agency. Although power relationships and social control can play a key role, medical technology can also serve as an agentive tool to be utilized. We (1) offer the alternative framework of Actor Network Theory to view medical technology, (2) discuss the literature on medication adherence and technology, (3) delve into the ramifications of looking at adherence as a network and (4) use Digital Pills as a case study of dispersed agency. © 2015 John Wiley & Sons Ltd.

MULTIPLE INTELLIGENCES THEORY – A MILESTONE INNOVATION IN ENGLISH LANGUAGE TEACHING AT THE UNIVERSITY OF NIŠ MEDICAL SCHOOL

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Nataša Bakić-Mirić

2010-06-01

Full Text Available Theory of multiple intelligences is considered an innovation in both teaching and learning English language because it helps students develop all the eight intelligences that are grouped as verbal/linguistic, logical/mathematical, visual/spatial, bodily/kinesthetic, musical/rhythmic, interpersonal, intrapersonal and naturalist. The aforementioned intelligences are thought to represent ways in which individuals understand and perceive the world, solve problems and learn. Correspondingly, by focusing on the problem solving activities, teachers, by implementing theory of multiple intelligences encourage students not only to build-up their existing language knowledge but also learn new content and skills. The implementation of the theory of multiple intelligences in teaching the English language at the University of Niš Medical School has had a positive impact on learning English language and increased students' interest in language learning. Genarally speaking, this theory offers a better understanding of students’ intelligence and a greater appreciation of their strengths. It provides numerous opportunities for students to use and develop all the eight intelligences not just the few they excel in prior to enrolling a university or college.

Incapacity of the Mind Secondary to Medication Misuse as a Not Criminally Responsible Defense.

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Prat, Sebastien S; Losier, Bruno J; Moulden, Heather M; Chaimowitz, Gary A

2017-01-01

The manifestations of disorders of the mind may play a role in the occurrence of criminal behavior. In the majority of the cases, the presence of a psychiatric disorder is cited as the reason that an individual was not fully aware of his behavior. However, other conditions, such as seizure disorders or hypoglycemia, have also been linked to an inability to understand the nature and consequences of one's actions. On occasion, these situations can be explained by a state of automatism that may be described as insane or noninsane. In this article, we describe the case of a 77-year-old man, suffering from Parkinson's disease, where the issue of criminal responsibility associated with incapacity of the mind secondary to medication misuse was raised. We elaborate on the thinking behind this opinion and the implications according to Canadian law. Although the legal outcome of this case is specific to our jurisdiction, the clinical implication may be common to any patient suffering from a similar condition and may inform physicians, families, and lawyers. © 2016 American Academy of Forensic Sciences.

A Theory-Based Approach for Developing Interventions to Change Patient Behaviours: A Medication Adherence Example from Paediatric Secondary Care

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Gemma Heath

2015-12-01

Full Text Available In this article we introduce a Health Psychology approach to changing patient behaviour, in order to demonstrate the value of Health Psychology professional practice as applied within healthcare settings. Health Psychologists are experts in understanding, predicting and changing health-related behaviours at the individual, group and population level. They combine psychological theory, research evidence and service-user views to design interventions to solve clinically relevant behavioural problems and improve health outcomes. We provide a pragmatic overview of a theory and evidence-based Intervention Mapping approach for developing, implementing and evaluating interventions to change health-related behaviour. An example of a real behaviour change intervention designed to improve medication adherence in an adolescent patient with poorly controlled asthma is described to illustrate the main stages of the intervention development process.

The inadequacy of role models for educating medical students in ethics with some reflections on virtue theory.

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Erde, E L

1997-01-01

Persons concerned with medical education sometimes argued that medical students need no formal education in ethics. They contended that if admissions were restricted to persons of good character and those students were exposed to good role models, the ethics of medicine would take care of itself. However, no one seems to give much philosophic attention to the ideas of model or role model. In this essay, I undertake such an analysis and add an analysis of role. I show the weakness in relying on role models exclusively and draw implications from these for appeals to virtue theory. Furthermore, I indicate some of the problems about how virtue theory is invoked as the ethical theory that would most closely be associated to the role model rhetoric and consider some of the problems with virtue theory. Although Socrates was interested in the character of the (young) persons with whom he spoke, Socratic education is much more than what role modeling and virtue theory endorse. It-that is, philosophy-is invaluable for ethics education.

Control-value theory: using achievement emotions to improve understanding of motivation, learning, and performance in medical education: AMEE Guide No. 64.

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Artino, Anthony R; Holmboe, Eric S; Durning, Steven J

2012-01-01

In this AMEE Guide, we consider the emergent theoretical and empirical work on human emotion and how this work can inform the theory, research, and practice of medical education. In the Guide, we define emotion, in general, and achievement emotions, more specifically. We describe one of the leading contemporary theories of achievement emotions, control-value theory (Pekrun 2006), and we distinguish between different types of achievement emotions, their proximal antecedents, and their consequences for motivation, learning, and performance. Next, we review the empirical support for control-value theory from non-medical fields and suggest several important implications for educational practice. In this section, we highlight the importance of designing learning environments that foster a high degree of control and value for students. Finally, we end with a discussion of the need for more research on achievement emotions in medical education, and we propose several key research questions we believe will facilitate our understanding of achievement emotions and their impact on important educational outcomes.

Implementation of multiple intelligences theory in the English language course syllabus at the University of Nis Medical School.

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Bakić-Mirić, Natasa

2010-01-01

Theory of multiple intelligences (MI) is considered an innovation in learning the English language because it helps students develop all eight intelligences that, on the other hand, represent ways people understand the world around them, solve problems and learn. They are: verbal/linguistic, logical/mathematical, visual/spatial, bodily/kinaesthetic, musical/rhythmic, interpersonal, intrapersonal and naturalist. Also, by focusing on the problem-solving activities, teachers, by implementing theory of multiple intelligences, encourage students not only to build their existing language knowledge but also learn new content and skills. The objective of this study has been to determine the importance of implementation of the theory of multiple intelligences in the English language course syllabus at the University of Nis Medical School. Ways in which the theory of multiple intelligences has been implemented in the English language course syllabus particularly in one lecture for junior year students of pharmacy in the University of Nis Medical School. The English language final exam results from February 2009 when compared with the final exam results from June 2007 prior to the implementation of MI theory showed the following: out of 80 junior year students of pharmacy, 40 obtained grade 10 (outstanding), 16 obtained grade 9 (excellent), 11 obtained grade 8 (very good), 4 obtained grade 7 (good) and 9 obtained grade 6 (pass). No student failed. The implementation of the theory of multiple intelligences in the English language course syllabus at the University of Nis Medical School has had a positive impact on learning the English language and has increased students' interest in language learning. Genarally speaking, this theory offers better understanding of students' intelligence and greater appreciation of their strengths. It provides numerous opportunities for students to use and develop all eight intelligences not just the few they excel in prior to enrolling in a

Student identification of the need for complementary medicine education in Australian medical curricula: a constructivist grounded theory approach.

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Templeman, Kate; Robinson, Anske; McKenna, Lisa

2015-04-01

Across the Western world, including Australia, growing popularity of complementary medicines (CMs) mandates their implementation into medical education (ME). Medical students in international contexts have expressed a need to learn about CMs. In Australia, little is known about the student-specific need for CM education. The objective of this paper was to assess the self-reported need for CM education among Australian medical students. Thirty second-year to final-year medical students participated in semi-structured interviews. A constructivist grounded theory methodological approach was used to generate, construct and analyse data. Medical school education faculties in Australian universities. Medical students generally held favourable attitudes toward CMs but had knowledge deficits and did not feel adept at counselling patients about CMs. All students were supportive of CM education in ME, noting its importance in relation to the doctor-patient encounter, specifically with regard to interactions with medical management. As future practitioners, students recognised the need to be able to effectively communicate about CMs and advise patients regarding safe and effective CM use. Australian medical students expressed interest in, and the need for, CM education in ME regardless of their opinion of it, and were supportive of evidence-based CMs being part of their armamentarium. However, current levels of CM education in medical schools do not adequately enable this. This level of receptivity suggests the need for CM education with firm recommendations and competencies to assist CM education development required. Identifying this need may help medical educators to respond more effectively. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Determinants of Medical Tourism Intentions: Applying the Theory of Planned Behavior.

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Ramamonjiarivelo, Zo; Martin, David S; Martin, Warren S

2015-01-01

This study introduces the theory of planned behavior to health care marketers by extending and replicating a prior study that predicted student's intention to engage in medical tourism. Based on a sample of 164 usable survey responses, our findings suggested that the MEDTOUR scale (developed and introduced a prior study) is robust and works reasonably well with a national sample. Based on these findings, MEDTOUR appears to be worthy of further consideration by health marketing scholars.

System theory in medical diagnostic devices: an overview.

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Baura, Gail D

2006-01-01

Medical diagnostics refers to testing conducted either in vitro or in vivo to provide critical health care information for risk assessment, early diagnosis, treatment, or disease management. Typical in vivo diagnostic tests include the computed tomography scan, magnetic resonance imaging, and blood pressure screening. Typical in vitro diagnostic tests include cholesterol, Papanicolaou smear, and conventional glucose monitoring tests. Historically, devices associated with both types of diagnostics have used heuristic curve fitting during signal analysis. However, since the early 1990s, a few enterprising engineers and physicians have used system theory to improve their core processing for feature detection and system identification. Current applications include automated Pap smear screening for detection of cervical cancer and diagnosis of Alzheimer's disease. Future applications, such as disease prediction before symptom onset and drug treatment customization, have been catalyzed by the Human Genome Project.

Key Theories from Critical Medical Anthropology for Public Health Research. Part II: Medicine in the Social System, Medicine as a Social System

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Jennifer J. Carroll

2014-06-01

Full Text Available This article summarizes four significant theoretical concepts from the field of Critical Medical Anthropology in two parts: in the first part, biopower/discipline and explanatory models; in the second, structural violence, and identity politics and biological citizenship. The four subjects reviewed here have been chosen for their importance to our understanding of human behaviors related to health and illness, as well as for the impact that they can have on theory, research, and practice in the field of public health. These critical theories can provide new ways of thinking about professional roles, medical decisions, disease diagnosis and etiology, treatment adherence, prevention messaging, and all sorts of health-related behaviors and systems of understanding. They can also help public health researchers shed light on the human beliefs and activities that shape patterns of disease within and across populations. Whether a research question is being formulated or research findings are being analyzed, the critical social theories outlined here can foster a more holistic understanding of the human element in any public health project.

Personality Makes a Difference: Attachment Orientation Moderates Theory of Planned Behavior Prediction of Cardiac Medication Adherence.

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Peleg, Shira; Vilchinsky, Noa; Fisher, William A; Khaskia, Abed; Mosseri, Morris

2017-12-01

To achieve a comprehensive understanding of patients' adherence to medication following acute coronary syndrome (ACS), we assessed the possible moderating role played by attachment orientation on the effects of attitudes, subjective norms, and perceived behavioral control (PBC), as derived from the Theory of Planned Behavior (TPB; Ajzen, 1991), on intention and reported adherence. A prospective longitudinal design was employed. During hospitalization, ACS male patients (N = 106) completed a set of self-report questionnaires including sociodemographic variables, attachment orientation, and measures of TPB constructs. Six months post-discharge, 90 participants completed a questionnaire measuring adherence to medication. Attachment orientations moderated some of the predictions of the TPB model. PBC predicted intention and reported adherence, but these associations were found to be significant only among individuals with lower, as opposed to higher, attachment anxiety. The association between attitudes and intention was stronger among individuals with higher, as opposed to lower, attachment anxiety. Only among individuals with higher attachment avoidance, subjective norms were negatively associated with intention to take medication. Cognitive variables appear to explain both adherence intention and behavior, but differently, depending on individuals' attachment orientations. Integrating personality and cognitive models may prove effective in understanding patients' health behaviors. © 2016 Wiley Periodicals, Inc.

How to do a grounded theory study: a worked example of a study of dental practices.

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Sbaraini, Alexandra; Carter, Stacy M; Evans, R Wendell; Blinkhorn, Anthony

2011-09-09

Qualitative methodologies are increasingly popular in medical research. Grounded theory is the methodology most-often cited by authors of qualitative studies in medicine, but it has been suggested that many 'grounded theory' studies are not concordant with the methodology. In this paper we provide a worked example of a grounded theory project. Our aim is to provide a model for practice, to connect medical researchers with a useful methodology, and to increase the quality of 'grounded theory' research published in the medical literature. We documented a worked example of using grounded theory methodology in practice. We describe our sampling, data collection, data analysis and interpretation. We explain how these steps were consistent with grounded theory methodology, and show how they related to one another. Grounded theory methodology assisted us to develop a detailed model of the process of adapting preventive protocols into dental practice, and to analyse variation in this process in different dental practices. By employing grounded theory methodology rigorously, medical researchers can better design and justify their methods, and produce high-quality findings that will be more useful to patients, professionals and the research community.

How to do a grounded theory study: a worked example of a study of dental practices

Directory of Open Access Journals (Sweden)

Evans R

2011-09-01

Full Text Available Abstract Background Qualitative methodologies are increasingly popular in medical research. Grounded theory is the methodology most-often cited by authors of qualitative studies in medicine, but it has been suggested that many 'grounded theory' studies are not concordant with the methodology. In this paper we provide a worked example of a grounded theory project. Our aim is to provide a model for practice, to connect medical researchers with a useful methodology, and to increase the quality of 'grounded theory' research published in the medical literature. Methods We documented a worked example of using grounded theory methodology in practice. Results We describe our sampling, data collection, data analysis and interpretation. We explain how these steps were consistent with grounded theory methodology, and show how they related to one another. Grounded theory methodology assisted us to develop a detailed model of the process of adapting preventive protocols into dental practice, and to analyse variation in this process in different dental practices. Conclusions By employing grounded theory methodology rigorously, medical researchers can better design and justify their methods, and produce high-quality findings that will be more useful to patients, professionals and the research community.

The enforcement regulation for the law for radiation technicians engaging in medical treatment

International Nuclear Information System (INIS)

1985-01-01

The ordinance is set up under the provisions of the law concerning radiation and x-ray technicians engaging in medical treatment, to enforce it. An application for the license of such a technician shall be filed according to the form prescribed, attached with a copy or an abstract of the census register of the applicant and a medical certificate of a doctor concerning whether the applicant is an insane, deaf or blind person, or a case of epidemic. The membership registration of such a technician shall include the number and date of the registration, the prefecture of his legal domicile, name birth date and sex distinction, the year and month of his success in the examination for such technicains, the items concerning the cancellation of the license or the suspension of the business, etc. The subjects of the examination for such technicians are physics, radiological physics, electrical engineering, chemistry, general basic medical science, radiological biology, photographing technology, treatment technics and others. An application for the examination for such technicians shall be filed to the Minister of Health and Welfare, attached with a personal history, a study certificate or a diploma of graduation, a photograph of the applicant and other specified documents. (Kubozono, M.)

K-3 vitamininin sıçan glioma (C6) ve insan glioblastomamultiforme hücre çoğalmasına invitro etkileri

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Öztopçu, Pınar; Kabadere, Selda; Uyar, Ruhi

2005-01-01

Amaç: Glioblastoma multiforme beyin dokusu içerisine hızla yayılan ve onu yıkıma ugratan, sinir sisteminde görülme sıklıgı yüksek oldukça tehlikeli bir tümör çesididir. K-3 vitamininin çesitli kanser hücre dizileri üzerinde hücre çogalmasını baskılayıcı etkisi oldugu bildirilmektedir. Çalısmamızda K-3 vitamininin, sıçan glioma (C6) ve insan glioblastoma multiforme hücrelerinin çogalması üzerindeki baskılayıcı etkilerini karsılastırarak belirlemeyi amaçladık. Yöntem: K-3 vitamin...

Safety in numbers 7: Veni, vidi, duci: a grounded theory evaluation of nursing students' medication dosage calculation problem-solving schemata construction.

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Weeks, Keith W; Higginson, Ray; Clochesy, John M; Coben, Diana

2013-03-01

This paper evaluates nursing students' transition through schemata construction and competence development in medication dosage calculation problem-solving (MDC-PS). We advance a grounded theory from interview data that reflects the experiences and perceptions of two groups of undergraduate pre-registration nursing students: eight students exposed to a prototype authentic MDC-PS environment and didactic transmission methods of education and 15 final year students exposed to the safeMedicate authentic MDC-PS environment. We advance a theory of how classroom-based 'chalk and talk' didactic transmission environments offered multiple barriers to accurate MDC-PS schemata construction among novice students. While conversely it was universally perceived by all students that authentic learning and assessment environments enabled MDC-PS schemata construction through facilitating: 'seeing' the authentic features of medication dosage problems; context-based and situational learning; learning within a scaffolded environment that supported construction of cognitive links between the concrete world of clinical MDC-PS and the abstract world of mathematics; and confidence-building in their cognitive and functional competence ability. Drawing on the principle of veni, vidi, duci (I came, I saw, I calculated), we combined the two sets of evaluations to offer a grounded theoretical basis for schemata construction and competence development within this critical domain of professional practice. Copyright © 2012 Elsevier Ltd. All rights reserved.

Medical education and cognitive continuum theory: an alternative perspective on medical problem solving and clinical reasoning.

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Custers, Eugène J F M

2013-08-01

Recently, human reasoning, problem solving, and decision making have been viewed as products of two separate systems: "System 1," the unconscious, intuitive, or nonanalytic system, and "System 2," the conscious, analytic, or reflective system. This view has penetrated the medical education literature, yet the idea of two independent dichotomous cognitive systems is not entirely without problems.This article outlines the difficulties of this "two-system view" and presents an alternative, developed by K.R. Hammond and colleagues, called cognitive continuum theory (CCT). CCT is featured by three key assumptions. First, human reasoning, problem solving, and decision making can be arranged on a cognitive continuum, with pure intuition at one end, pure analysis at the other, and a large middle ground called "quasirationality." Second, the nature and requirements of the cognitive task, as perceived by the person performing the task, determine to a large extent whether a task will be approached more intuitively or more analytically. Third, for optimal task performance, this approach needs to match the cognitive properties and requirements of the task. Finally, the author makes a case that CCT is better able than a two-system view to describe medical problem solving and clinical reasoning and that it provides clear clues for how to organize training in clinical reasoning.

'The medical' and 'health' in a critical medical humanities.

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Atkinson, Sarah; Evans, Bethan; Woods, Angela; Kearns, Robin

2015-03-01

As befits an emerging field of enquiry, there is on-going discussion about the scope, role and future of the medical humanities. One relatively recent contribution to this debate proposes a differentiation of the field into two distinct terrains, 'medical humanities' and 'health humanities,' and calls for a supersession of the former by the latter. In this paper, we revisit the conceptual underpinnings for a distinction between 'the medical' and 'health' by looking at the history of an analogous debate between 'medical geography' and 'the geographies of health' that has, over the last few years, witnessed a re-blurring of the distinction. Highlighting the value of this debate within the social sciences for the future development of the medical humanities, we call for scholars to take seriously the challenges of critical and cultural theory, community-based arts and health, and the counter-cultural creative practices and strategies of activist movements in order to meet the new research challenges and fulfill the radical potential of a critical medical humanities.

Exploring the transition of undergraduate medical students into a clinical clerkship using organizational socialization theory.

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Atherley, Anique E; Hambleton, Ian R; Unwin, Nigel; George, Colette; Lashley, Paula M; Taylor, Charles G

2016-04-01

Transitions in medical education are emotionally and socially dynamic; this may affect learning. Students transitioning from preclinical to clinical training may experience negative consequences. Less is understood about students' experiences during transitions within clinical training and influential factors. The authors used organizational socialization theory to explore a transition within the clinical years. Final-year medical students experienced a nine-week internal medicine clerkship; willing students participated. Students (n = 101; 97 %) completed a questionnaire with open-ended questions at the beginning and end of the clerkship and participated in six consecutive focus groups, until data saturation occurred (n = 37). Data were thematically analyzed. Socialization was challenging. Many students experienced difficulty developing relationships with team members. Students with a positive attitude experienced a smoother transition. Many students were uncertain of their roles, concerned about the workload and desired guidance to meet clerkship demands. This transition resulted in varied outcomes from enjoyment, increased confidence and student development through to disinterest. Transitions within clinical training are complex. Faculty should focus on adequate socialization in a new clerkship as this may facilitate a smoother transition. This may necessitate orientations, staff training, and formal student support. Further research is needed on the impact of these recommendations on learning and well-being.

Toward a Child Rights Theory in Pediatric Bioethics.

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Goldhagen, Jeffrey; Mercer, Raul; Webb, Elspeth; Nathawad, Rita; Shenoda, Sherry; Lansdown, Gerison

2016-01-01

This article offers a child rights theory in pediatric bioethics, applying the principles, standards, and norms of child rights, health equity, and social justice to medical and ethical decision-making. We argue that a child rights theory in pediatric bioethics will help pediatricians and pediatric bioethicists analyze and address the complex interplay of biomedical and social determinants of child health. These core principles, standards and norms, grounded in the U.N. Convention on the Rights of the Child (CRC), provide the foundational elements for the theory and a means for better understanding the complex determinants of children's health and well-being. Rights-based approaches to medical and ethical decision-making provide strategies for applying and translating these elements into the practice of pediatrics and pediatric bioethics by establishing a coherent, consistent, and contextual theory that is relevant to contemporary practice. The proposed child rights theory extends evolving perspectives on the relationship between human rights and bioethics to both child rights and pediatric bioethics.

Using Principal-Agent Theory as a Framework for Analysis in Evaluating the Multiple Stakeholders Involved in the Accreditation and Quality Assurance of International Medical Branch Campuses

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Borgos, Jill E.

2013-01-01

This article applies the theoretical framework of principal-agent theory in order to better understand the complex organisational relationships emerging between entities invested in the establishment and monitoring of cross-border international branch campus medical schools. Using the key constructs of principal-agent theory, information asymmetry…

Understanding Postdisaster Substance Use and Psychological Distress Using Concepts from the Self-Medication Hypothesis and Social Cognitive Theory.

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Alexander, Adam C; Ward, Kenneth D

2017-11-10

This article applies constructs from the Self-Medication Hypothesis and Social Cognitive Theory to explain the development of substance use and psychological distress after a disaster. A conceptual model is proposed, which employs a sequential mediation model, identifying perceived coping self-efficacy, psychological distress, and self-medication as pathways to substance use after a disaster. Disaster exposure decreases perceived coping self-efficacy, which, in turn, increases psychological distress and subsequently increases perceptions of self-medication in vulnerable individuals. These mechanisms lead to an increase in postdisaster substance use. Last, recommendations are offered to encourage disaster researchers to test more complex models in studies on postdisaster psychological distress and substance use.

Machine medical ethics

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Pontier, Matthijs

2015-01-01

The essays in this book, written by researchers from both humanities and sciences, describe various theoretical and experimental approaches to adding medical ethics to a machine in medical settings. Medical machines are in close proximity with human beings, and getting closer: with patients who are in vulnerable states of health, who have disabilities of various kinds, with the very young or very old, and with medical professionals. In such contexts, machines are undertaking important medical tasks that require emotional sensitivity, knowledge of medical codes, human dignity, and privacy. As machine technology advances, ethical concerns become more urgent: should medical machines be programmed to follow a code of medical ethics? What theory or theories should constrain medical machine conduct? What design features are required? Should machines share responsibility with humans for the ethical consequences of medical actions? How ought clinical relationships involving machines to be modeled? Is a capacity for e...

Assessment of blood donation intention among medical students in Pakistan--An application of theory of planned behavior.

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Faqah, Anadil; Moiz, Bushra; Shahid, Fatima; Ibrahim, Mariam; Raheem, Ahmed

2015-12-01

Theory of Planned Behavior proposes a model which can measure how human actions are guided. It has been successfully utilized in the context of blood donation. We employed a decision-making framework to determine the intention of blood donation among medical students who have never donated blood before the study. Survey responses were collected from 391 medical students from four various universities on a defined questionnaire. The tool composed of 20 questions that were formulated to explain donation intention based on theory of planned behavior. The construct included questions related to attitude, subjective norm and perceived behavior control, descriptive norm, moral norm, anticipated regret, donation anxiety and religious norm. Pearson's correlational relationships were measured between independent and dependent variables of intention to donate blood. ANOVA was applied to observe the model fit; a value of 0.000 was considered statistically significant. A multiple regression analysis was conducted to explore the relative importance of the main independent variables in the prediction of intention. Multi-collinearity was also evaluated to determine that various independent variables determine the intention. The reliability of measures composed of two items was assessed using inter-item correlations. Three hundred and ninety-one medical students (M:F; 1:2.2) with mean age of 21.96 years ± 1.95 participated in this study. Mean item score was 3.8 ± 0.83. Multiple regression analysis suggested that perceived behavioral control, anticipated regret and attitude were the most influential factors in determining intention of blood donation. Donation anxiety was least correlated and in fact bore a negative correlation with intention. ANOVA computed an F value of 199.082 with a p-value of 0.000 indicating fitness of model. The value of R square and adjusted R square was 0.811 and 0.807 respectively indicating strong correlation between various independent and dependent

Medicine as a Community of Practice: Implications for Medical Education.

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Cruess, Richard L; Cruess, Sylvia R; Steinert, Yvonne

2018-02-01

The presence of a variety of independent learning theories makes it difficult for medical educators to construct a comprehensive theoretical framework for medical education, resulting in numerous and often unrelated curricular, instructional, and assessment practices. Linked with an understanding of identity formation, the concept of communities of practice could provide such a framework, emphasizing the social nature of learning. Individuals wish to join the community, moving from legitimate peripheral to full participation, acquiring the identity of community members and accepting the community's norms.Having communities of practice as the theoretical basis of medical education does not diminish the value of other learning theories. Communities of practice can serve as the foundational theory, and other theories can provide a theoretical basis for the multiple educational activities that take place within the community, thus helping create an integrated theoretical approach.Communities of practice can guide the development of interventions to make medical education more effective and can help both learners and educators better cope with medical education's complexity. An initial step is to acknowledge the potential of communities of practice as the foundational theory. Educational initiatives that could result from this approach include adding communities of practice to the cognitive base; actively engaging students in joining the community; creating a welcoming community; expanding the emphasis on explicitly addressing role modeling, mentoring, experiential learning, and reflection; providing faculty development to support the program; and recognizing the necessity to chart progress toward membership in the community.

Developing a framework for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)--a realist synthesis.

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Maidment, Ian; Booth, Andrew; Mullan, Judy; McKeown, Jane; Bailey, Sylvia; Wong, Geoffrey

2017-07-03

Medication-related adverse events have been estimated to be responsible for 5700 deaths and cost the UK £750 million annually. This burden falls disproportionately on older people. Outcomes from interventions to optimise medication management are caused by multiple context-sensitive mechanisms. The MEdication Management in Older people: REalist Approaches BAsed on Literature and Evaluation (MEMORABLE) project uses realist synthesis to understand how, why, for whom and in what context interventions, to improve medication management in older people on complex medication regimes residing in the community, work. This realist synthesis uses secondary data and primary data from interviews to develop the programme theory. A realist logic of analysis will synthesise data both within and across the two data sources to inform the design of a complex intervention(s) to help improve medication management in older people. 1. Literature review The review (using realist synthesis) contains five stages to develop an initial programme theory to understand why processes are more or less successful and under which situations: focussing of the research question; developing the initial programme theory; developing the search strategy; selection and appraisal based on relevance and rigour; and data analysis/synthesis to develop and refine the programme theory and context, intervention and mechanism configurations. 2. Realist interviews Realist interviews will explore and refine our understanding of the programme theory developed from the realist synthesis. Up to 30 older people and their informal carers (15 older people with multi-morbidity, 10 informal carers and 5 older people with dementia), and 20 care staff will be interviewed. 3. Developing framework for the intervention(s) Data from the realist synthesis and interviews will be used to refine the programme theory for the intervention(s) to identify: the mechanisms that need to be 'triggered', and the contexts related to these

The enforcement regulation for the law for radiation and x-ray technicians engaging in medical treatment

International Nuclear Information System (INIS)

1980-01-01

The ordinance is set up under the provisions of the law concerning radiation and X-ray technicians engaging in medical treatment, to enforce it. An application for the license of such a technician shall be filed according to the form prescribed, attached with a copy or an abstract of the census register of the applicant and a medical certificate of a doctor concerning whether the applicant is an insane, deaf or blind person, or a case of epidemic. The membership registration of such a technician shall include the number and date of the registration, the prefecture of his legal domicile, name, birth date and sex distinction, the year and month of his success in the examination for such technicains, the items concerning the cancellation of the license or the suspension of the business, etc. The subjects of the examination for such technicians are physics, radiological physics, electrical engineering, chemistry, general basic medical science, radiological biology, photographing technology, treatment technics and others. An application for the examination for such technicians shall be filed to the Minister of Health and Welfare, attached with a personal history, a study certificate or a diploma of graduation, a photograph of the applicant and other specified documents. (Okada, K.)

The Process of Parents' Decision-Making to Discharge Their Child against Medical Advice (DAMA: A grounded theory study

Directory of Open Access Journals (Sweden)

Nikbakht Nasrabadi Alireza

2016-05-01

Full Text Available Discharge against medical advice (DAMA refers to the phenomenon that patient or the patient’s surrogate decides to leave the hospital before the attending physician confirms the patient is discharged. Children are much more vulnerable to such discharges. This process occurs with different mechanisms that identifying them can be helpful in reducing this phenomenon. We aimed to explore the process of parents' decision-making to discharge their child against medical advice. In-depth, semi-structured interviews were conducted with 10 fathers, 10 mothers, 6 nurses and 3 physician assistants and the data were collected to the point of saturation. Grounded theory methodology was adopted for data collection and analysis. The results of qualitative analysis in the field of the parents' decisionmaking on the DAMA revealed 4 main themes: "lack of family-centered care", "disruption of the parenting process", "distrust to the medical team and center" and "psychological strategy of shirk responsibility for child care and treatment ". By providing family-centered care, adopting measures to empowering the families, developing the trust of parents to the health care team and developing a discharge plan from the beginning of children hospitalization with the cooperation of health care team and parents and considering all factors such as child's special health condition and parent's health related perceptions and beliefs, children will not be discharged against medical advice and will experience better outcomes.

Ernst Rüdin's Unpublished 1922-1925 Study "Inheritance of Manic-Depressive Insanity": Genetic Research Findings Subordinated to Eugenic Ideology.

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Kösters, Gundula; Steinberg, Holger; Kirkby, Kenneth Clifford; Himmerich, Hubertus

2015-11-01

In the early 20th century, there were few therapeutic options for mental illness and asylum numbers were rising. This pessimistic outlook favoured the rise of the eugenics movement. Heredity was assumed to be the principal cause of mental illness. Politicians, scientists and clinicians in North America and Europe called for compulsory sterilisation of the mentally ill. Psychiatric genetic research aimed to prove a Mendelian mode of inheritance as a scientific justification for these measures. Ernst Rüdin's seminal 1916 epidemiological study on inheritance of dementia praecox featured large, systematically ascertained samples and statistical analyses. Rüdin's 1922-1925 study on the inheritance of "manic-depressive insanity" was completed in manuscript form, but never published. It failed to prove a pattern of Mendelian inheritance, counter to the tenets of eugenics of which Rüdin was a prominent proponent. It appears he withheld the study from publication, unable to reconcile this contradiction, thus subordinating his carefully derived scientific findings to his ideological preoccupations. Instead, Rüdin continued to promote prevention of assumed hereditary mental illnesses by prohibition of marriage or sterilisation and was influential in the introduction by the National Socialist regime of the 1933 "Law for the Prevention of Hereditarily Diseased Offspring" (Gesetz zur Verhütung erbkranken Nachwuchses).

Why we need a theory of suffering, and lots of other theories as well: commentary.

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Churchill, Larry R

1991-01-01

In the first section of his article, "The Role of Suffering and Community in Clinical Ethics," Erich Loewy sketches a theory of suffering. His conviction is that clinical medical ethics is not clearly rooted in theory and is inadequately grounded because of this. While acknowledging the merits of virtue ethics and casuistry, Loewy quickly dispenses with them, as contenders for this theoretical basis. Kantianism and utilitarianism are likewise rejected as "a universally acceptable grounding for ethics." In their place, Loewy proposes that "a deeper and more universal grounding can be found in the capacity of sentient beings to suffer." It is on this capacity to suffer that he builds his hierarchies of moral value, including primary, secondary, and symbolic worth. This theory of suffering should be welcomed. It promises to expand our awareness of clinical experience, and moral life generally, away from autonomy, utility, or virtue orientations toward attention to suffering and our response to it. Such a theory can give us a revitalized language to probe the issues of medical ethics. This should lead us to a careful reading of Loewy's larger work on which this article is based. Yet my enthusiasm is tempered by Loewy's noncritical acceptance of a peculiar, yet pervasive, understanding of the role and use of theory in ethics....

Eliminating mental disability as a legal criterion in deprivation of liberty cases: The impact of the Convention on the Rights of Persons With Disabilities on the insanity defense, civil commitment, and competency law.

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Slobogin, Christopher

2015-01-01

A number of laws that are associated with deprivations of liberty, including the insanity defense, civil commitment, guardianship of the person and numerous competency doctrines in the criminal context, require proof of mental disability as a predicate. The Convention on the Rights of Persons With Disabilities commands signatory states to eliminate that predicate. Summarizing principles set out in my book Minding Justice: Laws That Deprive People With Mental Disability of Life and Liberty, I explain how this seemingly radical stance can be implemented. Specifically, this article proposes adoption of an "integrationist defense" in the criminal context, an "undeterrability requirement" when the state seeks preventive detention outside of the criminal process, and a "basic rationality and self-regard test" for incompetency determinations. None of these proposals requires proof of a mental disorder as a predicate condition. Copyright © 2015 Elsevier Ltd. All rights reserved.

Decision theory on the quality evaluation of medical images; A teoria da decisao na avaliacao da qualidade da imagem medica

Energy Technology Data Exchange (ETDEWEB)

Lessa, Patricia Silva

2001-10-01

The problem of quality has been a constant issue in every organization.One is always seeking to produce more, to do it at a lower cost, and to do it with better quality. However, in this country, there is no radiographic film quality control system for radiographic services. The tittle that actually gets done is essentially ad hoc and superficial. The implications of this gap, along with some other shortcomings that exist in process as a whole (the state of the x-ray equipment, the adequate to use in order to obtain a radiography, the quality of the film, the processing of the film, the brightness and homogeneity of the viewing boxes, the ability of the radiologist), have a very negative impact on the quality of the medical image, and, as result, to the quality of the medical diagnosis and therapy. It frequently happens that many radiographs have to be repeated, which leads to an increase of the patient's exposure to radiation, as well as of the cost of the procedure for the patient. Low quality radiographs that are not repeated greatly increase the probability of a wrong diagnosis, and consequently, of inadequate therapeutical procedures, thus producing increased incidence of bad outcomes and higher costs. The paradigm proposed in order to establish a system for the measurement of the image's quality is Decision Theory. The problem of the assessment of the image is studied by proposing a Decision Theory approach. The review of the literature reveals a great concern with the quality of the image, along with an absence of an adequate paradigm and several essentially empirical procedures. Image parameters are developed in order to formalize the problem in terms of Decision Theory, and various aspects of image digitalisation are exposed. Finally, a solution is presented, including a protocol for quality control. (author)

Medication adherence as a learning process: insights from cognitive psychology.

Science.gov (United States)

Rottman, Benjamin Margolin; Marcum, Zachary A; Thorpe, Carolyn T; Gellad, Walid F

2017-03-01

Non-adherence to medications is one of the largest contributors to sub-optimal health outcomes. Many theories of adherence include a 'value-expectancy' component in which a patient decides to take a medication partly based on expectations about whether it is effective, necessary, and tolerable. We propose reconceptualising this common theme as a kind of 'causal learning' - the patient learns whether a medication is effective, necessary, and tolerable, from experience with the medication. We apply cognitive psychology theories of how people learn cause-effect relations to elaborate this causal-learning challenge. First, expectations and impressions about a medication and beliefs about how a medication works, such as delay of onset, can shape a patient's perceived experience with the medication. Second, beliefs about medications propagate both 'top-down' and 'bottom-up', from experiences with specific medications to general beliefs about medications and vice versa. Third, non-adherence can interfere with learning about a medication, because beliefs, adherence, and experience with a medication are connected in a cyclic learning problem. We propose that by conceptualising non-adherence as a causal-learning process, clinicians can more effectively address a patient's misconceptions and biases, helping the patient develop more accurate impressions of the medication.

Psychometric Properties of a Protection Motivation Theory-based Questionnaire to Assess Self-Medication in a Sample of Elderly Iranians

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Nasser Hatamzadeh

2016-12-01

Full Text Available Introduction: The existence of standard tools is one of the basic needs of scientists of healthy behavior for predicting health-related behaviors. The aim of the present study was to design a psychometrically sound instrument to measure the protection motivation theory constructs regarding self-medication for elderly Iranians. Methods: The study was conducted in spring 2016. The sample consisted of 196 Iranians between the ages of 60 and 74. The study took place in Ahvaz, Iran.  The instrument included perceived susceptibility, severity, response costs, response efficacy, self-efficacy, rewards, and fear constructs. The qualitative component of the study, which consisted of interviews with experts and a systematic review of the literature, provided the data to write the items for the instrument, followed by determining the content validity. Principal components analysis with Oblique rotation was performed to extract correlated constructs. The Kaiser-Meyer-Olkin (KMO and Bartlett's tests were performed to examine the suitability of the data for factor analysis. Cronbach’s Coefficient Alpha was used to estimate the internal consistency of the scales. Results: The KMO test statistic of 0.90 revealed the sampling adequacy for doing factor analysis and Bartlett's test of sphericity was significant (p < 0.001. Seven constructs were extracted based on Eigenvalues of ≥ 1.00 and factor loadings of ≥ 0.40. Cronbach’s α for the constructs, namely, perceived susceptibility, severity, response costs, response efficacy, self-efficacy, rewards and fear were 0.84, 0.86, 0.81, 0.82, 0.88, 0.89, and 0.85, respectively.  The seven constructs accounted for 69.41% of the variation. Conclusion: The developed scales for measuring the protection motivation theory constructs regarding self-medication have acceptable psychometric properties among elderly Iranians.

Machiavelli’den Hobbes’a Rönesans Dönemi Siyaset Teorisinde İnsan Doğası ve Toplum Anlayışı / The Human Nature and the Notion of Society in Renaissance Political Theory: From Machiavelli to Hobbes

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Olkan SENEMOĞLU

2016-07-01

Full Text Available Bu çalışma Machiavelli’den başlayıp Hobbes’a kadar uzanan süreçte insan doğası ve toplum anlayışının nasıl ele alındığına ve bu anlayışın düşünürlerin kendi sistemlerindeki yerine odaklanmaktadır. Fakat çalışmada Yunan düşünürler Platon ve Aristoteles›ten başlayıp, Doğu düşünürleri Farabi ve İbn-i Sina’ya kadar insan doğası ve toplum tartışmalarına da yer verilmiştir. Böylece ele alınan dönemle, öncesinin kısa bir karşılaştırması yapılırken bu dönemin ayırıcı özelliği de gösterilmeye çalışılmaktadır. İnsan doğası tartışması düşünürler için kendi sistemlerini oluşturmada kilit rol oynamaktadır. Bundan dolayı Machiavelli, insanın açgözlü, çıkarcı olduğunu düşündüğü için yöneticiye dikkatli olması gerektiğini söylediği gibi, Hobbes, insanın doğası gereği kendi çıkarını düşünmeye yöneldiğini ve insanın insanla süren sonsuz bir savaşım içinde olduğunu düşündüğü için bu savaş halini bir barış hali olarak tesis edecek bir egemenlik sistemi geliştirmektedir. Diğer taraftan, düşünürlerin insan doğası tartışmaları, insanın diğer varlıklardan hangi yönüyle farklılaştığına dikkat çekerken, toplumun oluşma nedeni de yine insanın doğası gereği duyduğu gereksinimler veya doğasındaki eksiklikler itibariyle var olabileceğine odaklanmıştır. / This study focuses on how the human nature and the the notion of society were evaluated during the period starting from Machiavelli to Hobbes and the position of such an understanding within the system of these philosophers. However, the article also considers the discussions on human nature and society including the Greek philosophers from Plato and Aristoteles to Eastern philosophers, such as Farabi and Avicenna. Thus, a comparison of the previous era and the subject matter has ben established. The discussions around the human nature have a principal

How Iranian Medical Trainees Approach their Responsibilities in Clinical Settings; A Grounded Theory Research

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Omid Asemani

2015-09-01

Full Text Available Background: It seems we are now experiencing “responsibility problems” among medical trainees (MTs and some of those recently graduated from medical schools in Iran. Training responsible professionals have always been one of the main concerns of medical educators. Nevertheless, there is a dearth of research in the literature on “responsibility” especially from the medical education point of view. Therefore, the present study was carried out with the aim of presenting a theoretical based framework for understanding how MTs approach their responsibilities in educational settings. Method: This qualitative study was conducted at Shiraz University of Medical Sciences (SUMS using the grounded theory methodology. 15 MTs and 10 clinical experts and professional nurses were purposefully chosen as participants. Data was analyzed using the methodology suggested by Corbin and Strauss, 1998. Results: “Try to find acceptance toward expectations”, “try to be committed to meet the expectations” and “try to cope with unacceptable expectations” were three main categories extracted based on the research data. Abstractly, the main objective for using these processes was “to preserve the integrity of student identity” which was the core category of this research too. Moreover, it was also found that practically, “responsibility” is considerably influenced by lots of positive and negative contextual and intervening conditions. Conclusion: “Acceptance” was the most decisive variable highly effective in MTs’ responsibility. Therefore, investigating the “process of acceptance” regarding the involved contextual and intervening conditions might help medical educators correctly identify and effectively control negative factors and reinforce the constructive ones that affect the concept of responsibility in MTs.

Flight nursing expertise: towards a middle-range theory

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Reimer, Andrew P.; Moore, Shirley M.

2010-01-01

Aim This paper presents a middle-range Theory of Flight Nursing Expertise. Background Rotary-wing (helicopter) medical transport has grown rapidly in the USA since its introduction, particularly during the past 5 years. Patients once considered too sick to transport are now being transported more frequently and over longer distances. Many limitations are imposed by the air medical transport environment and these require nurses to alter their practice. Data sources A literature search was conducted using Pubmed, Medline, CINAHL, secondary referencing and an Internet search from 1960 to 2008 for studies related to the focal concepts in flight nursing. Discussion The middle-range Theory of Flight Nursing Expertise is composed of nine concepts (experience, training, transport environment of care, psychomotor skills, flight nursing knowledge, cue recognition, pattern recognition, decision-making and action) and their relationships. Five propositions describe the relationships between those concepts and how they apply to flight nursing expertise. Implications for nursing After empirical testing, this theory may be a useful tool to assist novice flight nurses to attain the skills necessary to provide safe and competent care more efficiently, and may aid in designing curricula and programmes of research. Conclusion Research is needed to determine the usefulness of this theory in both rotary and fixed-wing medical transport settings, and to examine the similarities and differences related to expertise needed for different flight nurse team compositions. Curriculum and training innovations can result from increased understanding of the concepts and relationships proposed in this theory. PMID:20337803

Health values and prospect theory: a comment.

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Stratmann-Schoene, D; Klose, T

2001-01-01

In a recent volume of Medical Decision Making, Treadwell and Lenert stated that under prospect theory, community members compared with patients underestimate the utility of health improvements. In this comment, the authors show that this statement holds only for a subset of possible preference functions. Furthermore, the authors provide arguments that, in general, the rater's current health state is not the appropriate reference level if applying prospect theory to health valuations.

"History, Theory and Ethics of Medicine": The Last Ten Years. A Survey of Course Content, Methods and Structural Preconditions at Twenty-nine German Medical Faculties.

Science.gov (United States)

Schildmann, Jan; Bruns, Florian; Hess, Volker; Vollmann, Jochen

2017-01-01

Objective: "History, Theory, Ethics of Medicine" (German: "Geschichte, Theorie, Ethik der Medizin", abbreviation: GTE) forms part of the obligatory curriculum for medical students in Germany since the winter semester 2003/2004. This paper presents the results of a national survey on the contents, methods and framework of GTE teaching. Methods: Semi-structured questionnaire dispatched in July 2014 to 38 institutions responsible for GTE teaching. Descriptive analysis of quantitative data and content analysis of free-text answers. Results: It was possible to collect data from 29 institutes responsible for GTE teaching (response: 76%). There is at least one professorial chair for GTE in 19 faculties; two professorial chairs or professorships remained vacant at the time of the survey. The number of students taught per academic year ranges from 350. Teaching in GTE comprises an average of 2.18 hours per week per semester (min: 1, max: 6). Teaching in GTE is proportionally distributed according to an arithmetic average as follows: history: 35.4%, theory 14.7% and ethics 49.9%. Written learning objectives were formulated for GTE in 24 faculties. The preferred themes of teaching in history, theory or ethics which according to respondents should be taught comprise a broad spectrum and vary. Teaching in ethics (79 from a max. of 81 possible points) is, when compared to history (61/81) and theory (53/81), attributed the most significance for the training of medical doctors. Conclusion: 10 years after the introduction of GTE the number of students and the personnel resources available at the institutions vary considerably. In light of the differences regarding the content elicited in this study the pros and cons of heterogeneity in GTE should be discussed.

Historical perspectives of mental health in the Eastern Cape

African Journals Online (AJOL)

ment approved the spending of GBP50 000 towards the settlement of .... Mission hospitals contributed significantly to the development of health ... cheap accommodation for the black insane, which resulted in a saving ..... Wu M. Between universalism and racism: Tensions in theories of treatment in South African psychiatry.

Medical technology: a Pandora's box?

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Hewa, Soma

1994-01-01

This paper examines the development of medical technology in terms of Max Weber's theory of rationalization. It argues that medical technology is a part of the general process of social, political and economic changes in modern Western societies. Medical technology today keeps many people alive who, in the past, would have died from their illness. In recent years, burgeoning technological achievements in medicine have been regarded as a threat to the individual's freedom to die. Many people believe that the prolongation of life only adds to the suffering of the patient and to the emotional distress of the family. They argue that a quiet death is preferable to the indignities inflicted by mechanical life support. This paper addresses these issues in light of Weber's theoretical arguments.

Medical students' perceptions of general practice as a career; a phenomenological study using socialisation theory.

Science.gov (United States)

Reid, Katherine; Alberti, Hugh

2018-04-23

The ageing population and push to community care has significantly increased the workload of General Practitioners (GPs) in the UK and internationally. In an attempt to tackle this, NHS England has promised 5000 more GPs by 2020/21; however, recruitment is in crisis with GP training posts remaining unfilled. Little research has been carried out to assess the fundamental questions of what medical students' perceptions of General Practice are and what shapes their perceptions at medical school. We aimed to explore medical students' conceptualisations of being a GP and specifically the role of the medical school in shaping their perceptions. Two focus groups of year one and year four medical students were undertaken using an interpretive phenomenological approach. Our study has revealed that medical students perceive General Practice to lack prestige and challenge. These perceptions come, at least in part, from a process of socialisation within medical school, whereby medical students internalise and adopt their role models' perceptions and values, and the values portrayed by the hidden curriculum in their medical school culture. Perceived external pressures to pursue a career in General Practice can have a negative influence and medical schools should be made aware of this.

How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE guide No. 59.

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Ten Cate, Th J; Kusurkar, Rashmi A; Williams, Geoffrey C

2011-01-01

Self-determination Theory (SDT), designed by Edward Deci and Richard Ryan, serves among the current major motivational theories in psychology. SDT research has been conducted in many areas, among which are education and health care, but its applications in medical education are rare. The potential of SDT to help understand processes in medical education justifies this Guide. SDT is explained in seven principles, one of which is the distinction of three innate psychological needs of human beings: for competence, for autonomy and for relatedness. Further, SDT elaborates how humans tend to internalise regulation of behaviour that initially has been external, in order to develop autonomous, self-determined behaviour. Implications of SDT for medical education are discussed with reference to preparation and selection, curriculum structure, classroom teaching, assessments and examinations, self-directed learning, clinical teaching, students as teachers and researchers, continuing professional development, faculty development and stress among trainees.

How does an increase in undergraduate teaching load affect GP teacher motivation? A grounded theory study using data from a new medical school.

Science.gov (United States)

Harding, Alex; Sweeney, Grace

2013-07-01

The opening of a new medical school is a cause for celebration. Starting with a clean slate often gives the opportunity to adopt more modern teaching practices. However, encouraging large numbers of clinicians to start teaching and to adopt these new methods brings its own set of challenges. During the expansion phase of a new medical school, it was often noted that new teachers seemed to have considerable difficulties, and often expressed these as negativity towards student placements. This did not chime with much of the work from established schools, which seemed to evaluate expansion of teaching more positively. We wanted to better understand the issues involved. Semi-structured interviews were conducted involving GPs who had received medical students over the first four years of a newly established medical school. The aims were to assess the impact of the students on the new teachers, and to try to better understand why some teachers were experiencing difficulties. We collected qualitative and quantitative data at the interviews. The qualitative data were analysed using grounded theory which aims to link emerging themes together. The findings suggest that as the quantity of teaching medical students increases, the enjoyment and commitment to teaching may decrease. Concerns over the administration of teaching may begin to predominate. Two factors may help to reduce this: 1 Adequate investment in manpower and premises to reduce time and space constraints on teaching. 2 Practices considering themselves as teaching practices where education is a part of the practice identity.

«EN DEHORS DES MURS». POUR UNE HISTOIRE RENOUVELÉE DES INSTITUTIONS DE LA FOLIE À L’ÉPOQUE CONTEMPORAINE

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Fauvel, Aude

2015-06-01

Full Text Available Following the 1961 famous works by Michel Foucault and Erving Goffman (A History of Insanity in the Age of Reason and Asylums: Essays on the Social Situation of Mental Patients and Other Inmates, many historians have considered that the medicalization of insanity in the modern age had mostly led to a “great confinement” and a greater segregation of all individuals deemed mentally unfit during the “asylum era”. However, new research demonstrates that this classic narrative of the psychiatric past needs to be revised. It discloses that, ever since the 19th century, a whole other medical culture existed as a challenge to asylums, a culture that advocated the integration of the mad and fought to disassociate psychiatry from the dominant model of confinement all throughout the occidental world. This article aims at presenting the results of these historical works that depict another aspect of the psychiatric history, exploring “boarding out” practices, instead of asylum ones.

A formative evaluation of the implementation of a medication safety data collection tool in English healthcare settings: A qualitative interview study using normalisation process theory.

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Rostami, Paryaneh; Ashcroft, Darren M; Tully, Mary P

2018-01-01

Reducing medication-related harm is a global priority; however, impetus for improvement is impeded as routine medication safety data are seldom available. Therefore, the Medication Safety Thermometer was developed within England's National Health Service. This study aimed to explore the implementation of the tool into routine practice from users' perspectives. Fifteen semi-structured interviews were conducted with purposely sampled National Health Service staff from primary and secondary care settings. Interview data were analysed using an initial thematic analysis, and subsequent analysis using Normalisation Process Theory. Secondary care staff understood that the Medication Safety Thermometer's purpose was to measure medication safety and improvement. However, other uses were reported, such as pinpointing poor practice. Confusion about its purpose existed in primary care, despite further training, suggesting unsuitability of the tool. Decreased engagement was displayed by staff less involved with medication use, who displayed less ownership. Nonetheless, these advocates often lacked support from management and frontline levels, leading to an overall lack of engagement. Many participants reported efforts to drive scale-up of the use of the tool, for example, by securing funding, despite uncertainty around how to use data. Successful improvement was often at ward-level and went unrecognised within the wider organisation. There was mixed feedback regarding the value of the tool, often due to a perceived lack of "capacity". However, participants demonstrated interest in learning how to use their data and unexpected applications of data were reported. Routine medication safety data collection is complex, but achievable and facilitates improvements. However, collected data must be analysed, understood and used for further work to achieve improvement, which often does not happen. The national roll-out of the tool has accelerated shared learning; however, a number of

A formative evaluation of the implementation of a medication safety data collection tool in English healthcare settings: A qualitative interview study using normalisation process theory.

Directory of Open Access Journals (Sweden)

Paryaneh Rostami

Full Text Available Reducing medication-related harm is a global priority; however, impetus for improvement is impeded as routine medication safety data are seldom available. Therefore, the Medication Safety Thermometer was developed within England's National Health Service. This study aimed to explore the implementation of the tool into routine practice from users' perspectives.Fifteen semi-structured interviews were conducted with purposely sampled National Health Service staff from primary and secondary care settings. Interview data were analysed using an initial thematic analysis, and subsequent analysis using Normalisation Process Theory.Secondary care staff understood that the Medication Safety Thermometer's purpose was to measure medication safety and improvement. However, other uses were reported, such as pinpointing poor practice. Confusion about its purpose existed in primary care, despite further training, suggesting unsuitability of the tool. Decreased engagement was displayed by staff less involved with medication use, who displayed less ownership. Nonetheless, these advocates often lacked support from management and frontline levels, leading to an overall lack of engagement. Many participants reported efforts to drive scale-up of the use of the tool, for example, by securing funding, despite uncertainty around how to use data. Successful improvement was often at ward-level and went unrecognised within the wider organisation. There was mixed feedback regarding the value of the tool, often due to a perceived lack of "capacity". However, participants demonstrated interest in learning how to use their data and unexpected applications of data were reported.Routine medication safety data collection is complex, but achievable and facilitates improvements. However, collected data must be analysed, understood and used for further work to achieve improvement, which often does not happen. The national roll-out of the tool has accelerated shared learning; however

A study on the civil liability of radiological technologist in medical malpractice

International Nuclear Information System (INIS)

Lim, Chang Seon

1995-01-01

Recently the suits for medical malpractice are gradually increasing in this country. The main purpose of this study is to excavate the most suitable theories about civil liabilities on medical malpractice by radiological technologist. To solve the above-mentioned problems in medical malpractice, I have proceeded to make a survey of traditional theories and tried to excavate the most suitable theories for our medical circumstances among those theories. Both domestic and foreign relevant professional literatures and legal cases were investigated in this study. Several important findings of this study are as follows. First, the nature of legal interrelationship between radiological technologist and physician(or the representative of a hospital) is to define the content of employment. But in the eye of medical law, the interrelationship between radiological technologist and physician is written that radiological technologist should be directed by physician. Second, the nature of legal interrelationship between patient and physician(or the representative of a hospital) is to define the content of legal obligation of physician(or the representative of a hospital), and radiological technologist execute his obligation as proxy for physician. Therefore, patient can not clame any legal right to radiological technologist. Third, radiological technologist has the obligation of Due Care in medical practice. Fourth, on the medical malpractice by radiological technologist the civil liability can be treated as either tortious liability or contractual liability, and physician (or the representative of hospital) take the responsibility for the damage compensation. In this case, physician has the right of indemnity to radiological technologist. But it should be dinied or extremely limited

Rhazes, a pioneer in contribution to trials in medical practice.

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Ghaffari, Farzaneh; Naseri, Mohsen; Jafari Hajati, Razieh; Zargaran, Arman

2017-12-01

Medical history explains that Persian physicians used scientific methods based on clinical experiences and observations for treatment from pre-Islamic time (before 637 AD) and centuries later (in the Islamic era). Rhazes was one of the Persian physicians acknowledged as a pharmacist, chemist and prominent scientific writer on various subjects of medicine and philosophy. In this study, we aimed to investigate clinical experiences, as well as the ethical and critical views of Rhazes in medical practice. Rhazes promoted ethics in the medical profession. He expressed critical key points about ancient written texts. He broke ancient physicians' taboos in medical theories and evaluated them based on his own experiences. He designed animal and preclinical evaluations for his theories and also performed the first clinical trials with control groups in the history. His critical views about medical sciences as well as his beliefs in experiments resulted in many medical, chemical and pharmaceutical findings. Therefore, in history, he can be considered as the pioneer in using trials and experiments for approving medical methods.

Compulsory Medication, Trial Competence, and Penal Theory

DEFF Research Database (Denmark)

Ryberg, Jesper

2016-01-01

competence? Would it be morally acceptable for the state to forcibly subject a defendant to psychotropic medication in order to restore his/her competence to stand trial? In this article it is argued that the reason that has constituted the main argument in favor of forcible medication of defendants —namely...

Medical and Non-Medical Predictors of Disability Discharge Disposition for Navy Personnel with a Back Problem: A Focus on Entitlement

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1988-03-28

Washington D.C. 20350-1000. Stryker, S., & Gottlieb, A. (1981). Attribution theory and symbolic interactionism : A comparison. In J.H. Howes, W...ERFORMIING ORGANIZATION 6b OFFiCE SYMBOL 7a NAME OF MONITORING ORGANIZATION (If applicable) Naval Health Research Center 40 Commander, Naval Medical Command...Washington, DC 20372 ea NAME OF FUNDING/SPONSORING Bb OFFICE SYMBOL 9. PROCUREMENT INSTRUMENT IDENTIFICATION NUMBER ORGANIZATION Naval Medical (If applicable

Medical homes: challenges in translating theory into practice.

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Carrier, Emily; Gourevitch, Marc N; Shah, Nirav R

2009-07-01

The concept of the medical home has existed since the 1960s, but has recently become a focus for discussion and innovation in the health care system. The most prominent definitions of the medical home are those presented by the Patient-Centered Primary Care Collaborative, the National Committee for Quality Assurance, and the Commonwealth Fund. These definitions share: adoption of health information technology and decision support systems, modification of clinical practice patterns, and ensuring continuity of care. Each of these components is a complex undertaking, and there is scant evidence to guide assessment of diverse strategies for achieving their integration into a medical home. Without a shared vocabulary and common definitions, policy-makers seeking to encourage the development of medical homes, providers seeking to improve patient care, and payers seeking to develop appropriate systems of reimbursement will face challenges in evaluating and disseminating the medical home model.

[Ethics, knowledge and psychiatry: in Aulus Cornelius Celsus' De Medicina].

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Trancas, Bruno; Borja Santos, Nuno

2007-01-01

Modern medicine has many roots on greco-roman practice of the medical art. The authors analyse the work De Medicina by Aulus Cornelius Celsus. They look upon the nature of the medical knowledge, the principles of ethics, causality and describe the mental disorders (phrenitis, depression, third insanity, seizure disorder and womb disease), with special detail to signs and symptoms, treatment and prognosis. An association with current medical knowledge is established.

State of Digital Education Options in the areas of Medical Terminology and the History, Theory and Ethics of Medicine.

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Schochow, Maximilian; Steger, Florian

2015-01-01

Institutes of the history of medicine, the theory of medicine, and medical ethics at German institutions of higher learning have created various e-learning options that are based on different learning platforms and tailored to the specific curricular needs of individual teaching. Up to now no valid data has been available about the types of such e-learning options as well as possibilities of future developments thanks to coordinated cooperation among the different institutes. Of 31 German institutes of the history and theory of medicine and medical ethics that were asked to fill out a questionnaire, 30 answered, which equals a return rate of 97 per cent. The questionnaire was completed between July and August 2012 using a telephone survey. Available to students online, digitally interactive teaching tools have boomed in the course of the last few years at German institutes of the history of medicine, the theory of medicine, and medical ethics. This trend is also reflected in a willingness of more than half of the respective departments (67 per cent) to expand their e-learning options on the basis of previous experience. The offered e-learning systems are accepted very well by the students. 57 per cent of the institutes stated, that 90-100 per cent of the students use the offered systems regularly. E-learning courses for terminology are offered particularly often, this is also reflected in the intended extension of these courses by the majority of institutes which plan to expand their e-learning systems. This article discusses the results of a comprehensive empirical survey about e-learning. It illustrates ways in which individual German institutes plan to expand their e-learning options in the future. Finally, specific proposals for cooperation among institutions (not just online) are introduced, the purpose of which is to produce synergy in e-learning.

State of Digital Education Options in the areas of Medical Terminology and the History, Theory and Ethics of Medicine

Science.gov (United States)

Schochow, Maximilian; Steger, Florian

2015-01-01

Background: Institutes of the history of medicine, the theory of medicine, and medical ethics at German institutions of higher learning have created various e-learning options that are based on different learning platforms and tailored to the specific curricular needs of individual teaching. Up to now no valid data has been available about the types of such e-learning options as well as possibilities of future developments thanks to coordinated cooperation among the different institutes. Methods: Of 31 German institutes of the history and theory of medicine and medical ethics that were asked to fill out a questionnaire, 30 answered, which equals a return rate of 97 per cent. The questionnaire was completed between July and August 2012 using a telephone survey. Results: Available to students online, digitally interactive teaching tools have boomed in the course of the last few years at German institutes of the history of medicine, the theory of medicine, and medical ethics. This trend is also reflected in a willingness of more than half of the respective departments (67 per cent) to expand their e-learning options on the basis of previous experience. The offered e-learning systems are accepted very well by the students. 57 per cent of the institutes stated, that 90-100 per cent of the students use the offered systems regularly. E-learning courses for terminology are offered particularly often, this is also reflected in the intended extension of these courses by the majority of institutes which plan to expand their e-learning systems. Conclusions: This article discusses the results of a comprehensive empirical survey about e-learning. It illustrates ways in which individual German institutes plan to expand their e-learning options in the future. Finally, specific proposals for cooperation among institutions (not just online) are introduced, the purpose of which is to produce synergy in e-learning. PMID:26038682

Bullock on Rat Gastrointestinal Microflora

African Journals Online (AJOL)

Dr Olaleye

the years, P. nigrescens has been used as an ingredient in the medications for insanity ... to safeguard the microbiota of the GI (Davis and Milner,. 2010). Although most ..... Sunday, D., Kazeem, S. I., Matthew, D., Patrick E. C.,. Charles W. and ...

Theory-guided, empirically supported avenues for intervention on HIV medication nonadherence: findings from the Healthy Living Project.

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Johnson, Mallory O; Catz, Sheryl L; Remien, Robert H; Rotheram-Borus, Mary Jane; Morin, Stephen F; Charlebois, Edwin; Gore-Felton, Cheryl; Goldsten, Rise B; Wolfe, Hannah; Lightfoot, Marguerita; Chesney, Margaret A

2003-12-01

Adherence to antiretroviral therapy (ART) remains a challenge in efforts to maximize HIV treatment benefits. Previous studies of antiretroviral adherence are limited by low statistical power, homogeneous samples, and biased assessment methods. Based on Social Action Theory and using a large, diverse sample of men and women living with HIV, the objectives of the current study are to clarify correlates of nonadherence to ART and to provide theory-guided, empirically supported direction for intervening on ART nonadherence. Cross-sectional interview study utilizing a computerized interview. Recruited from clinics, agencies, and via media ads in four U.S. cities from June 2000 to January 2002. Two thousand seven hundred and sixty-five HIV-positive adults taking ART. Computer-assessed self-reported antiretroviral adherence. Thirty-two percent reported less than 90% adherence to ART in the prior 3 days. A number of factors were related to nonadherence in univariate analysis. Multivariate analyses identified that being African American, being in a primary relationship, and a history of injection drug use or homelessness in the past year were associated with greater likelihood of nonadherence. Furthermore, adherence self-efficacy, and being able to manage side effects and fit medications into daily routines were protective against nonadherence. Being tired of taking medications was associated with poorer adherence whereas a belief that nonadherence can make the virus stronger was associated with better adherence. Results support the need for multifocused interventions to improve medication adherence that address logistical barriers, substance use, attitudes and expectancies, as well as skills building and self-efficacy enhancement. Further exploration of issues related to adherence for African Americans and men in primary relationships is warranted.

Behavioural, Financial, and Health & Medical Economics: A Connection

OpenAIRE

Chang, Chia-Lin; McAleer, Michael; Wong, Wing-Keung

2015-01-01

textabstractThis Opinion article briefly reviews some of the literature in behavioural and financial economics that are related to health & medical economics. We then discuss some of the research on behavioural and financial economics that could be extended to health & medical economics beyond the existing areas in theory, statistics and econometrics.

“History, Theory and Ethics of Medicine”: The Last Ten Years. A Survey of Course Content, Methods and Structural Preconditions at Twenty-nine German Medical Faculties

Science.gov (United States)

Schildmann, Jan; Bruns, Florian; Hess, Volker; Vollmann, Jochen

2017-01-01

Objective: “History, Theory, Ethics of Medicine” (German: “Geschichte, Theorie, Ethik der Medizin”, abbreviation: GTE) forms part of the obligatory curriculum for medical students in Germany since the winter semester 2003/2004. This paper presents the results of a national survey on the contents, methods and framework of GTE teaching. Methods: Semi-structured questionnaire dispatched in July 2014 to 38 institutions responsible for GTE teaching. Descriptive analysis of quantitative data and content analysis of free-text answers. Results: It was possible to collect data from 29 institutes responsible for GTE teaching (response: 76%). There is at least one professorial chair for GTE in 19 faculties; two professorial chairs or professorships remained vacant at the time of the survey. The number of students taught per academic year ranges from 350. Teaching in GTE comprises an average of 2.18 hours per week per semester (min: 1, max: 6). Teaching in GTE is proportionally distributed according to an arithmetic average as follows: history: 35.4%, theory 14.7% and ethics 49.9%. Written learning objectives were formulated for GTE in 24 faculties. The preferred themes of teaching in history, theory or ethics which according to respondents should be taught comprise a broad spectrum and vary. Teaching in ethics (79 from a max. of 81 possible points) is, when compared to history (61/81) and theory (53/81), attributed the most significance for the training of medical doctors. Conclusion: 10 years after the introduction of GTE the number of students and the personnel resources available at the institutions vary considerably. In light of the differences regarding the content elicited in this study the pros and cons of heterogeneity in GTE should be discussed. PMID:28584871

Association between Perceived Value and Self-Medication with Antibiotics: An Observational Study Based on Health Belief Model Theory

Directory of Open Access Journals (Sweden)

Annisa N. Insany

2015-06-01

Full Text Available High prevalence of self medication with antibiotics can increase the probability of irrational use of antibiotics which may lead antibiotics resistance. Thus, shifting of behavior is required to minimize the irrational use of antibiotics. This study was aimed to determine the association between public perceived value and self-medication with antibiotics which can be used to develop an intervention model in order to reduce the practice of self-medication with antibiotics. An observational study was conducted during the period of November–December 2014.The subjects were patients who visit primary health care facilities in Bandung. A structured-interview that has been validated was used to investigate the association between perceived value and self-medication behavior based on the Health Belief Model theory (perceived susceptibility, benefits, barrier, and cues to action. Approximately 506 respondents were drawn randomly from 43 community healthcare centers and 8 pharmacies. Data was analyzed by using descriptive statistics and logistic regression (CI 95%, α = 5%. Validity and reliability of the questionnaire were shown with a correlation coefficient of >0.3 and a cronbach-alpha value of 0.719, respectively. We found that 29.45% of respondents practiced self-medication with antibiotics over the last six months. Additionally, there was no significant association between the perceived susceptibility, benefits, barrier, and cues to action with self-medication behavior (p>0.05. Easiness to access antibiotics without prescription was presumed as a factor that contribute to self-medication with antibiotics, therefore strict regulation in antibiotics use is very needed as a basic intervention to decrease self-medication with antibiotic.

Medical anthropology: toward a third moment in social science?

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Dressler, W W

2001-12-01

This article about medical anthropology was inspired by the work of Pierre Bourdieu, specifically, his efforts to reconcile the antinomy of a "social structuralist" and a "cultural constructivist" perspective. These perspectives are often opposed in the literature, but, in Bourdieu's view, human life cannot be studied without taking into account both how individuals are situated within and constrained by social structures and how those individuals construct an understanding of and impose meaning on the world around them. I argue that the special subject matter of medical anthropology--human health--demands that a synthetic approach be taken in our theory and research. I illustrate this argument with examples from my own research on social and cultural factors associated with blood pressure, and I point to other examples of this synthesis in medical anthropology. The results of this research hold promise for the continuing refinement of culture theory.

A Comparison between Discrimination Indices and Item-Response Theory Using the Rasch Model in a Clinical Course Written Examination of a Medical School.

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Park, Jong Cook; Kim, Kwang Sig

2012-03-01

The reliability of test is determined by each items' characteristics. Item analysis is achieved by classical test theory and item response theory. The purpose of the study was to compare the discrimination indices with item response theory using the Rasch model. Thirty-one 4th-year medical school students participated in the clinical course written examination, which included 22 A-type items and 3 R-type items. Point biserial correlation coefficient (C(pbs)) was compared to method of extreme group (D), biserial correlation coefficient (C(bs)), item-total correlation coefficient (C(it)), and corrected item-total correlation coeffcient (C(cit)). Rasch model was applied to estimate item difficulty and examinee's ability and to calculate item fit statistics using joint maximum likelihood. Explanatory power (r2) of Cpbs is decreased in the following order: C(cit) (1.00), C(it) (0.99), C(bs) (0.94), and D (0.45). The ranges of difficulty logit and standard error and ability logit and standard error were -0.82 to 0.80 and 0.37 to 0.76, -3.69 to 3.19 and 0.45 to 1.03, respectively. Item 9 and 23 have outfit > or =1.3. Student 1, 5, 7, 18, 26, 30, and 32 have fit > or =1.3. C(pbs), C(cit), and C(it) are good discrimination parameters. Rasch model can estimate item difficulty parameter and examinee's ability parameter with standard error. The fit statistics can identify bad items and unpredictable examinee's responses.

Designing a curriculum for communication skills training from a theory and evidence-based perspective.

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Street, Richard L; De Haes, Hanneke C J M

2013-10-01

Because quality health care delivery requires effective clinician-patient communication, successful training of health professionals requires communication skill curricula of the highest quality. Two approaches for developing medical communication curricula are a consensus approach and a theory driven approach. We propose a theory-driven, communication function framework for identifying important communication skills, one that is focused on the key goals and outcomes that need to be accomplished in clinical encounters. We discuss 7 communication functions important to medical encounters and the types of skills needed to accomplish each. The functional approach has important pedagogical implications including the importance of distinguishing the performance of a behavior (capacity) from the outcome of that behavior in context (effectiveness) and the recognition that what counts as effective communication depends on perspective (e.g., observer, patient). Consensus and theory-driven approaches to medical communication curricula are not necessarily contradictory and can be integrated to further enhance ongoing development and improvements in medical communication education. A functional approach should resonate with practicing clinicians and continuing education initiatives in that it is embraces the notion that competent communication is situation-specific as clinicians creatively use communicative skills to accomplish the key goals of the encounter. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Medical Tourism, Medical Migration, and Global Justice: Implications for Biosecurity in a Globalized World.

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Cohen, I Glenn

2017-05-01

We live in the age of globalization. In medicine, that globalization has brought many benefits such as the diffusion of technology and the spread of health care training, but it has also brought threats to biosecurity. This article examines how medical tourism and medical migration pose risks to biosecurity. It also argues that designing legal responses to these risks requires not only technical competence but also a theory of global justice to guide that design. © The Author 2017. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

Justice and medical ethics.

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Gillon, R

1985-07-20

Justice, in the sense of fair adjudication between conflicting claims, is held to be relevant to a wide range of issues in medical ethics. Several differing concepts of justice are briefly described, including Aristotle's formal principle of justice, libertarian theories, utilitarian theories, Marxist theories, the theory of John Rawls, and the view--held, for example, by W.D. Ross--that justice is essentially a matter of reward for individual merit.

Cognitive Load Theory: implications for medical education: AMEE Guide No. 86.

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Young, John Q; Van Merrienboer, Jeroen; Durning, Steve; Ten Cate, Olle

2014-05-01

Cognitive Load Theory (CLT) builds upon established models of human memory that include the subsystems of sensory, working and long-term memory. Working memory (WM) can only process a limited number of information elements at any given time. This constraint creates a "bottleneck" for learning. CLT identifies three types of cognitive load that impact WM: intrinsic load (associated with performing essential aspects of the task), extraneous load (associated with non-essential aspects of the task) and germane load (associated with the deliberate use of cognitive strategies that facilitate learning). When the cognitive load associated with a task exceeds the learner's WM capacity, performance and learning is impaired. To facilitate learning, CLT researchers have developed instructional techniques that decrease extraneous load (e.g. worked examples), titrate intrinsic load to the developmental stage of the learner (e.g. simplify task without decontextualizing) and ensure that unused WM capacity is dedicated to germane load, i.e. cognitive learning strategies. A number of instructional techniques have been empirically tested. As learners' progress, curricula must also attend to the expertise-reversal effect. Instructional techniques that facilitate learning among early learners may not help and may even interfere with learning among more advanced learners. CLT has particular relevance to medical education because many of the professional activities to be learned require the simultaneous integration of multiple and varied sets of knowledge, skills and behaviors at a specific time and place. These activities possess high "element interactivity" and therefore impose a cognitive load that may surpass the WM capacity of the learner. Applications to various medical education settings (classroom, workplace and self-directed learning) are explored.

Deontological foundations for medical ethics?

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Gillon, R

1985-05-04

Gillon outlines the principles of the deontological, or duty-based, group of moral theories in one of a series of British Medical Journal articles on the philosophical foundations of medical ethics. He differentiates between monistic theories, such as Immanuel Kant's, which rely on a single moral principle, and pluralistic theories, such as that of W.D. Ross, which rely on several principles that potentially could conflict. He summarizes the contributions of Kant and Ross to the development of deontological thought, then concludes his essay with brief paragraphs on other deontological approaches to the resolution of conflicting moral principles.

Healing insanity: skills and expert knowledge of Igbo healers ...

African Journals Online (AJOL)

The paper offers an endogenous theory of symbolic release underlying a genuinely Igbo cosmological and epistemological strategy, side by side with the ritual of tying and untying for releasing the forces hampered by intrusion, and for achieving treatment based on culturally meaningful herbal and animal resources.

Improvement of the training system of medical and pharmaceutical specialists at medical college of Saratov State Medical University

Directory of Open Access Journals (Sweden)

Popkov V.M.

2015-06-01

Full Text Available The development of high-technological medical care in Russia has improved the quality of rendering of medical aid to the population, but at the same time the lack of efficient, qualified specialists has been revealed. Today graduates of professional educational institution are characterized by the knowledge in theory and inefficient practical experience, while the employer is interested in the optimal combination of these qualities. All of these facts lead to the necessity of introducing into the educational process technologies of dual training as a tool of approximation theory to practice Saratov. Medical University may share the experience of introduction and organization of elements of the complex educational system in the process of realization of the programs of secondary professional education through the creation of educational-productive cluster on the bases of clinics.

Integrating the teaching role into one’s identity : A qualitative study of beginning undergraduate medical teachers

NARCIS (Netherlands)

van Lankveld, T.; Schoonenboom, J.; Kusurkar, R.A.; Volman, M.; Beishuizen, J.; Croiset, G.

Beginning medical teachers often see themselves as doctors or researchers rather than as teachers. Using both figured worlds theory and dialogical self theory, this study explores how beginning teachers in the field of undergraduate medical education integrate the teacher role into their identity. A

Managing uncertainty: a grounded theory of stigma in transgender health care encounters.

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Poteat, Tonia; German, Danielle; Kerrigan, Deanna

2013-05-01

A growing body of literature supports stigma and discrimination as fundamental causes of health disparities. Stigma and discrimination experienced by transgender people have been associated with increased risk for depression, suicide, and HIV. Transgender stigma and discrimination experienced in health care influence transgender people's health care access and utilization. Thus, understanding how stigma and discrimination manifest and function in health care encounters is critical to addressing health disparities for transgender people. A qualitative, grounded theory approach was taken to this study of stigma in health care interactions. Between January and July 2011, fifty-five transgender people and twelve medical providers participated in one-time in-depth interviews about stigma, discrimination, and health care interactions between providers and transgender patients. Due to the social and institutional stigma against transgender people, their care is excluded from medical training. Therefore, providers approach medical encounters with transgender patients with ambivalence and uncertainty. Transgender people anticipate that providers will not know how to meet their needs. This uncertainty and ambivalence in the medical encounter upsets the normal balance of power in provider-patient relationships. Interpersonal stigma functions to reinforce the power and authority of the medical provider during these interactions. Functional theories of stigma posit that we hold stigmatizing attitudes because they serve specific psychological functions. However, these theories ignore how hierarchies of power in social relationships serve to maintain and reinforce inequalities. The findings of this study suggest that interpersonal stigma also functions to reinforce medical power and authority in the face of provider uncertainty. Within functional theories of stigma, it is important to acknowledge the role of power and to understand how stigmatizing attitudes function to maintain

A communication-theory based view on telemedical communication.

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Schall, Thomas; Roeckelein, Wolfgang; Mohr, Markus; Kampshoff, Joerg; Lange, Tim; Nerlich, Michael

2003-01-01

Communication theory based analysis sheds new light on the use of health telematics. This analysis of structures in electronic medical communication shows communicative structures with special features. Current and evolving telemedical applications are analyzed. The methodology of communicational theory (focusing on linguistic pragmatics) is used to compare it with its conventional counterpart. The semiotic model, the roles of partners, the respective message and their relation are discussed. Channels, sender, addressee, and other structural roles are analyzed for different types of electronic medical communication. The communicative processes are shown as mutual, rational action towards a common goal. The types of communication/texts are analyzed in general. Furthermore the basic communicative structures of medical education via internet are presented with their special features. The analysis shows that electronic medical communication has special features compared to everyday communication: A third participant role often is involved: the patient. Messages often are addressed to an unspecified partner or to an unspecified partner within a group. Addressing in this case is (at least partially) role-based. Communication and message often directly (rather than indirectly) influence actions of the participants. Communication often is heavily regulated including legal implications like liability, and more. The conclusion from the analysis is that the development of telemedical applications so far did not sufficiently take communicative structures into consideration. Based on these results recommendations for future developments of telemedical applications/services are given.

Tensions in mentoring medical students toward self-directed and reflective learning in a longitudinal portfolio-based mentoring system - An activity theory analysis.

Science.gov (United States)

Heeneman, Sylvia; de Grave, Willem

2017-04-01

In medical education, students need to acquire skills to self-direct(ed) learning (SDL), to enable their development into self-directing and reflective professionals. This study addressed the mentor perspective on how processes in the mentor-student interaction influenced development of SDL. n = 22 mentors of a graduate-entry medical school with a problem-based curriculum and longitudinal mentoring system were interviewed (n = 1 recording failed). Using activity theory (AT) as a theoretical framework, thematic analysis was applied to the interview data to identify important themes. Four themes emerged: centered around the role of the portfolio, guiding of students' SDL in the context of assessment procedures, mentor-role boundaries and longitudinal development of skills by both the mentor and mentee. Application of AT showed that in the interactions between themes tensions or supportive factors could emerge for activities in the mentoring process. The mentors' perspective on coaching and development of reflection and SDL of medical students yielded important insights into factors that can hinder or support students' SDL, during a longitudinal mentor-student interaction. Coaching skills of the mentor, the interaction with a portfolio and the context of a mentor community are important factors in a longitudinal mentor-student interaction that can translate to students' SDL skills.

Exploring the situational motivation of medical specialists: a qualitative study.

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van der Burgt, Stéphanie M E; Kusurkar, Rashmi A; Croiset, Gerda; Peerdeman, Saskia M

2018-02-26

The aim was to obtain insight into the factors in the work environment that motivate or demotivate a medical specialist during his/her working day. A qualitative ethnographic design was used, and a constructivist approach was adopted with the Self-Determination theory of motivation as a framework. Six medical specialists from VU University Medical Center in the Netherlands, recruited through convenience, snowball, and purposive sampling, were shadowed for one day each. Data were transcribed and open-coded. Themes were finalized through discussion and consensus. Sixty hours of observation data identified motivating and demotivating factors categorized into four themes that are important for specialists' motivation. Informational technology issues are demotivating factors. Working with colleagues can be both a motivating and demotivating factor, e.g., filling in for each other through feelings of relatedness was motivating. Being in control of one's planning through feelings of autonomy was motivating. Furthermore, patient care and teaching, especially in combination, stimulated specialists' motivation. Regarding the design of the study, we found that situational motivation is indeed observable. The basic psychological needs autonomy, competence, and relatedness are important for specialists' motivation. Investing in a more motivating, open, transparent, and basic-needs- supportive work environment for medical specialists is necessary. Keywords: Continuing professional development, motivation, medical specialists, self-determination theory, qualitative research.

Antoine-Marie Chambeyron (1797-1851): a forgotten disciple of Jean-Etienne Esquirol (1772-1840).

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Walusinski, Olivier

2017-09-01

Antoine-Marie Chambeyron (1797-1851) was a disciple of Jean-Etienne Esquirol (1772-1840) that history forgot, undoubtedly because he made no original contribution to psychiatric nosography. In 1827, his interest in the medical-legal status of the insane led him to translate into French and annotate the first medical-legal psychiatric treatise ever published, which was the work of the German philosopher Johann Christoph Hoffbauer (1766-1827). His translation played a role in shaping the French Law of 1838, the first piece of modern legislation aimed at protecting the rights of mental patients and limiting the State's power to confine them arbitrarily. Chambeyron is among the least-cited contributors to the prestigious work of nineteenth-century French alienists.

Medical leaders or masters?-A systematic review of medical leadership in hospital settings.

Science.gov (United States)

Berghout, Mathilde A; Fabbricotti, Isabelle N; Buljac-Samardžić, Martina; Hilders, Carina G J M

2017-01-01

Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal-and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal 'leaders' in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care.

Predicting medical staff intention to use an online reporting system with modified unified theory of acceptance and use of technology.

Science.gov (United States)

Chang, I-Chiu; Hsu, Hui-Mei

2012-01-01

Barriers to report incident events using an online information system (IS) may be different from those of a paper-based reporting system. The nationwide online Patient-Safety Reporting System (PSRS) contains a value judgment behind use of the system, similar to the Value of Perceived Consequence (VPC), which is seldom discussed in ISs applications of other disciplines. This study developed a more adequate research framework by integrating the VPC construct into the well-known Unified Theory of Acceptance and Use of Technology (UTAUT) model as a theoretical base to explore the predictors of medical staff's intention to use online PSRS. The results showed that management support was an important factor to influence medical staff's intention of using PSRS. The effects of factors such as performance expectancy, perceived positive, and perceived negative consequence on medical staff's intention of using PSRS were moderated by gender, age, experience, and occupation. The results proved that the modified UTAUT model is significant and useful in predicting medical staff's intention of using the nationwide online PSRS.

Why Assessment in Medical Education Needs a Solid Foundation in Modern Test Theory

Science.gov (United States)

Schauber, Stefan K.; Hecht, Martin; Nouns, Zineb M.

2018-01-01

Despite the frequent use of state-of-the-art psychometric models in the field of medical education, there is a growing body of literature that questions their usefulness in the assessment of medical competence. Essentially, a number of authors raised doubt about the appropriateness of psychometric models as a guiding framework to secure and refine…

Constructivism: the view of knowledge that ended philosophy or a theory of learning and instruction?

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Colliver, Jerry A

2002-01-01

Constructivism is referred to in two very different ways in education including medical education: to refer to a view of knowledge and to refer to a theory of learning and hence instruction. This proposal (a) distinguishes between these two usages of constructivism and (b) concludes that constructivism is not a theory of learning and thus as such has little to offer that might be of value to medical education.

A conceptual framework for the use of illness narratives in medical education.

Science.gov (United States)

Kumagai, Arno K

2008-07-01

The use of narratives, including physicians' and patients' stories, literature, and film, is increasingly popular in medical education. There is, however, a need for an overarching conceptual framework to guide these efforts, which are often dismissed as "soft" and placed at the margins of medical school curricula. The purpose of this article is to describe the conceptual basis for an approach to patient-centered medical education and narrative medicine initiated at the University of Michigan Medical School in the fall of 2003. This approach, the Family Centered Experience, involves home visits and conversations between beginning medical students and patient volunteers and their families and is aimed at fostering humanism in medicine. The program incorporates developmental and learning theory, longitudinal interactions with individuals with chronic illness, reflective learning, and small-group discussions to explore the experience of illness and its care. The author describes a grounding of this approach in theories of empathy and moral development and clarifies the educational value that narratives bring to medical education. Specific pedagogical considerations, including use of activities to create "cognitive disequilibrium" and the concept of transformative learning, are also discussed and may be applied to narrative medicine, professionalism, multicultural education, medical ethics, and other subject areas in medical education that address individuals and their health care needs in society.

A medical social work perspective on rehabilitation.

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Fugl-Meyer, Kerstin Sjögren

2016-10-12

This paper introduces a biopsychosocial model for use as a tool by medical social workers and other rehabilitation professionals for the descriptive analysis of the case history and follow-up of patients needing rehabilitative support. The model is based on action theory and emphasizes the demands on evidence-based clarification of the interplay between a subject's contextual life situation, their ability to act in order to realize their goals, and their emotional adaptation. Using clinical experience and literature searches, a standard operations procedure to adequately document the case history in clinical practice is suggested, thus providing strategies through which the work of medical social workers can be based on evidence. Some specific areas of concern for the medical social worker within the rehabilitation of disabled people are highlighted.

Intention to Drive After Drinking Among Medical Students: Contributions of the Protection Motivation Theory.

Science.gov (United States)

Amaral, Ricardo Abrantes; Malbergier, André; Lima, Danielle Ruiz; Santos, Verena Castellani Vitor; Gorenstein, Clarice; Andrade, Arthur Guerra de

The aim of this study was to investigate whether cognitive variables proposed by the protection motivation theory (PMT) were predictive of occasional and frequent intention to drive after drinking in medical students. One hundred fifty-five students attending preclinical years at a Medical School in São Paulo, Brazil, participated in the study. They were asked about their last month substance use, history of drinking and driving, including driving after binge drinking, and risk perceptions based on a self-report questionnaire with statements about protection motivation, threat, and coping appraisals from the PMT model. Fifty-two students (33%) had previous experience of driving after drinking during the last year, and 54 students (35%) reported intention to drive after drinking within the next year. Regression analysis showed that higher scores in perception of personal vulnerability to risks were associated with occasional and frequent intention to continue pursuing this particular behavior. Poorer evaluations about short-term consequences of alcohol consumption and cognitions regarding external rewards were significantly associated with reported intention to continue driving after drinking. Considering the social and health impact of alcohol-impaired behaviors, our findings suggest the need of interventional efforts focused in increasing students' awareness about the negative consequences of drinking and driving aiming to enhance their motivation towards more adaptive behaviors.

Medical Problem-Solving: A Critique of the Literature.

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McGuire, Christine H.

1985-01-01

Prescriptive, decision-analysis of medical problem-solving has been based on decision theory that involves calculation and manipulation of complex probability and utility values to arrive at optimal decisions that will maximize patient benefits. The studies offer a methodology for improving clinical judgment. (Author/MLW)

Professional identity in medical students: pedagogical challenges to medical education.

Science.gov (United States)

Wilson, Ian; Cowin, Leanne S; Johnson, Maree; Young, Helen

2013-01-01

Professional identity, or how a doctor thinks of himself or herself as a doctor, is considered to be as critical to medical education as the acquisition of skills and knowledge relevant to patient care. This article examines contemporary literature on the development of professional identity within medicine. Relevant theories of identity construction are explored and their application to medical education and pedagogical approaches to enhancing students' professional identity are proposed. The influence of communities of practice, role models, and narrative reflection within curricula are examined. Medical education needs to be responsive to changes in professional identity being generated from factors within medical student experiences and within contemporary society.

Genetics: A New Landscape for Medical Geography

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Carrel, Margaret; Emch, Michael

2014-01-01

The emergence and re-emergence of human pathogens resistant to medical treatment will present a challenge to the international public health community in the coming decades. Geography is uniquely positioned to examine the progressive evolution of pathogens across space and through time, and to link molecular change to interactions between population and environmental drivers. Landscape as an organizing principle for the integration of natural and cultural forces has a long history in geography, and, more specifically, in medical geography. Here, we explore the role of landscape in medical geography, the emergent field of landscape genetics, and the great potential that exists in the combination of these two disciplines. We argue that landscape genetics can enhance medical geographic studies of local-level disease environments with quantitative tests of how human-environment interactions influence pathogenic characteristics. In turn, such analyses can expand theories of disease diffusion to the molecular scale and distinguish the important factors in ecologies of disease that drive genetic change of pathogens. PMID:24558292

Medical leaders or masters?—A systematic review of medical leadership in hospital settings

Science.gov (United States)

Fabbricotti, Isabelle N.; Buljac-Samardžić, Martina; Hilders, Carina G. J. M.

2017-01-01

Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal–and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal ‘leaders’ in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care. PMID:28910335

The moral development of medical students: a pilot study of the possible influence of medical education.

Science.gov (United States)

Self, D J; Schrader, D E; Baldwin, D C; Wolinsky, F D

1993-01-01

Medicine endorses a code of ethics and encourages a high moral character among doctors. This study examines the influence of medical education on the moral reasoning and development of medical students. Kohlberg's Moral Judgment Interview was given to a sample of 20 medical students (41.7% of students in that class). The students were tested at the beginning and at the end of their medical course to determine whether their moral reasoning scores had increased to the same extent as other people who extend their formal education. It was found that normally expected increases in moral reasoning scores did not occur over the 4 years of medical education for these students, suggesting that their educational experience somehow inhibited their moral reasoning ability rather than facilitating it. With a range of moral reasoning scores between 315 and 482, the finding of a mean increase from first year to fourth year of 18.5 points was not statistically significant at the P Kohlberg's cognitive moral development theory, some interpretations and explanations are given for the findings of the study.

[The madness of Herakles in Euripides and Sophocles].

Science.gov (United States)

Charlier, Philippe

2003-01-01

In the ancient Greek world madness was conceived as a punishment sent by the gods to men found guilty of various sins. Heralkes, who kills his wife Megara and their sons, is the best example of Greek literature offers of the tragic consequences of mental disease. The article conducts a medical observation of Sophocles' and Euripides' descriptions of Herakles' insanity.

Game theory: applications for surgeons and the operating room environment.

Science.gov (United States)

McFadden, David W; Tsai, Mitchell; Kadry, Bassam; Souba, Wiley W

2012-11-01

Game theory is an economic system of strategic behavior, often referred to as the "theory of social situations." Very little has been written in the medical literature about game theory or its applications, yet the practice of surgery and the operating room environment clearly involves multiple social situations with both cooperative and non-cooperative behaviors. A comprehensive review was performed of the medical literature on game theory and its medical applications. Definitive resources on the subject were also examined and applied to surgery and the operating room whenever possible. Applications of game theory and its proposed dilemmas abound in the practicing surgeon's world, especially in the operating room environment. The surgeon with a basic understanding of game theory principles is better prepared for understanding and navigating the complex Operating Room system and optimizing cooperative behaviors for the benefit all stakeholders. Copyright © 2012 Mosby, Inc. All rights reserved.

Medical semiotics in the 18th century: a theory of practice?

Science.gov (United States)

Hess, V

1998-06-01

Medical semiotics in the 18th century was more than a premodern form of diagnosis. Its structure allowed for the combination of empirically proven rules of instruction with the theoretical knowledge of the new sciences, employing the relation between the sign and the signified.

Health values and prospect theory.

Science.gov (United States)

Treadwell, J R; Lenert, L A

1999-01-01

Health values are important components of medical decisions. Experimental data suggest that people value health in complex and dynamic ways. Prospect theory is a descriptive theory of choice that may accurately characterize how people assign values to health states. The authors first provide background on prospect theory and how it can be applied to health values. Next, they review the relevant health research and find mixed support for prospect theory. Last, they discuss implications of prospect theory for cost-effectiveness analysis. The application of prospect theory to health deserves further research because it may help clarify the link between health and values.

[Medical science and the human image--on the theory of medical tasks].

Science.gov (United States)

Jenny, S

1993-06-22

Our science-determined medicine interprets the non-individual partial aspects of disease that are approachable by causal analytical thought; therefore, it becomes only then an art of healing when it is complemented by medical craftsmanship and philosophic reflection. Naturopathy perceives the individual as an open self-regulatory system whose innumerable mechanisms and strategies for maintenance of integrity have to be supported. In medical practise both concepts have always to be available concomitantly and and in equal rights, not only for repair of lesions but also for real healing.

Ethical analysis of non-medical fetal ultrasound.

Science.gov (United States)

Leung, John Lai Yin; Pang, Samantha Mei Che

2009-09-01

Obstetric ultrasound is the well-recognized prenatal test used to visualize and determine the condition of a pregnant woman and her fetus. Apart from the clinical application, some businesses have started promoting the use of fetal ultrasound machines for nonmedical reasons. Non-medical fetal ultrasound (also known as 'keepsake' ultrasound) is defined as using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication. Notwithstanding the guidelines and warnings regarding ultrasound safety issued by governments and professional bodies, the absence of scientifically proven physical harm to fetuses from this procedure seems to provide these businesses with grounds for rapid expansion. However, this argument is too simplistic because current epidemiological evidence is not synchronous with advancing ultrasound technology. As non-medical fetal ultrasound has aroused very significant public attention, a thorough ethical analysis of this topic is essential. Using a multifaceted approach, we analyse the ethical perspective of non-medical fetal ultrasound in terms of the expectant mother, the fetus and health professionals. After applying four major theories of ethics and principles (the precautionary principle; theories of consequentialism and impartiality; duty-based theory; and rights-based theories), we conclude that obstetric ultrasound practice is ethically justifiable only if the indication for its use is based on medical evidence. Non-medical fetal ultrasound can be considered ethically unjustifiable. Nevertheless, the ethical analysis of this issue is time dependent owing to rapid advancements in ultrasound technology and the safety issue. The role of health professionals in ensuring that obstetric ultrasound is an ethically justifiable practice is also discussed.

An introduction to medical statistics

International Nuclear Information System (INIS)

Hilgers, R.D.; Bauer, P.; Scheiber, V.; Heitmann, K.U.

2002-01-01

This textbook teaches all aspects and methods of biometrics as a field of concentration in medical education. Instrumental interpretations of the theory, concepts and terminology of medical statistics are enhanced by numerous illustrations and examples. With problems, questions and answers. (orig./CB) [de

Political strategy, business strategy, and the academic medical center: linking theory and practice.

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Souba, W W; Weitekamp, M R; Mahon, J F

2001-09-01

The purpose of this paper is to link external political strategy theory to a specific health care setting-that of the academic medical center (AMC). Political strategy encompasses those activities undertaken by AMCs to acquire, develop, and use power (clout, influence, and credibility) to gain an advantage in situations of conflict. It should be differentiated from internal politics, a topic that will not be dealt with in this review. Political strategy should also be distinguished from but not divorced from competitive strategy. As political and social action can change the competitive landscape and the rules of competition, AMCs must become adept in issues management and stakeholder management. The focus on political strategy is a reflection of the enormous changes in the external environment that have impacted AMCs in recent years. These changes have often emerged out of political and social action and they impact significantly on the organization's more traditional business strategies. We suggest that a tighter alignment between political and business strategies in the future will help ensure organizational survival and success. This article reviews the literature and theory in corporate political strategy and illustrates the application of political strategy with examples of issues and problems faced by AMCs. Models of political strategy are well crafted, and this article concludes with succinct observations on the use of political strategies to enhance the business-based strategies of AMCs. Although the focus is on AMCs, the use of political strategies is applicable to any health care institution. Copyright 2001 Academic Press.

Framing risks and benefits of medical tourism: a content analysis of medical tourism coverage in Korean American community newspapers.

Science.gov (United States)

Jun, Jungmi; Oh, Kyeung Mi

2015-01-01

This study examines Korean American community newspapers' representation of risks and benefits involved with medical tourism offered in Korea. Using framing theory, this research attempts to explain Korean Americans' highly positive perceptions and high willingness to use health and medical services in Korea through medical tourism rather than using such services in the United States. The result of content analyses indicated that Korean American community newspapers are rarely engaged in risk communication and lack sufficient information about potential risks of medical tourism while emphasizing diverse benefits. Korean ethnic media, as the primary source of health communication for Korean Americans, should provide more reliable health and medical information for the population's appropriate health management.

Change theory for accounting system reform in health sector: a case study of kerman university of medical sciences in iran.

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Mehrolhassani, Mohammad Hossein; Emami, Mozhgan

2013-11-01

Change theories provide an opportunity for organizational managers to plan, monitor and evaluate changes using a framework which enable them, among others, to show a fast response to environmental fluctuations and to predict the changing patterns of individuals and technology. The current study aimed to explore whether the change in the public accounting system of the Iranian health sector has followed Kurt Lewin's change theory or not. This study which adopted a mixed methodology approach, qualitative and quantitative methods, was conducted in 2012. In the first phase of the study, 41 participants using purposive sampling and in the second phase, 32 affiliated units of Kerman University of Medical Sciences (KUMS) were selected as the study sample. Also, in phase one, we used face-to-face in-depth interviews (6 participants) and the quote method (35 participants) for data collection. We used a thematic framework analysis for analyzing data. In phase two, a questionnaire with a ten-point Likert scale was designed and then, data were analyzed using descriptive indicators, principal component and factorial analyses. The results of phase one yielded a model consisting of four categories of superstructure, apparent infrastructure, hidden infrastructure and common factors. By linking all factors, totally, 12 components based on the quantitative results showed that the state of all components were not satisfactory at KUMS (5.06±2.16). Leadership and management; and technology components played the lowest and the greatest roles in implementing the accrual accounting system respectively. The results showed that the unfreezing stage did not occur well and the components were immature, mainly because the emphasis was placed on superstructure components rather than the components of hidden infrastructure. The study suggests that a road map should be developed in the financial system based on Kurt Lewin's change theory and the model presented in this paper underpins the change

Teacher Perspectives of Interdisciplinary Coteaching Relationships in a Clinical Skills Course: A Relational Coordination Theory Analysis.

Science.gov (United States)

Daniel, Michelle M; Ross, Paula; Stalmeijer, Renée E; de Grave, Willem

2018-01-01

Phenomenon: Interdisciplinary coteaching has become a popular pedagogic model in medical education, yet there is insufficient research to guide effective practices in this context. Coteaching relationships are not always effective, which has the potential to affect the student experience. The purpose of this study was to explore interdisciplinary coteaching relationships between a physician (MD) and social behavioral scientist (SBS) in an undergraduate clinical skills course. We aimed to gain an in-depth understanding of what teachers perceive as influencing the quality of relationships to begin to construct a framework for collaborative teaching in medical education. A qualitative study was conducted consisting of 12 semistructured interviews (6 MD and 6 SBS) and 2 monodisciplinary focus groups. Sampling was purposive and aimed at maximal variation from among 64 possible faculty. The data were analyzed using the constant comparative method to develop a grounded theory. Five major themes resulted from the analysis that outline a framework for interdisciplinary coteaching: respect, shared goals, shared knowledge and understanding, communication, and complementary pairings. Insights: The first 4 themes align with elements of relational coordination theory, an organizational theory of collaborative practice that describes how work roles interact. The complementary pairings extend this theory from work roles to individuals, with unique identities and personal beliefs and values about teaching. Prior studies on coteaching have not provided a clear linkage to theory. The conceptual framework helps suggest future directions for coteaching research and has practical implications for administrative practices and faculty development. These findings contribute to the sparse research in medical education on interdisciplinary coteaching relationships.

Preserving professional credibility: grounded theory study of medical trainees' requests for clinical support.

Science.gov (United States)

Kennedy, Tara J T; Regehr, Glenn; Baker, G Ross; Lingard, Lorelei

2009-02-09

To develop a conceptual framework of the influences on medical trainees' decisions regarding requests for clinical support from a supervisor. Phase 1: members of teaching teams in internal and emergency medicine were observed during regular clinical activities (216 hours) and subsequently completed brief interviews. Phase 2: 36 in depth interviews were conducted using videotaped vignettes to probe tacit influences on decisions to request support. Data collection and analysis used grounded theory methods. Three teaching hospitals in an urban setting in Canada. 124 members of teaching teams on general internal medicine wards and in the emergency department, comprising 31 attending physicians, 57 junior and senior residents, 28 medical students, and eight nurses. Purposeful sampling to saturation was conducted. Trainees' decisions about whether or not to seek clinical support were influenced by three issues: the clinical question (clinical importance, scope of practice), supervisor factors (availability, approachability), and trainee factors (skill, desire for independence, evaluation). Trainees perceived that requesting frequent/inappropriate support threatened their credibility and used rhetorical strategies to preserve credibility. These strategies included building a case for the importance of requests, saving requests for opportune moments, making a plan before requesting support, and targeting requests to specific team members. Trainees consider not only clinical implications but also professional credibility when requesting support from clinical supervisors. Exposing the complexity of this process provides the opportunity to make changes to training programmes to promote timely supervision and provides a framework for further exploration of the impact of clinical training on quality of care of patients.

Medical design anthropology

DEFF Research Database (Denmark)

Ventura, Jonathan; Gunn, Wendy

Barnard and Spencer define medical anthropology in the Encyclopedia of Social and Cultural Anthropology as "Medical anthropology is, as the phrase implies, unavoidably concerned with the paradigm of modern Western medicine, whether implicitly or explicitly" (2002: 541). Recently there is a new...... focus in medical sociology and anthropology, which is patient's practices and influence on wider global health environment (see for example vol. 36(2) of Sociology of Health & Illness). While various social science theoreticians have written about agentic abilities of objects, there is a gap...... in literature concerning various levels of socio-cultural influence of the medical environment through medical products. In our research we have outlined the importance of medical design anthropology (MDA) to the practice and theory of design (Ventura and Gunn, 2016). In this paper, we study the ways in which...

"Pioneers in Physiology": A Project by First-Year Medical Graduates

Science.gov (United States)

Sucharita, S.; Avadhany, Sandhya T.

2011-01-01

The medical curriculum is vast, and students are expected to learn many subjects at the same time. Medical students are often stressed and find it difficult to cope with the curriculum. In addition, some first-year students find theory and practical classes to be monotonous. One of the difficulties faced by faculty members is, therefore, to…

Gatekeepers of a Profession? Employability as Capital in the Recruitment of Medical Interns

Science.gov (United States)

Lindberg, Ola

2013-01-01

The present article concerns employability in physicians' professional practice. Drawing on interview data from recruiters at 21 Swedish hospitals with the most applicants for a medical internship, the article seeks to develop a theory of what constitutes an "employable medical intern". Using Pierre Bourdieu's concept of capital, two…

Social Dominance Theory and Medical Specialty Choice

Science.gov (United States)

Lepièce, Brice; Reynaert, Christine; van Meerbeeck, Philippe; Dory, Valérie

2016-01-01

Understanding how medical students select their specialty is a fundamental issue for public health and educational policy makers. One of the factors that students take into account is a specialty's prestige which hinges partly on its focus on technique rather than whole person. We examine the potential of a psychological framework, social…

Using self-regulation theory to examine patient goals, barriers, and facilitators for taking medication.

Science.gov (United States)

Kucukarslan, Suzan N; Thomas, Sheena; Bazzi, Abraham; Virant-Young, Deborah

2009-12-01

: Self-regulation theory predicts that patient behavior is determined by the patient's assessment of his/her condition (illness presentation) and related health goals. Patients will adapt their behavior to achieve those goals. However, there are multiple levels of goals. In such cases, those lower-level goals (health goals) that are strongly correlated with higher-level goals (i.e. quality of life [QOL]) are more likely to drive patient behavior. Medication non-compliance is a health behavior that challenges healthcare practitioners. Thus, the primary aim of this paper is to explore the relationship between the lower-level goals for taking medication with higher-level goals. This paper also identifies patient-perceived barriers and facilitators toward achieving goals as they may relate to patients' illness representation. : To identify lower- and higher-level goals associated with medication use for chronic conditions. To determine if there is a relationship between higher-level (global) goals and lower-level (health-related) goals. To identify patient-perceived facilitators and barriers to achieving those goals. : This was a prospective, observational study using a mailed survey. The setting was a US Midwestern state-wide survey. Participants were patients living in the community with hypertension, heart disease, diabetes mellitus, or arthritis, and taking prescription medication for any one of those conditions. The main outcome measures were lower- and higher-level goals related to medication use. The survey asked the participants if they had achieved their goals and to identify factors that may pose as barriers or facilitators to achieving them. Pearson correlation was used to test the relationship between the lower- and higher-level goals at p goals existed (p = 0.03). Preventing future health problems was the most important lower-level goal for almost half of the respondents. Approximately 43% of the respondents said 'improving or maintaining quality of

Development of a program theory for shared decision-making: a realist review protocol.

Science.gov (United States)

Groot, Gary; Waldron, Tamara; Carr, Tracey; McMullen, Linda; Bandura, Lori-Ann; Neufeld, Shelley-May; Duncan, Vicky

2017-06-17

The practicality of applying evidence to healthcare systems with the aim of implementing change is an ongoing challenge for practitioners, policy makers, and academics. Shared decision- making (SDM), a method of medical decision-making that allows a balanced relationship between patients, physicians, and other key players in the medical decision process, is purported to improve patient and system outcomes. Despite the oft-mentioned benefits, there are gaps in the current literature between theory and implementation that would benefit from a realist approach given the value of this methodology to analyze complex interventions. In this protocol, we outline a study that will explore: "In which situations, how, why, and for whom does SDM between patients and health care providers contribute to improved decision making?" A seven step iterative process will be described including preliminary theory development, establishment of a search strategy, selection and appraisal of literature, data extraction, analysis and synthesis of extracted results from literature, and formation of a revised program theory with the input of patients, physicians, nurse navigators, and policy makers from a stakeholder session. The goal of the realist review will be to identify and refine a program theory for SDM through the identification of mechanisms which shape the characteristics of when, how, and why SDM will, and will not, work. PROSPERO CRD42017062609.

Reducing the time-lag between onset of chest pain and seeking professional medical help: a theory-based review

Directory of Open Access Journals (Sweden)

Baxter Susan K

2013-02-01

Full Text Available Abstract Background Research suggests that there are a number of factors which can be associated with delay in a patient seeking professional help following chest pain, including demographic and social factors. These factors may have an adverse impact on the efficacy of interventions which to date have had limited success in improving patient action times. Theory-based methods of review are becoming increasingly recognised as important additions to conventional systematic review methods. They can be useful to gain additional insights into the characteristics of effective interventions by uncovering complex underlying mechanisms. Methods This paper describes the further analysis of research papers identified in a conventional systematic review of published evidence. The aim of this work was to investigate the theoretical frameworks underpinning studies exploring the issue of why people having a heart attack delay seeking professional medical help. The study used standard review methods to identify papers meeting the inclusion criterion, and carried out a synthesis of data relating to theoretical underpinnings. Results Thirty six papers from the 53 in the original systematic review referred to a particular theoretical perspective, or contained data which related to theoretical assumptions. The most frequently mentioned theory was the self-regulatory model of illness behaviour. Papers reported the potential significance of aspects of this model including different coping mechanisms, strategies of denial and varying models of treatment seeking. Studies also drew attention to the potential role of belief systems, applied elements of attachment theory, and referred to models of maintaining integrity, ways of knowing, and the influence of gender. Conclusions The review highlights the need to examine an individual’s subjective experience of and response to health threats, and confirms the gap between knowledge and changed behaviour. Interventions face

From vagueness in medical thought to the foundations of fuzzy reasoning in medical diagnosis.

Science.gov (United States)

Seising, Rudolf

2006-11-01

This article delineates a relatively unknown path in the history of medical philosophy and medical diagnosis. It is concerned with the phenomenon of vagueness in the physician's "style of thinking" and with the use of fuzzy sets, systems, and relations with a view to create a model of such reasoning when physicians make a diagnosis. It represents specific features of medical ways of thinking that were mentioned by the Polish physician and philosopher Ludwik Fleck in 1926. The paper links Lotfi Zadeh's work on system theory before the age of fuzzy sets with system-theory concepts in medical philosophy that were introduced by the philosopher Mario Bunge, and with the fuzzy-theoretical analysis of the notions of health, illness, and disease by the Iranian-German physician and philosopher Kazem Sadegh-Zadeh. Some proposals to apply fuzzy sets in medicine were based on a suggestion made by Zadeh: symptoms and diseases are fuzzy in nature and fuzzy sets are feasible to represent these entity classes of medical knowledge. Yet other attempts to use fuzzy sets in medicine were self-contained. The use of this approach contributed to medical decision-making and the development of computer-assisted diagnosis in medicine. With regard to medical philosophy, decision-making, and diagnosis; the framework of fuzzy sets, systems, and relations is very useful to deal with the absence of sharp boundaries of the sets of symptoms, diagnoses, and phenomena of diseases. The foundations of reasoning and computer assistance in medicine were the result of a rapid accumulation of data from medical research. This explosion of knowledge in medicine gave rise to the speculation that computers could be used for the medical diagnosis. Medicine became, to a certain extent, a quantitative science. In the second half of the 20th century medical knowledge started to be stored in computer systems. To assist physicians in medical decision-making and patient care, medical expert systems using the theory

Making Sense of Grounded Theory Approach: Implications for Medial Education Research

OpenAIRE

Mohsen Tavokol; S Torabi; AA Zeialoo

2009-01-01

This article first gives a definition of grounded theory and its development and use in medicine and medical education. The fundamental differences of grounded theory with quantitative methods are discussed along a full discussion of the steps required to use a grounded theory approach. At the end the questions in the area of medical education which can best addressed with this approach are provided. 

Leadership theory and motivation of medical imaging employees.

Science.gov (United States)

Kalar, Traci; Wright, Donna Lee

2007-01-01

*This literature review explores how transactional, transformational, and charismatic leadership theories might be applied in a typical stressful hypothetical department situation. *Transactional department leaders motivate employees using extrinsic rewards, encouraging them to do what is needed to get the minimal results with no encouragement for higher levels of thinking. *Transformational department leaders motivate employees by transforming their beliefs and values to be more in alignment with the organization's values and goals. This alignment helps create higher levels of intrinsic motivation. *Charismatic leaders exhibit the same behaviors as transformational leaders to motivate employees; however; because of their specific characteristics, their effectiveness can be limited to only times of distress or crisis. The situation in the particular department determines which leadership theory is likely to be most successful.

A "His Story" of Insanity: Madness and Masculinity in Twentieth-Century American Literature

OpenAIRE

Bumeistere, Lilita

2013-01-01

This thesis is an interdisciplinary study of the largely neglected relationship between madness and masculinity based on three American literary works written during different periods of the twentieth century. The study utilizes literary, social, and medical research in order to provide a holistic view of madness and masculinity as two social constructs that interact with and are contingent on each other. In Sherwood Anderson’s “Hands,” Ken Kesey’s One Flew Over the Cuckoo’s Nest, and David F...

Making Sense of Grounded Theory Approach: Implications for Medial Education Research

Directory of Open Access Journals (Sweden)

Mohsen Tavokol

2009-02-01

Full Text Available This article first gives a definition of grounded theory and its development and use in medicine and medical education. The fundamental differences of grounded theory with quantitative methods are discussed along a full discussion of the steps required to use a grounded theory approach. At the end the questions in the area of medical education which can best addressed with this approach are provided. 

Predicting substance-abuse treatment providers' communication with clients about medication assisted treatment: a test of the theories of reasoned action and planned behavior.

Science.gov (United States)

Roberto, Anthony J; Shafer, Michael S; Marmo, Jennifer

2014-01-01

The purpose of this investigation is to determine if the theory of reasoned action (TRA) and theory of planned behavior (TPB) can retrospectively predict whether substance-abuse treatment providers encourage their clients to use medicated-assisted treatment (MAT) as part of their treatment plan. Two-hundred and ten substance-abuse treatment providers completed a survey measuring attitudes, subjective norms, perceived behavioral control, intentions, and behavior. Results indicate that substance-abuse treatment providers have very positive attitudes, neutral subjective norms, somewhat positive perceived behavioral control, somewhat positive intentions toward recommending MAT as part of their clients' treatment plan, and were somewhat likely to engage in the actual behavior. Further, the data fit both the TRA and TPB, but with the TPB model having better fit and predictive power for this target audience and behavior. The theoretical and practical implications for the developing messages for substance-abuse treatment providers and other health-care professionals who provide treatment to patients with substance use disorders are discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

Medical emplotment

DEFF Research Database (Denmark)

Mønsted, Troels Sune

’. Theoretically the project departs from Computer Supported Cooperative Work and Participatory Design and is informed by Medical Informatics, Design Research and Science and Technology Studies. Methodically the project is founded on collaborative prototyping, ethnographic studies, and design interventions...... philosophy and building on theory on narrative reasoning, the dissertation offers the notions of emplotment and re-emplotment to describe how physicians marshal information from various sources, including the medical record, the patient and coSummary to form a narrative, when making sense of patients...

Quality specifications in postgraduate medical e-learning: an integrative literature review leading to a postgraduate medical e-learning model.

Science.gov (United States)

De Leeuw, R A; Westerman, Michiel; Nelson, E; Ket, J C F; Scheele, F

2016-07-08

E-learning is driving major shifts in medical education. Prioritizing learning theories and quality models improves the success of e-learning programs. Although many e-learning quality standards are available, few are focused on postgraduate medical education. We conducted an integrative review of the current postgraduate medical e-learning literature to identify quality specifications. The literature was thematically organized into a working model. Unique quality specifications (n = 72) were consolidated and re-organized into a six-domain model that we called the Postgraduate Medical E-learning Model (Postgraduate ME Model). This model was partially based on the ISO-19796 standard, and drew on cognitive load multimedia principles. The domains of the model are preparation, software design and system specifications, communication, content, assessment, and maintenance. This review clarified the current state of postgraduate medical e-learning standards and specifications. It also synthesized these specifications into a single working model. To validate our findings, the next-steps include testing the Postgraduate ME Model in controlled e-learning settings.

Becoming a caregiver: attachment theory and poorly performing doctors.

Science.gov (United States)

Adshead, Gwen

2010-02-01

In this paper, I review a theoretical paradigm (attachment theory) which facilitates an understanding of how human care-giving and care-eliciting behaviours develop and are maintained over the lifespan. I argue that this paradigm has particular utility in: (i) the training of doctors; (ii) understanding why some doctors and medical students experience high levels of stress, and (iii) developing interventions to help those who struggle to manage high levels of work-related stress. I carried out a review of key texts and previously published studies of attachment styles in caregivers. Large-scale epidemiological studies, using valid and reliable measures, show that insecure attachment styles are found in a proportion of normal populations of both males and females. Insecure attachment is associated with impaired stress management and subtle deficits in care-giving sensitivity. It is reasonable to assume that a proportion of students entering medical training and doctors with performance problems may have insecure attachment styles which influence how they approach their training experience and how they manage occupational stress. Attachment theory is a useful paradigm for thinking about training as a professional caregiver. Insecure early attachment experiences may be a risk factor for poor stress management in some medical students and doctors who are exposed to increasing demands as carers. These findings lead to suggestions for possible research and support interventions.

Traditional knowledge and formulations of medicinal plants used by the traditional medical practitioners of bangladesh to treat schizophrenia like psychosis.

Science.gov (United States)

Ahmed, Md Nasir; Kabidul Azam, Md Nur

2014-01-01

Schizophrenia is a subtle disorder of brain development and plasticity; it affects the most basic human processes of perception, emotion, and judgment. In Bangladesh the traditional medical practitioners of rural and remote areas characterized the schizophrenia as an insanity or a mental problem due to possession by ghosts or evil spirits and they have used various plant species' to treat such symptoms. The aim of the present study was to conduct an ethnomedicinal plant survey and documentation of the formulations of different plant parts used by the traditional medical practitioners of Rangamati district of Bangladesh for the treatment of schizophrenia like psychosis. It was observed that the traditional medical practitioners used a total of 15 plant species to make 14 formulations. The plants were divided into 13 families, used for treatment of schizophrenia and accompanying symptoms like hallucination, depression, oversleeping or insomnia, deterioration of personal hygiene, forgetfulness, and fear due to evil spirits like genies or ghost. A search of the relevant scientific literatures showed that a number of plants used by the medicinal practitioners have been scientifically validated in their uses and traditional medicinal knowledge has been a means towards the discovery of many modern medicines. Moreover, the antipsychotic drug reserpine, isolated from the dried root of Rauvolfia serpentina species, revolutionized the treatment of schizophrenia. So it is very much possible that formulations of the practitioner, when examined scientifically in their entireties, can form discovery of lead compounds which can be used as safe and effective antipsychotic drug to treat schizophrenia.

Traditional Knowledge and Formulations of Medicinal Plants Used by the Traditional Medical Practitioners of Bangladesh to Treat Schizophrenia Like Psychosis

Directory of Open Access Journals (Sweden)

Md. Nasir Ahmed

2014-01-01

Full Text Available Schizophrenia is a subtle disorder of brain development and plasticity; it affects the most basic human processes of perception, emotion, and judgment. In Bangladesh the traditional medical practitioners of rural and remote areas characterized the schizophrenia as an insanity or a mental problem due to possession by ghosts or evil spirits and they have used various plant species’ to treat such symptoms. The aim of the present study was to conduct an ethnomedicinal plant survey and documentation of the formulations of different plant parts used by the traditional medical practitioners of Rangamati district of Bangladesh for the treatment of schizophrenia like psychosis. It was observed that the traditional medical practitioners used a total of 15 plant species to make 14 formulations. The plants were divided into 13 families, used for treatment of schizophrenia and accompanying symptoms like hallucination, depression, oversleeping or insomnia, deterioration of personal hygiene, forgetfulness, and fear due to evil spirits like genies or ghost. A search of the relevant scientific literatures showed that a number of plants used by the medicinal practitioners have been scientifically validated in their uses and traditional medicinal knowledge has been a means towards the discovery of many modern medicines. Moreover, the antipsychotic drug reserpine, isolated from the dried root of Rauvolfia serpentina species, revolutionized the treatment of schizophrenia. So it is very much possible that formulations of the practitioner, when examined scientifically in their entireties, can form discovery of lead compounds which can be used as safe and effective antipsychotic drug to treat schizophrenia.

Cognitive load theory: Practical implications and an important challenge

Directory of Open Access Journals (Sweden)

Jimmie Leppink, Ph.D.

2017-10-01

Full Text Available The field of medical education has adopted a wide variety of theories from other fields. A fairly recent example is cognitive load theory, which originated in educational psychology. Several empirical studies inspired by cognitive load theory and reviews of practical implications of cognitive load theory have contributed to guidelines for the design of medical education. Simultaneously, several research groups have developed instruments for the measurement of cognitive load in a medical education context. These developments notwithstanding, obtaining evidence for different types of cognitive load remains an important challenge. Therefore, the aim of this article is twofold: to provide medical educators with three key guidelines for the design of instruction and assessment and to discuss several fundamental issues in the remaining challenges presented by different types of cognitive load. The guidelines revolve around minimizing cognitive activity that does not contribute to learning, working with specific learning goals in mind, and appreciating the multifaceted relation between learning and assessment. Key issues around the types of cognitive load include the context in which learning occurs, the continued use of single-item mental effort ratings, and the timing of cognitive load and learning outcome measurements.

Designing a curriculum for communication skills training from a theory and evidence-based perspective

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Street, Richard L.; de Haes, Hanneke C. J. M.

2013-01-01

Because quality health care delivery requires effective clinician-patient communication, successful training of health professionals requires communication skill curricula of the highest quality. Two approaches for developing medical communication curricula are a consensus approach and a theory

Medical Humanities in Nepal: Present Scenario.

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Dhakal, Ajaya Kumar; Shankar, P Ravi; Dhakal, Sanjaya; Shrestha, Devendra; Piryani, Rano Mal

2014-01-01

Humanities have an essential role in medical education. The current gap between the humanities and medicine has to be bridged and there should be continuous and vigorous debate about the theory and practice of medical humanities. Medical humanities is a relatively new concept even in developed countries, and is at infancy stage in developing countries. In Nepal, modules on medical humanities have been initiated in certain medical schools by enthusiastic faculties and it requires further debates for inclusion in curriculum.

Reconstructing a lost tradition: the philosophy of medical education in an age of reform.

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Martin, Christopher

2013-01-01

At the 100th anniversary of Abraham Flexner's landmark report on medical education, critical reassessment of the direction of medical education reform evinced valuable interdisciplinary contributions from biomedicine, sociology, psychology and education theory. However, to date, philosophy has been absent from the discussion despite its long standing contribution to studies on education in other professions. This discussion paper examines how the philosophical tradition can contribute to scholarship in medical education. It begins with an explanation of the scholarly tradition of philosophy of education and its role in thinking in education more generally. It then makes links between this tradition and the context of medical education in the Flexner era of education reform. The paper then argues that this tradition is necessary to the understanding of medical education reform post-Flexner and that doctors must benefit from an education derived from this tradition in order to be able to carry out their work. These foundations are characterised as a hidden, but always present, tradition in medical education. Two ways in which this 'lost tradition' can inform medical education theory and practice are identified: firstly, by the establishment of a public canon of medical education texts that express such a tradition, and, secondly, by the incorporation of a variety of 'signature pedagogies' exemplary of liberal education. © Blackwell Publishing Ltd 2013.

When is a theory a theory? A case example.

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Alkin, Marvin C

2017-08-01

This discussion comments on the approximately 20years history of writings on the prescriptive theory called Empowerment Evaluation. To do so, involves examining how "Empowerment Evaluation Theory" has been defined at various points of time (particularly 1996 and now in 2015). Defining a theory is different from judging the success of a theory. This latter topic has been addressed elsewhere by Michael Scriven, Michael Patton, and Brad Cousins. I am initially guided by the work of Robin Miller (2010) who has written on the issue of how to judge the success of a theory. In doing so, she provided potential standards for judging the adequacy of theories. My task is not judging the adequacy or success of the Empowerment Evaluation prescriptive theory in practice, but determining how well the theory is delineated. That is, to what extent do the writings qualify as a prescriptive theory. Copyright © 2016 Elsevier Ltd. All rights reserved.

Prediction of pharmacist intention to provide medication disposal education using the theory of planned behaviour.

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Tai, Bik-Wai Bilvick; Hata, Micah; Wu, Stephanie; Frausto, Sonya; Law, Anandi V

2016-10-01

Lack of familiarity with proper medication disposal options among patients can lead to personal and environmental safety concerns, besides signalling non-adherence. Given that community pharmacists are in a position to educate patients, this study assessed community pharmacists' knowledge on medication disposal and examined the utility of the theory of planned behaviour (TPB) in predicting their intention to provide medication disposal education to their patients. A cross-sectional, self-administered survey was distributed to community pharmacists in California. Descriptive statistics were reported for all survey items. Cronbach's alpha and Pearson correlation were used to determine the reliability for the four TPB constructs (attitude, subjective norm, perceived behavioural control and intention). Multiple linear regressions were performed to predict intent using the other three TPB constructs. Pharmacists (n = 142) demonstrated a positive intention to provide education (mean = 5.91 ± 1.22; range: 2 to 8), but most (67.9%) provided this information once a month or less. Attitude (β = 0.266, P = 0.001), subjective norm (β = 0.333, P behavioural control (β = 0.211, P = 0.009) were significant predictors of intention, accounting for 40.8% of the variance in intention to provide disposal education. Scale reliability ranged from 0.596 to 0.619 for the four constructs. Few pharmacists accurately selected all of the appropriate recommendations of disposal for non-controlled and controlled substances (15.9% and 10.1%, respectively). Pharmacists showed favourable attitude, subjective norm, perceived behaviour control and intention in providing such education. However, their knowledge in this area may be lacking and they are not consistently providing this information to their patients. © 2016 John Wiley & Sons, Ltd.

Quality of Life Theory II. Quality of Life as the Realization of Life Potential: A Biological Theory of Human Being

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Soren Ventegodt

2003-01-01

Full Text Available This review presents one of the eight theories of the quality of life (QOL used for making the SEQOL (self-evaluation of quality of life questionnaire or the quality of life as realizing life potential. This theory is strongly inspired by Maslow and the review furthermore serves as an example on how to fulfill the demand for an overall theory of life (or philosophy of life, which we believe is necessary for global and generic quality-of-life research.Whereas traditional medical science has often been inspired by mechanical models in its attempts to understand human beings, this theory takes an explicitly biological starting point. The purpose is to take a close view of life as a unique entity, which mechanical models are unable to do. This means that things considered to be beyond the individual's purely biological nature, notably the quality of life, meaning in life, and aspirations in life, are included under this wider, biological treatise. Our interpretation of the nature of all living matter is intended as an alternative to medical mechanism, which dates back to the beginning of the 20th century. New ideas such as the notions of the human being as nestled in an evolutionary and ecological context, the spontaneous tendency of self-organizing systems for realization and concord, and the central role of consciousness in interpreting, planning, and expressing human reality are unavoidable today in attempts to scientifically understand all living matter, including human life.

Connectivism: A knowledge learning theory for the digital age?

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Goldie, John Gerard Scott

2016-10-01

The emergence of the internet, particularly Web 2.0 has provided access to the views and opinions of a wide range of individuals opening up opportunities for new forms of communication and knowledge formation. Previous ways of navigating and filtering available information are likely to prove ineffective in these new contexts. Connectivism is one of the most prominent of the network learning theories which have been developed for e-learning environments. It is beginning to be recognized by medical educators. This article aims to examine connectivism and its potential application. The conceptual framework and application of connectivism are presented along with an outline of the main criticisms. Its potential application in medical education is then considered. While connectivism provides a useful lens through which teaching and learning using digital technologies can be better understood and managed, further development and testing is required. There is unlikely to be a single theory that will explain learning in technological enabled networks. Educators have an important role to play in online network learning.

An Assessment of Health Literacy Rates in a Sample of Active-Duty Military Personnel at a Major Medical Center

Science.gov (United States)

2008-01-01

behaviors, for exam- ple, adherence to medical regiments, proper exercise, and diet. Social cognitive theory was developed by Albert Bandura and...and Health Education: Theory, Research and Practtce.3rd ed. San Francisco, CA. Jossey-Bass; 2002:214-245. 19. Bandura A. Social cognitive theory: an...SoclaLCognitlve_Theory_Overview. htm. Accessed April 2006. 21. Bandura A. Health promotion by social cogni- tive means. Health Educ Bebav. 2004;31(2):143- 164. 318

Birth Territory: a theory for midwifery practice.

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Fahy, Kathleen M; Parratt, Jenny Anne

2006-07-01

The theory of Birth Territory describes, explains and predicts the relationships between the environment of the individual birth room, issues of power and control, and the way the woman experiences labour physiologically and emotionally. The theory was synthesised inductively from empirical data generated by the authors in their roles as midwives and researchers. It takes a critical post-structural feminist perspective and expands on some of the ideas of Michel Foucault. Theory synthesis was also informed by current research about the embodied self and the authors' scholarship in the fields of midwifery, human biology, sociology and psychology. In order to demonstrate the significance of the theory, it is applied to two clinical stories that both occur in hospital but are otherwise different. This analysis supports the central proposition that when midwives use 'midwifery guardianship' to create and maintain the ideal Birth Territory then the woman is most likely to give birth naturally, be satisfied with the experience and adapt with ease in the post-birth period. These benefits together with the reduction in medical interventions also benefit the baby. In addition, a positive Birth Territory is posited to have a broader impact on the woman's partner, family and society in general.

Professional development of medical students: problems and promises.

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Wear, D

1997-12-01

Observers and critics of the medical profession, both within and without, urge that more attention be paid to the moral sensibilities, the characters, of medical students. Passing on particular moral values and actions to physicians has always been an essential core of medical training, and this call for renewal is not new in modern medicine. Some of the structures and characteristics of modern medical education, however, often work directly against the professionalism that the education espouses. For example, medical students are socialized into a hierarchy that has broad implications for relations among health care professionals, other health care workers, and patients, and academic medicine has not promoted and taught critical reflection about the values and consequences of this hierarchy. Further, behind the formal curriculum lies the "hidden curriculum" of values that are unconsciously or half-consciously passed on from the faculty and older trainees. Two resources for thinking anew about professional development for medical students are feminist standpoint theory and critical multicultural theory, each of which raises important and fundamental questions about defining the role of medicine in society and the role of the physician in medicine. The author discusses these two theories and their implications for medical education, showing how they can be used to move discussions of professional development into analysis of the widespread social consequences of how a society organizes its health care and into critical reflection on the nature of medical knowledge.

Change Theory for Accounting System Reform in Health Sector: A Case Study of Kerman University of Medical Sciences in Iran

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Mohammad Hossein Mehrolhasani

2013-11-01

Full Text Available BackgroundChange theories provide an opportunity for organizational managers to plan, monitor and evaluate changes using a framework which enable them, among others, to show a fast response to environmental fluctuations and to predict the changing patterns of individuals and technology. The current study aimed to explore whether the change in the public accounting system of the Iranian health sector has followed Kurt Lewin’s change theory or not. MethodsThis study which adopted a mixed methodology approach, qualitative and quantitative methods, was conducted in 2012. In the first phase of the study, 41 participants using purposive sampling and in the second phase, 32 affiliated units of Kerman University of Medical Sciences (KUMS were selected as the study sample. Also, in phase one, we used face-to-face in-depth interviews (6 participants and the quote method (35 participants for data collection. We used a thematic framework analysis for analyzing data. In phase two, a questionnaire with a ten-point Likert scale was designed and then, data were analyzed using descriptive indicators, principal component and factorial analyses. ResultsThe results of phase one yielded a model consisting of four categories of superstructure, apparent infrastructure, hidden infrastructure and common factors. By linking all factors, totally, 12 components based on the quantitative results showed that the state of all components were not satisfactory at KUMS (5.06±2.16. Leadership and management; and technology components played the lowest and the greatest roles in implementing the accrual accounting system respectively. ConclusionThe results showed that the unfreezing stage did not occur well and the components were immature, mainly because the emphasis was placed on superstructure components rather than the components of hidden infrastructure. The study suggests that a road map should be developed in the financial system based on Kurt Lewin’s change theory and

Medical practice and social authority.

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Pippin, R B

1996-08-01

Questions of medical ethics are often treated as especially difficult casuistical problems or as difficult cases illustrative of paradoxes or advantages in global moral theories. I argue here, in opposition to such approaches, for the inseparability of questions of social history and social theory from any normative assessment of medical practices. The focus of the discussion is the question of the legitimacy of the social authority exercised by physicians, and the insufficiency of traditional defences of such authority in liberal societies (voluntarist, informed consent approaches), as well as traditional attacks on such strategies (ideology critique). Seeing such authority as institution bound and role based, it is argued, can help reframe, more broadly and more adequately, what is an "ethical problem" in medical practice and why.

[The materialistic strategy of Henry Howard, a Québec alienist (1815-1887).].

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Fugère, A

1978-01-01

At the end of the 19th century, Henry Howard appeared as the first Quebec "aliéniste" to attempt to develop an inclusive theoretical treatise on the question of madness. Why this sudden upheaval ? There existed numerous european theories ; that might have sufficed. The author attempts to show the multiple connections of this theoretical pro-lect to the socio-political problems of québécois society. Howard tries, from the perspective of the theory which he elaborates, to intervene in the major discussions affecting Quebec: ultra montanism, the problem of universal compusory education, public morality. At a more professional level he attempts to intervene in the legal dispute opposing judicial and medical competence in the cases of insanity pleas, as well as in the question of the scientific and social status of the "aliéniste". The involvement in these struggles manifests itself in Howard's treatise as much at the level of the concepts themselves, and their architecture, as at the thematic level and in the applications which he naturally draws. It is not onty external and contingent but works on the text from the inside as well. The article attempts to suggest that at the very moment that the treatise on the alienated-which would become the "science" that we know today- seeks to structure itself into a theory, it cannot break its attachment to its determining social context and that, ignoring its ideological role it, in truth, succeeds only in creating illusion and the impression of a progressive process, all the while being circumstantial and having a verted interest.

Protocol for SAMS (Support and Advice for Medication Study: A randomised controlled trial of an intervention to support patients with type 2 diabetes with adherence to medication

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Sutton Stephen

2008-04-01

Full Text Available Abstract Background Although some interventions have been shown to improve adherence to medication for diabetes, results are not consistent. We have developed a theory-based intervention which we will evaluate in a well characterised population to test efficacy and guide future intervention development and trial design. Methods and Design The SAMS (Supported Adherence to Medication Study trial is a primary care based multi-centre randomised controlled trial among 200 patients with type 2 diabetes and an HbA1c of 7.5% or above. It is designed to evaluate the efficacy of a two-component motivational intervention based on the Theory of Planned Behaviour and volitional action planning to support medication adherence compared with standard care. The intervention is delivered by practice nurses. Nurses were trained using a workshop approach with role play and supervised using assessment of tape-recorded consultations. The trial has a two parallel groups design with an unbalanced three-to-two individual randomisation eight weeks after recruitment with twelve week follow-up. The primary outcome is medication adherence measured using an electronic medication monitor over 12 weeks and expressed as the difference between intervention and control in mean percentage of days on which the correct number of medication doses is taken. Subgroup analyses will explore impact of number of medications taken, age, HbA1c, and self-reported adherence at baseline on outcomes. The study also measures the effect of dispensing medication to trial participants packaged in the electronic medication-monitoring device compared with conventional medication packaging. This will be achieved through one-to-one randomisation at recruitment to these conditions with assessment of the difference between groups in self-report of medication adherence and change in mean HbA1c from baseline to eight weeks. Anonymised demographic data are collected on non-respondents. Central randomisation

Towards a theory of spacetime theories

CERN Document Server

Schiemann, Gregor; Scholz, Erhard

2017-01-01

This contributed volume is the result of a July 2010 workshop at the University of Wuppertal Interdisciplinary Centre for Science and Technology Studies which brought together world-wide experts from physics, philosophy and history, in order to address a set of questions first posed in the 1950s: How do we compare spacetime theories? How do we judge, objectively, which is the “best” theory? Is there even a unique answer to this question? The goal of the workshop, and of this book, is to contribute to the development of a meta-theory of spacetime theories. Such a meta-theory would reveal insights about specific spacetime theories by distilling their essential similarities and differences, deliver a framework for a class of theories that could be helpful as a blueprint to build other meta-theories, and provide a higher level viewpoint for judging which theory most accurately describes nature. But rather than drawing a map in broad strokes, the focus is on particularly rich regions in the “space of spaceti...

The implementation of medical revalidation: an assessment using normalisation process theory

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Abigail Tazzyman

2017-11-01

Full Text Available Abstract Background Medical revalidation is the process by which all licensed doctors are legally required to demonstrate that they are up to date and fit to practise in order to maintain their licence. Revalidation was introduced in the United Kingdom (UK in 2012, constituting significant change in the regulation of doctors. The governing body, the General Medical Council (GMC, envisages that revalidation will improve patient care and safety. This potential however is, in part, dependent upon how successfully revalidation is embedded into routine practice. The aim of this study was to use Normalisation Process Theory (NPT to explore issues contributing to or impeding the implementation of revalidation in practice. Methods We conducted seventy-one interviews with sixty UK policymakers and senior leaders at different points during the development and implementation of revalidation: in 2011 (n = 31, 2013 (n = 26 and 2015 (n = 14. We selected interviewees using purposeful sampling. NPT was used as a framework to enable systematic analysis across the interview sets. Results Initial lack of consensus over revalidation’s purpose, and scepticism about its value, decreased over time as participants recognised the benefits it brought to their practice (coherence category of NPT. Though acceptance increased across time, revalidation was not seen as a legitimate part of their role by all doctors. Key individuals, notably the Responsible Officer (RO, were vital for the successful implementation of revalidation in organisations (cognitive participation category. The ease with which revalidation could be integrated into working practices varied greatly depending on the type of role a doctor held and the organisation they work for and the provision of resources was a significant variable in this (collective action category. Formal evaluation of revalidation in organisations was lacking but informal evaluation was taking place. Revalidation had

Academic Primer Series: Eight Key Papers about Education Theory.

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Gottlieb, Michael; Boysen-Osborn, Megan; Chan, Teresa M; Krzyzaniak, Sara M; Pineda, Nicolas; Spector, Jordan; Sherbino, Jonathan

2017-02-01

Many teachers adopt instructional methods based on assumptions of best practices without attention to or knowledge of supporting education theory. Familiarity with a variety of theories informs education that is efficient, strategic, and evidence-based. As part of the Academic Life in Emergency Medicine Faculty Incubator Program, a list of key education theories for junior faculty was developed. A list of key papers on theories relevant to medical education was generated using an expert panel, a virtual community of practice synthetic discussion, and a social media call for resources. A three-round, Delphi-informed voting methodology including novice and expert educators produced a rank order of the top papers. These educators identified 34 unique papers. Eleven papers described the general use of education theory, while 23 papers focused on a specific theory. The top three papers on general education theories and top five papers on specific education theory were selected and summarized. The relevance of each paper for junior faculty and faculty developers is also presented. This paper presents a reading list of key papers for junior faculty in medical education roles. Three papers about general education theories and five papers about specific educational theories are identified and annotated. These papers may help provide foundational knowledge in education theory to inform junior faculty teaching practice.

EXPERIENCE IN DEVELOPMENT MEDICAL KITS FOR MEDICAL SERVICES OF THE RUSSIAN FEDERATION ARMED FORCES

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E. O. Rodionov

2016-01-01

Full Text Available Introduction. The development of modern, complete-standard issue equipment for the Armed Forces Medical Service is an urgent organizational and management task. First aid kits, medical bags, sets of medical equipment, medical kits and packing existed until recently; no longer meet modern requirements for a number of objective reasons. The aim of the study was the formation of programs of development of modern samples of complete-standard-issue equipment. Materials and methods. The study was conducted based on the analysis of scientific literature and guidelines which regulate different aspects of the Armed Forces Medical Service complete-standard issue equipment. The study used methods like: retrospective, content analysis, comparison and description, logical, structural and functional analysis, expert assessments, decision-making, as well as the methods of the theory of constraints and other systems. Results and discussion. rmation of the range of medical property in modern conditions for inclusion into complete-standard issue equipment is connected with the need to make timely decisions on choosing the most efficient models, taking into account market conditions and economic opportunities. There are requirements established for the complete-samples standard issue equipment for their use outside a medical organization. Development program structure of complete-standard-issue equipment is shown, as well as examples of the formation of the content of medical equipment kits. On the basis of the offered program a new complete-standard issue equipment of the Armed Forces Medical Service was created. In accordance with the principles of the theory of constraints a strategy to optimize the composition of sets of medical equipment was developed. It included comprehensive solutions aimed at stabilizing the activity of the pharmaceutical industry in the interest of the Armed Forces Medical Service. Conclusions. An offered program has allowed developing

Broadening conceptions of learning in medical education: the message from teamworking.

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Bleakley, Alan

2006-02-01

There is a mismatch between the broad range of learning theories offered in the wider education literature and a relatively narrow range of theories privileged in the medical education literature. The latter are usually described under the heading of 'adult learning theory'. This paper critically addresses the limitations of the current dominant learning theories informing medical education. An argument is made that such theories, which address how an individual learns, fail to explain how learning occurs in dynamic, complex and unstable systems such as fluid clinical teams. Models of learning that take into account distributed knowing, learning through time as well as space, and the complexity of a learning environment including relationships between persons and artefacts, are more powerful in explaining and predicting how learning occurs in clinical teams. Learning theories may be privileged for ideological reasons, such as medicine's concern with autonomy. Where an increasing amount of medical education occurs in workplace contexts, sociocultural learning theories offer a best-fit exploration and explanation of such learning. We need to continue to develop testable models of learning that inform safe work practice. One type of learning theory will not inform all practice contexts and we need to think about a range of fit-for-purpose theories that are testable in practice. Exciting current developments include dynamicist models of learning drawing on complexity theory.

Dual processing model of medical decision-making

Science.gov (United States)

2012-01-01

Background Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. Methods We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. Results We show that physician’s beliefs about whether to treat at higher (lower) probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker’s threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. Conclusions We have developed the first dual processing model of medical decision-making that has potential to enrich the current medical

Dual processing model of medical decision-making.

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Djulbegovic, Benjamin; Hozo, Iztok; Beckstead, Jason; Tsalatsanis, Athanasios; Pauker, Stephen G

2012-09-03

Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. We show that physician's beliefs about whether to treat at higher (lower) probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker's threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. We have developed the first dual processing model of medical decision-making that has potential to enrich the current medical decision-making field, which is still to the

Intended location of future career practice among graduating medical students: perspective from social cognitive career theory in Nepal.

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Sapkota, B P; Amatya, A

2013-09-01

Medical workforce shortages and mal-distributions world-wide make understanding how, where and what our future doctors wish to practice is increasingly important. Understanding of factors such as available infrastructure, provision of incentives and many others influences the decisions of doctors to leave or to stay. Therefore the strategies effective for retention, is imperative in conducting the study based on a sound theoretical framework in predicting future medical workforce needs. The study used the theoretical framework of Social Cognitive Career Theory to identify the predictors on future practice location. The study was cross-sectional descriptive in design targeting the Nepalese medical students in the final year and doing internships in Nepal. Anonymous self administered questionnaire was distributed among 480 students but 393 students were involved due to non response and incompleteness. Findings of the study were presented in frequency tables for univariate descriptive analysis and bivariate findings were presented by cross tabulation. About two thirds 259 (65.9%) of the participants had chosen within country location for future practice. Among those who had chosen within country choice, about an equal percentage of the respondents had chosen rural 131 (50.8%) and urban 128 (49.2%) location. Among those who had chosen within country for future practice location, less than one fifth of the participants had chosen private sector for future practice. Majority of the medical graduates wish to practice within country location. Most of which chose public sector for future practice. None of the SCCT construct had any significant association within country location.

Practical trials in medical education

DEFF Research Database (Denmark)

Tolsgaard, Martin G; Kulasegaram, Kulamakan M; Ringsted, Charlotte

2017-01-01

participants across several settings and (iii) multiple outcome measures with long-term follow-up to evaluate both benefits and risks. Questions posed by practical trials may be proactive in applying theory in the development of educational innovations or reactive to educational reforms and innovations. Non......CONTEXT: Concerns have been raised over the gap between education theory and practice and how research can contribute to inform decision makers on their choices and priorities. Little is known about how educational theories and research outcomes produced under optimal conditions in highly...... controlled settings generalise to the real-life education context. One way of bridging this gap is applying the concept of practical trials in medical education. In this paper we elaborate on characteristics of practical trials and based on examples from medical education we discuss the challenges...

Gender matters in medical education.

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Bleakley, Alan

2013-01-01

Women are in the majority in terms of entry to medical schools worldwide and will soon represent the majority of working doctors. This has been termed the 'feminising' of medicine. In medical education, such gender issues tend to be restricted to discussions of demographic changes and structural inequalities based on a biological reading of gender. However, in contemporary social sciences, gender theory has moved beyond both biology and demography to include cultural issues of gendered ways of thinking. Can contemporary feminist thought drawn from the social sciences help medical educators to widen their appreciation and understanding of the feminising of medicine? Post-structuralist feminist critique, drawn from the social sciences, focuses on cultural practices, such as language use, that support a dominant patriarchy. Such a critique is not exclusive to women, but may be described as supporting a tender-minded approach to practice that is shared by both women and men. The demographic feminising of medicine may have limited effect in terms of changing both medical culture and medical education practices without causing radical change to entrenched cultural habits that are best described as patriarchal. Medical education currently suffers from male biases, such as those imposed by 'andragogy', or adult learning theory, and these can be positively challenged through post-structuralist feminist critique. Women doctors entering the medical workforce can resist and reformulate the current dominant patriarchy rather than reproducing it, supported by male feminists. Such a feminising of medicine can extend to medical education, but will require an appropriate theoretical framework to make sense of the new territory. The feminising of medical education informed by post-structuralist frameworks may provide a platform for the democratisation of medical culture and practices, further informing authentic patient-centred practices of care. © Blackwell Publishing Ltd 2013.

Medical Rituals and Media Rituals

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Zoltán Zsinkó-Szabó

2013-01-01

Full Text Available In the present article the author examines the ritual elements of theprofessionalization during medical studies, and its interference with media content of medical significance, comparing the role of medical and media rituals on the way of becoming a doctor. It is to be explored how these medical soap operas, medical dramas, medical thrillers or crime stories do exert influence on medical identity and role expectations. Do medical students and their relatives (withmedical expertise frequently identify themselves with these roles? Is their way of reception critical or naïve? How media rituals are organizing, modulating the students’ medical perception and expectations. Is there a mediated “shadow initiation” via media or it is excluded and denied? Does it perfuse the common social experience of becoming a doctor via peer communication and peer shapingof model behavior? We search the answers in the context of a theory of media rituals.

'Medical ethics'--an alternative approach.

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Haldane, J J

1986-01-01

Contemporary medical ethics is generally concerned with the application of ethical theory to medico-moral dilemmas and with the critical analysis of the concepts of medicine. This paper presents an alternative programme: the development of a medical philosophy which, by taking as its starting point the two questions: what is man? and, what constitutes goodness in life? offers an account of health as one of the primary concepts of value. This view of the subject resembles that implied by ancient theories of goodness, and in later sections of the paper it is shown how Aristotle points us towards a coherent theory of human nature as psycho-physical, which overcomes the inadequacies of dualism and physicalist reductionism. What is on offer therefore, is the prospect of an integrated account of human nature and of what constitutes its flourishing: to be healthy is to be an active unity-of-parts in equilibrium. PMID:3761336

Perceptions and preferences of medical students regarding teaching ...

African Journals Online (AJOL)

... medical students regarding teaching methods in a Medical College, Mangalore India. ... of traditional methods with other methods such as PBL, video lectures and mannequins could be an effective way of teaching theory and clinical skills.

Patient safety education at Japanese medical schools: results of a nationwide survey.

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Maeda, Shoichi; Kamishiraki, Etsuko; Starkey, Jay

2012-05-10

Patient safety education, including error prevention strategies and management of adverse events, has become a topic of worldwide concern. The importance of the patient safety is also recognized in Japan following two serious medical accidents in 1999. Furthermore, educational curriculum guideline revisions in 2008 by relevant the Ministry of Education includes patient safety as part of the core medical curriculum. However, little is known about the patient safety education in Japanese medical schools partly because a comprehensive study has not yet been conducted in this field. Therefore, we have conducted a nationwide survey in order to clarify the current status of patient safety education at medical schools in Japan. Response rate was 60.0% (n = 48/80). Ninety-eight-percent of respondents (n = 47/48) reported integration of patient safety education into their curricula. Thirty-nine percent reported devoting less than five hours to the topic. All schools that teach patient safety reported use of lecture based teaching methods while few used alternative methods, such as role-playing or in-hospital training. Topics related to medical error theory and legal ramifications of error are widely taught while practical topics related to error analysis such as root cause analysis are less often covered. Based on responses to our survey, most Japanese medical schools have incorporated the topic of patient safety into their curricula. However, the number of hours devoted to the patient safety education is far from the sufficient level with forty percent of medical schools that devote five hours or less to it. In addition, most medical schools employ only the lecture based learning, lacking diversity in teaching methods. Although most medical schools cover basic error theory, error analysis is taught at fewer schools. We still need to make improvements to our medical safety curricula. We believe that this study has the implications for the rest of the world as a

Patient safety education at Japanese medical schools: results of a nationwide survey

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Maeda Shoichi

2012-05-01

Full Text Available Abstract Background Patient safety education, including error prevention strategies and management of adverse events, has become a topic of worldwide concern. The importance of the patient safety is also recognized in Japan following two serious medical accidents in 1999. Furthermore, educational curriculum guideline revisions in 2008 by relevant the Ministry of Education includes patient safety as part of the core medical curriculum. However, little is known about the patient safety education in Japanese medical schools partly because a comprehensive study has not yet been conducted in this field. Therefore, we have conducted a nationwide survey in order to clarify the current status of patient safety education at medical schools in Japan. Results Response rate was 60.0% (n = 48/80. Ninety-eight-percent of respondents (n = 47/48 reported integration of patient safety education into their curricula. Thirty-nine percent reported devoting less than five hours to the topic. All schools that teach patient safety reported use of lecture based teaching methods while few used alternative methods, such as role-playing or in-hospital training. Topics related to medical error theory and legal ramifications of error are widely taught while practical topics related to error analysis such as root cause analysis are less often covered. Conclusions Based on responses to our survey, most Japanese medical schools have incorporated the topic of patient safety into their curricula. However, the number of hours devoted to the patient safety education is far from the sufficient level with forty percent of medical schools that devote five hours or less to it. In addition, most medical schools employ only the lecture based learning, lacking diversity in teaching methods. Although most medical schools cover basic error theory, error analysis is taught at fewer schools. We still need to make improvements to our medical safety curricula. We believe that this

Understanding older adults' medication decision making and behavior: A study on over-the-counter (OTC) anticholinergic medications.

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Holden, Richard J; Srinivas, Preethi; Campbell, Noll L; Clark, Daniel O; Bodke, Kunal S; Hong, Youngbok; Boustani, Malaz A; Ferguson, Denisha; Callahan, Christopher M

2018-03-06

Older adults purchase and use over-the-counter (OTC) medications with potentially significant adverse effects. Some OTC medications, such as those with anticholinergic effects, are relatively contraindicated for use by older adults due to evidence of impaired cognition and other adverse effects. To inform the design of future OTC medication safety interventions for older adults, this study investigated consumers' decision making and behavior related to OTC medication purchasing and use, with a focus on OTC anticholinergic medications. The study had a cross-sectional design with multiple methods. A total of 84 adults participated in qualitative research interviews (n = 24), in-store shopper observations (n = 39), and laboratory-based simulated OTC shopping tasks (n = 21). Simulated shopping participants also rank-ordered eight factors on their importance for OTC decision making. Findings revealed that many participants had concerns about medication adverse effects, generally, but were not aware of age-related risk associated with the use of anticholinergic medications. Analyses produced a map of the workflow of OTC-related behavior and decision making as well as related barriers such as difficulty locating medications or comparing them to an alternative. Participants reported effectiveness, adverse effects or health risks, and price as most important to their OTC medication purchase and use decisions. A persona analysis identified two types of consumers: the habit follower, who frequently purchased OTC medications and considered them safe; and the deliberator, who was more likely to weigh their options and consider alternatives to OTC medications. A conceptual model of OTC medication purchase and use is presented. Drawing on study findings and behavioral theories, the model depicts dual processes for OTC medication decision making - habit-based and deliberation-based - as well as the antecedents and consequences of decision making. This model suggests

Situativity theory: a perspective on how participants and the environment can interact: AMEE Guide no. 52.

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Durning, Steven J; Artino, Anthony R

2011-01-01

Situativity theory refers to theoretical frameworks which argue that knowledge, thinking, and learning are situated (or located) in experience. The importance of context to these theories is paramount, including the unique contribution of the environment to knowledge, thinking, and learning; indeed, they argue that knowledge, thinking, and learning cannot be separated from (they are dependent upon) context. Situativity theory includes situated cognition, situated learning, ecological psychology, and distributed cognition. In this Guide, we first outline key tenets of situativity theory and then compare situativity theory to information processing theory; we suspect that the reader may be quite familiar with the latter, which has prevailed in medical education research. Contrasting situativity theory with information processing theory also serves to highlight some unique potential contributions of situativity theory to work in medical education. Further, we discuss each of these situativity theories and then relate the theories to the clinical context. Examples and illustrations for each of the theories are used throughout. We will conclude with some potential considerations for future exploration. Some implications of situativity theory include: a new way of approaching knowledge and how experience and the environment impact knowledge, thinking, and learning; recognizing that the situativity framework can be a useful tool to "diagnose" the teaching or clinical event; the notion that increasing individual responsibility and participation in a community (i.e., increasing "belonging") is essential to learning; understanding that the teaching and clinical environment can be complex (i.e., non-linear and multi-level); recognizing that explicit attention to how participants in a group interact with each other (not only with the teacher) and how the associated learning artifacts, such as computers, can meaningfully impact learning.

[Schizophrenia and modern culture: reasons for insanity].

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Pérez-Álvarez, Marino

2012-02-01

After pointing out the uncertainty and confusion to which neurobiological research has led schizophrenia, as shown and acknowledged in recent reviews, we offer seven reasons for reconsidering schizophrenia a disorder of the self, rather than of the brain. The first reason starts out conceiving schizophrenia as a disorder of the self, in the perspective of current phenomenology. The second relates the fact of its recent origin (as of 1750) with the particular configuration of the modern self and with the great transformation of the community into a society of individuals (industrialization, urbanization). The third reason emphasizes the affinity between schizophrenia and adolescence, a critical age in the formation of the self, which started to be problematic at the end of the 18th century. The fourth is the better prognosis of schizophrenia in developing countries, in comparison to developed countries, which probably has to do with the process of modernization (which still maintains community structures in less developed countries). The fifth is the high incidence of schizophrenia among immigrants, as a fact to be explained in terms of a socio-evolutionary model. The sixth reason reviews the genetic legend of schizophrenia, and how epigenetics gives protagonism back to the environment. The seventh and last reason refers to the reconsideration of psychological therapy as the possible treatment of choice and not merely an adjunct to medication, as it is known that, for patients, interpersonal chemistry is more important than neurochemistry.

Teorias médicas e gestão urbana: a seca de 1877-79 em Fortaleza Medical theories and urban management: Fortaleza's 1877-79 drought

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Maria Clélia Lustosa Costa

2004-04-01

Full Text Available Ao longo do século XIX, as novas teorias médicas sobre a origem das doenças influenciaram normas e regulamentos de controle do comportamento da população e do espaço urbano. Neste trabalho, apresentam-se e discutem-se as idéias, práticas médicas e ações administrativas adotadas durante a seca de 1877-79 em Fortaleza, capital da província do Ceará. A seca foi acompanhada de uma epidemia de varíola e do aumento da migração da população sertaneja para a capital. Sem rede de serviços públicos capaz de atender à população de retirantes que se alojaram na cidade e nos arredores, a administração municipal esforçou-se para implementar recomendações dos médicos, baseadas nos modernos princípios de higienização. Demonstra-se, por meio da análise dos relatórios dos presidentes da província e dos inspetores de saúde pública, a influência daquelas teorias médicas sobre as práticas de reorganização urbana, numa situação de calamidade como o de Fortaleza em 1877.Down through the nineteenth century, new medical theories on the origin of disease influenced the norms and regulations that controlled the population's behavior and the urban space. The present study discusses the ideas, medical practices, and administrative initiatives adopted during the 1877-79 drought in Fortaleza, capital of Ceará province. The drought was accompanied by a smallpox epidemic, along with the increased migration of sertão dwellers to the capital. The city lacked a public service network capable of meeting the needs of this new population, which took up lodgings on the city and periphery. The municipal administration endeavored to implement the recommendations of physicians, based on modern principles of hygienization. Through an analysis of reports by the provincial presidents and by public health inspectors, the study intends to show how these medical theories influenced the practices of urban reorganization at a moment of public

Social Learning: Medical Student Perceptions of Geriatric House Calls

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Abbey, Linda; Willett, Rita; Selby-Penczak, Rachel; McKnight, Roberta

2010-01-01

Bandura's social learning theory provides a useful conceptual framework to understand medical students' perceptions of a house calls experience at Virginia Commonwealth University School of Medicine. Social learning and role modeling reflect Liaison Committee on Medical Education guidelines for "Medical schools (to) ensure that the learning…

A model of self-directed learning in internal medicine residency: a qualitative study using grounded theory.

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Sawatsky, Adam P; Ratelle, John T; Bonnes, Sara L; Egginton, Jason S; Beckman, Thomas J

2017-02-02

Existing theories of self-directed learning (SDL) have emphasized the importance of process, personal, and contextual factors. Previous medical education research has largely focused on the process of SDL. We explored the experience with and perception of SDL among internal medicine residents to gain understanding of the personal and contextual factors of SDL in graduate medical education. Using a constructivist grounded theory approach, we conducted 7 focus group interviews with 46 internal medicine residents at an academic medical center. We processed the data by using open coding and writing analytic memos. Team members organized open codes to create axial codes, which were applied to all transcripts. Guided by a previous model of SDL, we developed a theoretical model that was revised through constant comparison with new data as they were collected, and we refined the theory until it had adequate explanatory power and was appropriately grounded in the experiences of residents. We developed a theoretical model of SDL to explain the process, personal, and contextual factors affecting SDL during residency training. The process of SDL began with a trigger that uncovered a knowledge gap. Residents progressed to formulating learning objectives, using resources, applying knowledge, and evaluating learning. Personal factors included motivations, individual characteristics, and the change in approach to SDL over time. Contextual factors included the need for external guidance, the influence of residency program structure and culture, and the presence of contextual barriers. We developed a theoretical model of SDL in medical education that can be used to promote and assess resident SDL through understanding the process, person, and context of SDL.

Factors contributing to registered nurse medication administration error: a narrative review.

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Parry, Angela M; Barriball, K Louise; While, Alison E

2015-01-01

To explore the factors contributing to Registered Nurse medication administration error behaviour. A narrative review. Electronic databases (Cochrane, CINAHL, MEDLINE, BNI, EmBase, and PsycINFO) were searched from 1 January 1999 to 31 December 2012 in the English language. 1127 papers were identified and 26 papers were included in the review. Data were extracted by one reviewer and checked by a second reviewer. A thematic analysis and narrative synthesis of the factors contributing to Registered Nurses' medication administration behaviour. Bandura's (1986) theory of reciprocal determinism was used as an organising framework. This theory proposes that there is a reciprocal interplay between the environment, the person and their behaviour. Medication administration error is an outcome of RN behaviour. The 26 papers reported studies conducted in 4 continents across 11 countries predominantly in North America and Europe, with one multi-national study incorporating 27 countries. Within both the environment and person domain of the reciprocal determinism framework, a number of factors emerged as influencing Registered Nurse medication administration error behaviour. Within the environment domain, two key themes of clinical workload and work setting emerged, and within the person domain the Registered Nurses' characteristics and their lived experience of work emerged as themes. Overall, greater attention has been given to the contribution of the environment domain rather than the person domain as contributing to error, with the literature viewing an error as an event rather than the outcome of behaviour. The interplay between factors that influence behaviour were poorly accounted for within the selected studies. It is proposed that a shift away from error as an event to a focus on the relationships between the person, the environment and Registered Nurse medication administration behaviour is needed to better understand medication administration error. Copyright © 2014

Time-in-a-bottle (TIAB): a longitudinal, correlational study of patterns, potential predictors, and outcomes of immunosuppressive medication adherence in adult kidney transplant recipients.

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Russell, Cynthia L; Ashbaugh, Catherine; Peace, Leanne; Cetingok, Muammer; Hamburger, Karen Q; Owens, Sarah; Coffey, Deanna; Webb, Andrew W; Hathaway, Donna; Winsett, Rebecca P; Madsen, Richard; Wakefield, Mark R

2013-01-01

This study examined patterns, potential predictors, and outcomes of immunosuppressive medication adherence in a convenience sample of 121 kidney transplant recipients aged 21 yr or older from three kidney transplant centers using a theory-based, descriptive, correlational, longitudinal design. Electronic monitoring was conducted for 12 months using electronic monitoring. Participants were persistent in taking their immunosuppressive medications, but execution, which includes both taking and timing, was poor. Older age was the only demographic variable associated with medication adherence (r = 0.25; p = 0.005). Of the potential predictors examined, only medication self-efficacy was associated with medication non-adherence, explaining about 9% of the variance (r = 0.31, p = 0.0006). The few poor outcomes that occurred were not significantly associated with medication non-adherence, although the small number of poor outcomes may have limited our ability to detect a link. Future research should test fully powered, theory-based, experimental interventions that include a medication self-efficacy component. © 2013 John Wiley & Sons A/S.

Witness response at acute onset of stroke: a qualitative theory-guided study.

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Stephan U Dombrowski

Full Text Available Delay in calling emergency medical services following stroke limits access to early treatment that can reduce disability. Emergency medical services contact is mostly initiated by stroke witnesses (often relatives, rather than stroke patients. This study explored appraisal and behavioural factors that are potentially important in influencing witness behaviour in response to stroke.Semi-structured interviews with 26 stroke witnesses were transcribed and theory-guided content analysed was undertaken based on the Common Sense Self-Regulation Model (appraisal processes and Theory Domains Framework (behavioural determinants. Response behaviours were often influenced by heuristics-guided appraisal (i.e. mental rules of thumb. Some witnesses described their responses to the situation as 'automatic' and 'instinctive', rather than products of deliberation. Potential behavioural influences included: environmental context and resources (e.g. time of day, social influence (e.g. prompts from patients and beliefs about consequences (e.g. 999 accesses rapid help. Findings are based on retrospective accounts and need further verification in prospective studies.Witnesses play a key role in patient access to emergency medical services. Factors that potentially influence witnesses' responses to stroke were identified and could inform behavioural interventions and future research. Interventions might benefit from linking automatic/instinctive threat perceptions with deliberate appraisal of stroke symptoms, prompting action to call emergency medical services.

Diagnostic Reasoning across the Medical Education Continuum

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C. Scott Smith

2014-07-01

Full Text Available We aimed to study linguistic and non-linguistic elements of diagnostic reasoning across the continuum of medical education. We performed semi-structured interviews of premedical students, first year medical students, third year medical students, second year internal medicine residents, and experienced faculty (ten each as they diagnosed three common causes of dyspnea. A second observer recorded emotional tone. All interviews were digitally recorded and blinded transcripts were created. Propositional analysis and concept mapping were performed. Grounded theory was used to identify salient categories and transcripts were scored with these categories. Transcripts were then unblinded. Systematic differences in propositional structure, number of concept connections, distribution of grounded theory categories, episodic and semantic memories, and emotional tone were identified. Summary concept maps were created and grounded theory concepts were explored for each learning level. We identified three major findings: (1 The “apprentice effect” in novices (high stress and low narrative competence; (2 logistic concept growth in intermediates; and (3 a cognitive state transition (between analytical and intuitive approaches in experts. These findings warrant further study and comparison.

What motivates medical students to select medical studies: a systematic literature review.

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Goel, Sonu; Angeli, Federica; Dhirar, Nonita; Singla, Neetu; Ruwaard, Dirk

2018-01-17

There is a significant shortage of health workers across and within countries. It is of utmost importance to determine the factors that motivate students to opt for medical studies. The objective of this study is to group and review all the studies that investigated the motivational factors that underpin students' selection of medical study in recent years. The literature search was carried out by two researchers independently in PubMed, Google Scholar, Wiley and IndMED databases for articles published from year 2006 till 2016. A total of 38 combinations of MeSH words were used for search purpose. Studies related to medical students and interns have been included. The application of inclusion and exclusion criteria and PRISMA guidelines for reporting systematic review led to the final selection of 24 articles. The majority of the studies (n = 16; 66.6%) were from high-income countries followed by an equal number from upper-middle and lower-middle income countries (n = 4,16.7%). None of the studies were from low-income countries. All of the studies were cross-sectional in nature. The main motivating factors that emerged were scientific (interest in science / medicine, social interest and academia, flexible work hours and work independence), societal (prestige, job security, financial security) and humanitarian (serving the poor and under priviledged) in high-, upper-middle and lower-middle income countries, respectively. The findings were comparable to Maslow's hierarchy of needs theory of motivation. This systematic review identifies the motivational factors influencing students to join medical studies in different parts of the globe. These factors vary per country depending on the level of income. This study offers cues to policy makers and educators to formulate policy in order to tackle the shortage of health workers, i.e. medical doctors. However, more research is needed to translate health policy into concrete and effective measures.

African and Western moral theories in a bioethical context.

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Metz, Thaddeus

2010-04-01

The field of bioethics is replete with applications of moral theories such as utilitarianism and Kantianism. For a given dilemma, even if it is not clear how one of these western philosophical principles of right (and wrong) action would resolve it, one can identify many of the considerations that each would conclude is relevant. The field is, in contrast, largely unaware of an African account of what all right (and wrong) actions have in common and of the sorts of factors that for it are germane to developing a sound response to a given bioethical problem. My aim is to help rectify this deficiency by first spelling out a moral theory grounded in the mores of many sub-Saharan peoples, and then applying it to some major bioethical issues, namely, the point of medical treatment, free and informed consent, standards of care and animal experimentation. For each of these four issues, I compare and contrast the implications of the African moral theory with utilitarianism and Kantianism, my overall purposes being to highlight respects in which the African moral theory is distinct and to demonstrate that the field should take it at least as seriously as it does the Western theories.

A competency-based longitudinal core curriculum in medical neuroscience.

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Merlin, Lisa R; Horak, Holli A; Milligan, Tracey A; Kraakevik, Jeff A; Ali, Imran I

2014-07-29

Current medical educational theory encourages the development of competency-based curricula. The Accreditation Council for Graduate Medical Education's 6 core competencies for resident education (medical knowledge, patient care, professionalism, interpersonal and communication skills, practice-based learning, and systems-based practice) have been embraced by medical schools as the building blocks necessary for becoming a competent licensed physician. Many medical schools are therefore changing their educational approach to an integrated model in which students demonstrate incremental acquisition and mastery of all competencies as they progress through medical school. Challenges to medical schools include integration of preclinical and clinical studies as well as development of learning objectives and assessment measures for each competency. The Undergraduate Education Subcommittee (UES) of the American Academy of Neurology (AAN) assembled a group of neuroscience educators to outline a longitudinal competency-based curriculum in medical neuroscience encompassing both preclinical and clinical coursework. In development of this curriculum, the committee reviewed United States Medical Licensing Examination content outlines, Liaison Committee on Medical Education requirements, prior AAN-mandated core curricula for basic neuroscience and clinical neurology, and survey responses from educators in US medical schools. The newly recommended curriculum provides an outline of learning objectives for each of the 6 competencies, listing each learning objective in active terms. Documentation of experiences is emphasized, and assessment measures are suggested to demonstrate adequate achievement in each competency. These guidelines, widely vetted and approved by the UES membership, aspire to be both useful as a stand-alone curriculum and also provide a framework for neuroscience educators who wish to develop a more detailed focus in certain areas of study. © 2014 American Academy

Attachment in medical care: A review of the interpersonal model in chronic disease management.

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Jimenez, Xavier F

2017-03-01

Objective Patient-physician interaction is continually examined in an era prioritizing patient-centered approaches, yet elaboration beyond aspects of communication and empathy is lacking. Major chronic conditions would benefit tremendously from understanding interpersonal aspects of patient-physician encounters. This review intends to provide a concise introduction to the interpersonal model of attachment theory and how it informs both the patient-physician interaction and medical outcomes in chronic care. Methods A narrative review of the theoretical, neurobiological, epidemiological, investigational, and clinical literature on attachment theory and its impact on medical outcomes was conducted, utilizing a variety of key words as searched on PubMed database. Studies and reviews included were of a variety of sources, including textbooks and peer-reviewed journals. Reports in languages other than English were excluded. Results Measurable, discrete attachment styles and behavioral patterns correlate with poor medical outcomes, including nonadherence in insecure dismissing attachment and care overutilization in insecure preoccupied attachment. Furthermore, insecure dismissing attachment is associated with significant mortality. These variables can be easily assessed, and their effects are reversible, as evidenced by collaborative care outcome data. Discussion Attachment theory is useful a model with application in clinical and investigational aspects of chronic illness care. Implications and guidelines are explored.

Leadership development in UK medical training: pedagogical theory and practice.

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Bekas, Stavros

2015-01-01

PHENOMENON: The central role of clinical leadership in achieving the vision of quality and productivity could be attained by investing in its development in postgraduate medical education. A critical review of selected literature is presented. The author identifies some of the main theoretical constructs related to leadership; the pedagogical underpinning of medical leadership programs; their learning objectives; and the mixture of methods, individual and collective, to achieve them. INSIGHTS: How to best develop leadership through medical education remains an open debate. Experiential learning, reflective practice, action learning, and mentoring could provide the foundations of leadership development. Application of the aforementioned should be cautious due to limitations of the concept of leadership as currently promoted and lack of robust evaluation methodologies.

The problematization of medical tourism: a critique of neoliberalism.

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Smith, Kristen

2012-04-01

The past two decades have seen the extensive privatisation and marketisation of health care in an ever reaching number of developing countries. Within this milieu, medical tourism is being promoted as a rational economic development strategy for some developing nations, and a makeshift solution to the escalating waiting lists and exorbitant costs of health care in developed nations. This paper explores the need to problematize medical tourism in order to move beyond one dimensional neoliberal discourses that have, to date, dominated the arena. In this problematization, the paper discusses a range of understandings and uses of the term 'medical tourism' and situates it within the context of the neoliberal economic development of health care internationally. Drawing on theory from critical medical anthropology and health and human rights perspectives, the paper critically analyzes the assumed independence between the medical tourism industry and local populations facing critical health issues, where social, cultural and economic inequities are widening in terms of access, cost and quality of health care. Finally, medical tourism is examined in the local context of India, critiquing the increasingly indistinct roles played by government and private sectors, whilst linking these shifts to global market forces. © 2012 Blackwell Publishing Ltd.

Applying Expectancy Theory to residency training: proposing opportunities to understand resident motivation and enhance residency training.

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Shweiki, Ehyal; Martin, Niels D; Beekley, Alec C; Jenoff, Jay S; Koenig, George J; Kaulback, Kris R; Lindenbaum, Gary A; Patel, Pankaj H; Rosen, Matthew M; Weinstein, Michael S; Zubair, Muhammad H; Cohen, Murray J

2015-01-01

Medical resident education in the United States has been a matter of national priority for decades, exemplified initially through the Liaison Committee for Graduate Medical Education and then superseded by the Accreditation Council for Graduate Medical Education. A recent Special Report in the New England Journal of Medicine, however, has described resident educational programs to date as prescriptive, noting an absence of innovation in education. Current aims of contemporary medical resident education are thus being directed at ensuring quality in learning as well as in patient care. Achievement and work-motivation theories attempt to explain people's choice, performance, and persistence in tasks. Expectancy Theory as one such theory was reviewed in detail, appearing particularly applicable to surgical residency training. Correlations between Expectancy Theory as a work-motivation theory and residency education were explored. Understanding achievement and work-motivation theories affords an opportunity to gain insight into resident motivation in training. The application of Expectancy Theory in particular provides an innovative perspective into residency education. Afforded are opportunities to promote the development of programmatic methods facilitating surgical resident motivation in education.

An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory.

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Pelaccia, Thierry; Tardif, Jacques; Triby, Emmanuel; Charlin, Bernard

2011-03-14

Clinical reasoning plays a major role in the ability of doctors to make diagnoses and decisions. It is considered as the physician's most critical competence, and has been widely studied by physicians, educationalists, psychologists and sociologists. Since the 1970s, many theories about clinical reasoning in medicine have been put forward. This paper aims at exploring a comprehensive approach: the "dual-process theory", a model developed by cognitive psychologists over the last few years. After 40 years of sometimes contradictory studies on clinical reasoning, the dual-process theory gives us many answers on how doctors think while making diagnoses and decisions. It highlights the importance of physicians' intuition and the high level of interaction between analytical and non-analytical processes. However, it has not received much attention in the medical education literature. The implications of dual-process models of reasoning in terms of medical education will be discussed.

Rotation therapy for maniacs, melancholics and idiots: theory, practice and perception in European medical and literary case histories.

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Dickson, Sheila

2018-03-01

This article examines the development and use of rotation therapy in the emerging field of psychiatry at the beginning of the 19th century, and the cross-fertilization between British, Irish, German, French and other European proponents of 'Cox's Swing'. Its short-lived popularity is linked to prevalent Enlightenment thought, to the development of an industrial and technological society, to the modern medical theories of irritability, and to the new practice of 'moral management' of the mentally ill. Case studies documenting the use of the Swing are considered from these perspectives, and are compared with contemporary public reactions in the form of publications in newspapers and of a literary text by German Romantic author Ludwig Achim von Arnim.

A duplication of the mouth associated with a dysontogenic cyst: a case report and discussion of theories of origin.

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Mews, Lorissa; Isaac, Andre; Leonard, Norma; Lacson, Atilano G; AlQudehy, Zeinab Ali; El-Hakim, Hamdy

2014-05-01

IMPORTANCE Diprosopus is a medical condition that refers to full or partial craniofacial duplication. A particular subset of this condition, duplication of the mouth, is an exceedingly rare condition, with 7 reported cases in the medical literature. The embryogenesis and mechanism of disease are not well understood. The objective of this report was to describe a case of partial facial duplication with a discussion of the previous literature, leading to a proposed theory of embryogenesis for this rare anomaly. OBSERVATIONS We present a rare case of duplication of the mouth associated with an intraoral dysontogenic cyst, which presented with upper airway obstruction. The diagnostic and management strategies are discussed, as well as the histopathological features and theories of embryogenesis. CONCLUSIONS AND RELEVANCE On the basis of our findings, we propose the mechanism of origin for duplication of the mouth to be duplication of the first branchial arch. This case offers a deeper understanding of the mechanism of this disease than previously reported. Additional basic science and clinical research is needed to corroborate this theory.

The time and place of nostalgia: re-situating a French disease.

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O'Sullivan, Lisa

2012-10-01

The history of nostalgia as a clinical category has many highly specific national stories. This paper traces an aspect of this history, examining aspects of nostalgia's changing meanings in nineteenth-century France. Nostalgia was a disease triggered by displacement, which became medically and politically important after the French Revolution, when military surgeons encountered epidemics of nostalgia in the armed forces. Understood as a form of pathological homesickness, the category straddled environmental medicine and emerging ideas about insanity. The diagnosis became particularly important to Idéologue writers as a case study in regulating and redirecting the emotions, demonstrating the efficacy of their new "moral" treatments and an ability to generate patriotic attachment to the new nation state. Over the course of the century, nostalgia disintegrated as a medical condition reflecting a decline in environmental explanations for disease within medicine, and increasingly plastic meanings attached to nostalgic desire.

Information Seeking in Uncertainty Management Theory: Exposure to Information About Medical Uncertainty and Information-Processing Orientation as Predictors of Uncertainty Management Success.

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Rains, Stephen A; Tukachinsky, Riva

2015-01-01

Uncertainty management theory outlines the processes through which individuals cope with health-related uncertainty. Information seeking has been frequently documented as an important uncertainty management strategy. The reported study investigates exposure to specific types of medical information during a search, and one's information-processing orientation as predictors of successful uncertainty management (i.e., a reduction in the discrepancy between the level of uncertainty one feels and the level one desires). A lab study was conducted in which participants were primed to feel more or less certain about skin cancer and then were allowed to search the World Wide Web for skin cancer information. Participants' search behavior was recorded and content analyzed. The results indicate that exposure to two health communication constructs that pervade medical forms of uncertainty (i.e., severity and susceptibility) and information-processing orientation predicted uncertainty management success.

Factors Affecting Medical Service Quality.

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Mosadeghrad, Ali Mohammad

2014-02-01

A better understanding of factors influencing quality of medical service can pinpoint better strategies for quality assurance in medical services. This study aimed to identify factors affecting the quality of medical services provided by Iranian physicians. Exploratory in-depth individual interviews were conducted with sixty-four physicians working in various medical institutions in Iran. Individual, organizational and environmental factors enhance or inhibit the quality of medical services. Quality of medical services depends on the personal factors of the physician and patient, and factors pertaining to the healthcare setting and the broader environment. Differences in internal and external factors such as availability of resources, patient cooperation and collaboration among providers affect the quality of medical services and patient outcomes. Supportive leadership, proper planning, education and training and effective management of resources and processes improve the quality of medical services. This article contributes to healthcare theory and practice by developing a conceptual framework for understanding factors that influence medical services quality.

Justice and care: the implications of the Kohlberg-Gilligan debate for medical ethics.

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Sharpe, V A

1992-12-01

Carol Gilligan has identified two orientations to moral understanding; the dominant 'justice orientation' and the under-valued 'care orientation'. Based on her discernment of a 'voice of care', Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medical ethical theory. Specifically, I question whether the medical moral domain is adequately described by the norms of impartiality, universality, and equality that characterize the liberal ideal. My analysis of justice-oriented medical ethics, focuses on the libertarian theory of H.T. Engelhardt and the contractarian theory of R.M. Veatch. I suggest that in the work of E.D. Pellegrino and D.C. Thomasma we find not only a more authentic representation of medical morality but also a project that is compatible with the care orientation's emphasis on human need and responsiveness to particular others.

Rational noncompliance with prescribed medical treatment.

Science.gov (United States)

Stewart, Douglas O; DeMarco, Joseph P

2010-09-01

Despite the attention that patient noncompliance has received from medical researchers, patient noncompliance remains poorly understood and difficult to alter. With a better theory of patient noncompliance, both greater success in achieving compliance and greater respect for patient decision making are likely. The theory presented, which uses a microeconomic approach, bridges a gap in the extant literature that has so far ignored the contributions of this classic perspective on decision making involving the tradeoff of costs and benefits. The model also generates a surprising conclusion: that patients are typically acting rationally when they refuse to comply with certain treatments. However, compliance is predicted to rise with increased benefits and reduced costs. The prediction that noncompliance is rational is especially true in chronic conditions at the point that treatment begins to move closer to the medically ideal treatment level. Although the details of this theory have not been tested empirically, it is well supported by existing prospective and retrospective studies.

Futility and the varieties of medical judgment.

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Sulmasy, D P

1997-01-01

Pellegrino has argued that end-of-life decisions should be based upon the physician's assessment of the effectiveness of the treatment and the patient's assessment of its benefits and burdens. This would seem to imply that conditions for medical futility could be met either if there were a judgment of ineffectiveness, or if the patient were in a state in which he or she were incapable of a subjective judgment of the benefits and burdens of the treatment. I argue that a theory of futility according to Pellegrino would deny that latter but would permit some cases of the former. I call this the "circumspect" view. I show that Pellegrino would adopt the circumspect view because he would see the medical futility debate in the context of a system of medical ethics based firmly upon a philosophy of medicine. The circumspect view is challenged by those who would deny that one can distinguish objective from subjective medical judgments. I defend the circumspect view on the basis of a previously neglected aspect of the philosophy of medicine-an examination of varieties of medical judgment. I then offer some practical applications of this theory in clinical practice.

A social/emotional theory of 'mental illness'.

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Scheff, Thomas

2013-02-01

One reason that theories of mental illness have made little progress may be their focus on individuals, omitting the social/relational and emotional world. Adding these components will be difficult, however: in modern societies they have become virtually invisible, particularly the emotion of shame. The theory outlined here is based on the work of Cooley, Elias, Lewis and Goffman: shame is both social and individual and, if anticipation is included, virtually omnipresent in modern societies. It is proposed that most symptoms of mental illness are products of shame and relational feedback loops: emotion and alienation can both spiral leading to further alienation and chaotic or hidden emotions. Almost everyone is especially ashamed of their shame. Being ashamed of one's shame and/or anger can spiral when not acknowledged. Under certain conditions, these spirals continue without limit, generating immense force for acting out symptoms or depression. To the extent that this theory is true, we would need to rename the field using non-medical terms, such as emotional/social dysfunction.

Uma aventura no manicômio: a trajetória de Franco Basaglia An adventure in the insane asylum: the life of Franco Basaglia

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Paulo Amarante

1994-10-01

Full Text Available O processo de transformações no campo da saúde mental e das reformas psiquiátricas mantém estreitas relações com as questões práticas e teóricas surgidas a partir da experiência de Franco Basaglia. O presente texto propõe-se a refletir sobre sua trajetória, destacando os principias conceitos e referências teóricas por ele operados, e procurando demarcar o caráter singular de suas contribuições em relação ao projeto atual de desinstitucionalização em psiquiatria. Basaglia opera uma ruptura ao exercer um profundo questionamento sobre o saber e as instituições psiquiátricas, o que possibilita um novo quadro epistemológico e, conseqüentemente, cultural e assistencial no lidar com a loucura. Partindo da constatação de que esta obra é muito pouco conhecida, este texto procura revisitar o pensamento de Basaglia, sublinhando a originalidade de suas contribuições e atentando para a necessidade de seu melhor conhecimento por parte daqueles que se dedicam ao campo da saúde mental e das instituições sociais.The process of change in the mental health field and psychiatric reforms bear a close relationship to practical and theoretical issues stemming from Franco Basaglia's experience. This article is intended as a reflection on Basaglia's career, stressing the main concepts and theoretical references he worked with and seeking to trace the unique nature of his contributions to the current project for de-institutionalizing psychiatry. Basaglia produces a break by profoundly challenging psychiatric knowledge and institutions, thus allowing for a new epistemological framework (a framework that was thus also new in relation to culture and mental health care in dealing with insanity. Based on the observation that Basaglia's work is little known, this article attempts to revisit his thinking, highlighting the unique nature of his contributions and stressing the need for a better understanding of his work by those who are devoted

Dual processing model of medical decision-making

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Djulbegovic Benjamin

2012-09-01

Full Text Available Abstract Background Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I and/or an analytical, deliberative (system II processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. Methods We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. Results We show that physician’s beliefs about whether to treat at higher (lower probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker’s threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. Conclusions We have developed the first dual processing model of medical decision-making that has potential to

Physicians' communication with patients about adherence to HIV medication in San Francisco and Copenhagen: a qualitative study using Grounded Theory.

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Barfod, Toke S; Hecht, Frederick M; Rubow, Cecilie; Gerstoft, Jan

2006-12-04

Poor adherence is the main barrier to the effectiveness of HIV medication. The objective of this study was to explore and conceptualize patterns and difficulties in physicians' work with patients' adherence to HIV medication. No previous studies on this subject have directly observed physicians' behavior. This is a qualitative, cross-sectional study. We used a Grounded Theory approach to let the main issues in physicians' work with patients' adherence emerge without preconceiving the focus of the study. We included physicians from HIV clinics in San Francisco, U.S.A. as well as from Copenhagen, Denmark. Physicians were observed during their clinical work and subsequently interviewed with a semi-structured interview guide. Notes on observations and transcribed interviews were analyzed with NVivo software. We enrolled 16 physicians from San Francisco and 18 from Copenhagen. When we discovered that physicians and patients seldom discussed adherence issues in depth, we made adherence communication and its barriers the focus of the study. The main patterns in physicians' communication with patients about adherence were similar in both settings. An important barrier to in-depth adherence communication was that some physicians felt it was awkward to explore the possibility of non-adherence if there were no objective signs of treatment failure, because patients could feel "accused." To overcome this awkwardness, some physicians consciously tried to "de-shame" patients regarding non-adherence. However, a recurring theme was that physicians often suspected non-adherence even when patients did not admit to have missed any doses, and physicians had difficulties handling this low believability of patient statements. We here develop a simple four-step, three-factor model of physicians' adherence communication. The four steps are: deciding whether to ask about adherence or not, pre-questioning preparations, phrasing the question, and responding to the patient's answer. The three

Physicians' communication with patients about adherence to HIV medication in San Francisco and Copenhagen: a qualitative study using Grounded Theory

Directory of Open Access Journals (Sweden)

Rubow Cecilie

2006-12-01

Full Text Available Abstract Background Poor adherence is the main barrier to the effectiveness of HIV medication. The objective of this study was to explore and conceptualize patterns and difficulties in physicians' work with patients' adherence to HIV medication. No previous studies on this subject have directly observed physicians' behavior. Methods This is a qualitative, cross-sectional study. We used a Grounded Theory approach to let the main issues in physicians' work with patients' adherence emerge without preconceiving the focus of the study. We included physicians from HIV clinics in San Francisco, U.S.A. as well as from Copenhagen, Denmark. Physicians were observed during their clinical work and subsequently interviewed with a semi-structured interview guide. Notes on observations and transcribed interviews were analyzed with NVivo software. Results We enrolled 16 physicians from San Francisco and 18 from Copenhagen. When we discovered that physicians and patients seldom discussed adherence issues in depth, we made adherence communication and its barriers the focus of the study. The main patterns in physicians' communication with patients about adherence were similar in both settings. An important barrier to in-depth adherence communication was that some physicians felt it was awkward to explore the possibility of non-adherence if there were no objective signs of treatment failure, because patients could feel "accused." To overcome this awkwardness, some physicians consciously tried to "de-shame" patients regarding non-adherence. However, a recurring theme was that physicians often suspected non-adherence even when patients did not admit to have missed any doses, and physicians had difficulties handling this low believability of patient statements. We here develop a simple four-step, three-factor model of physicians' adherence communication. The four steps are: deciding whether to ask about adherence or not, pre-questioning preparations, phrasing the

Holistic integrative medicine: toward a new era of medical advancement.

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Fan, Daiming

2017-03-01

Medicine has encountered unprecedented problems associated with changes in nature, society, and environment, as well as with new human quests for survival, longevity, and health. In the meantime, the development of medicine is facing challenges that resulted from the over-division and specialization of disciplines and the fragmentation of medical knowledge. To construct a new medical system that is more suitable for human health and disease treatment, holistic integrative medicine (HIM), which regards the human body as a holistic entity, organically integrates the most advanced knowledge and theories in each medical field and the most effective practices in various clinical specialties to revise and adjust on the basis of social, environmental, and psychological conditions. HIM is the inevitable and necessary direction for the future development of medicine. In this article, we illustrated the connotation of HIM, the differences between HIM and other medical conceptions, and the practice of HIM in recent years.

Teoría feminista y sociología médica: bases para una discusión Feminist theory and medical sociology: issues for discussion

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Roberto P. Castro

1993-09-01

Full Text Available Se analiza la contribución de la teoría feminista a la sociología médica. En la primera parte se desarrollan los conceptos feministas más importantes: patriarcado, género, y sistema sexo/género. Se señala que cada concepto aclara aspectos sociales que han sido descuidados, aunque se reconoce que el concepto de patriarcado requiere aún de mayor desarrollo teórico. En la segunda parte se discuten los intentos del feminismo para desarrollar un nuevo conocimiento. Se discuten las ventajas de una ciencia feminista que problematice la dominación de género - que la ciencia común da por hecho -, y que permitiría una aproximación novedosa a la realidad social. Se enfatiza en la importancia de distinguir entre sexo y género, el aporte reciente de mayor relevancia para comprender la noción de ciencia feminista. Se señalan algunas de las aportaciones epistemológicas y metodológicas feministas. La tercera parte analiza las contribuciones más importantes de la teoría feminista en el campo de la sociología médica. Se indica como una de ellas a la problematización de los conceptos de "salud" y "enfermedad", así como la demostración de que son conceptos socialmente construidos como producto del orden patriarcal prevaleciente. Finalmente, se ilustra cómo el acercamiento feminista es útil para cuestionar las nociones y prácticas medicas, las que se basan en en la dominación de género y la reproducen.The contribution of feminist theory to medical sociology is analyzed. The first part discusses the main feminist concepts: patriarchy, gender, and sex/gender system. The article points out that such concepts illuminate social aspects that have been neglected. It is acknowledged that the concept of patriarchy requires further theoretical development. The second part discusses the feminist attempt to develop new knowledge. A "Feminist Science" would problematize gender domination, which current science takes for granted, and would allow

Factors Associated with Milk Consumption among College Students of Yazd University of Medical Sciences Based on Theory of Planned Behavior

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Mohammad Hossein Baghianimoghadam

2016-02-01

Full Text Available Introduction: Daily milk consumption can be introduced as a healthy dietary pattern associated with a range of health benefits. This study aimed to determine factors associated with milk consumption among students of Yazd university of medical sciences based on the theory of planned behavior. Materials & Methods: This cross-sectional study was conducted on 385 students in 2014, who were selected via stratified random sampling. The study data was collected from a questionnaire based on the indirect construct of theory of planned behavior. Finally, the study data were analyzed using the T-test, Chi-square, and Fisher's exact tests. Results: In the present study, 64% of the students consumed milk daily. The behavioral intention, behavioral beliefs, normative beliefs, control beliefs, and perceived power were significantly associated with the milk consumption (p<0.05. Conclusion: Educating the students in regard with the importance of receiving enough amount of milk, modifying their misconceptions as well as reinforcing positive beliefs can be effective in increasing milk consumption. In addition, increasing access to milk in university campuses should be taken into consideration.

Innovation in Indigenous Health and Medical Education: The Leaders in Indigenous Medical Education (LIME) Network as a Community of Practice.

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Mazel, Odette; Ewen, Shaun

2015-01-01

The Leaders in Indigenous Medical Education (LIME) Network aims to improve the quality and effectiveness of Indigenous health in medical education as well as best practice in the recruitment, retention, and graduation of Indigenous medical students. In this article we explore the utility of Etienne Wenger's "communities of practice" (CoP) concept in providing a theoretical framework to better understand the LIME Network as a form of social infrastructure to further knowledge and innovation in this important area of health care education reform. The Network operates across all medical schools in Australia and New Zealand. Utilizing a model of evaluation of communities of practice developed by Fung-Kee-Fung et al., we seek to analyze the outcomes of the LIME Network as a CoP and assess its approach and contribution to improving the implementation of Indigenous health in the medical curriculum and the graduation of Indigenous medical students. By reflecting on the Network through a community of practice lens, this article highlights the synthesis between the LIME Network and Wenger's theory and provides a framework with which to measure Network outputs. It also posits an opportunity to better capture the impact of Network activities into the future to ensure that it remains a relevant and sustainable entity.

ELENA GARRO, A DESHORA: FIGURAS LITERARIAS DE LA ABYECCIÓN

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Meritxell Hernando Marsal

2014-12-01

Full Text Available The massacre of Tlatelolco in 1968 was the most bloody incident of Diaz Ordaz’s government in Mexico and promoted a severe process of persecution and repression of the student movement. One of its consequences was the suspicion of betrayal by Elena Garro of the movement’s intellectual authors. Since then, Garro embodied an abject character of collaboration, in constant harassment, leading to her exile during twenty years.This paper considers the implications of the accusation and the diagnosis of insanity that accompanies it. For some critics this insanity is redeemed in her literary work, which in this operation achieves prominence; but the insanity can be thought of as irreducible. Garro’s delirious gaze doesn’t sublimate the trauma, but repeats again and again the political violence, with harassed, exposed and out of place characters, in situations of daily totalitarianism. Figures of betrayal emerge in her histories, involving characters and knowledge outside the language of the official left (animal, children, women, the indigenous, marked by their helplessness and questioning the premises of political parties. 

the realities surrounding the applicability of medical paternalism

African Journals Online (AJOL)

theories and arguments for and against medical paternalism, this study further ... situations yet the process of medical decision ... Poststgraduate School, Faculty of Law, University of Ilorin, Ilorin, Nigeria. ..... 'patient-centered' medicine now.

A Future of Communication Theory: Systems Theory.

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Lindsey, Georg N.

Concepts of general systems theory, cybernetics and the like may provide the methodology for communication theory to move from a level of technology to a level of pure science. It was the purpose of this paper to (1) demonstrate the necessity of applying systems theory to the construction of communication theory, (2) review relevant systems…

Medical education... meet Michel Foucault.

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Hodges, Brian D; Martimianakis, Maria A; McNaughton, Nancy; Whitehead, Cynthia

2014-06-01

There have been repeated calls for the greater use of conceptual frameworks and of theory in medical education. Although it is familiar to few medical educators, Michel Foucault's work is a helpful theoretical and methodological source. This article explores what it means to use a 'Foucauldian approach', presents a sample of Foucault's historical-genealogical studies that are relevant to medical education, and introduces the work of four researchers currently undertaking Foucauldian-inspired medical education research. Although they are not without controversy, Foucauldian approaches are employed by an increasing number of scholars and are helpful in shedding light on what it is possible to think, say and be in medical education. Our hope in sharing this Foucauldian work and perspective is that we might stimulate a dialogue that is forward-looking and optimistic about the possibilities for change in medical education. © 2014 John Wiley & Sons Ltd.

A Constructive Reframing of Student Roles and Systems Learning in Medical Education Using a Communities of Practice Lens.

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Gonzalo, Jed D; Thompson, Britta M; Haidet, Paul; Mann, Karen; Wolpaw, Daniel R

2017-12-01

Health systems are in the midst of a transformation that is being driven by a variety of forces. This has important implications for medical educators because clinical practice environments play a key role in learning and professional development, and evolving health systems are beginning to demand that providers have "systems-ready" knowledge, attitudes, and skills. Such implications provide a clear mandate for medical schools to modify their goals and prepare physicians to practice flexibly within teams and effectively contribute to the improvement of health care delivery. In this context, the concepts of value-added medical education, authentic student roles, and health systems science are emerging as increasingly important. In this Article, the authors use a lens informed by communities of practice theory to explore these three concepts, examining the implications that the communities of practice theory has in the constructive reframing of educational practices-particularly common student roles and experiences-and charting future directions for medical education that better align with the needs of the health care system. The authors apply several key features of the communities of practice theory to current experiential roles for students, then propose a new approach to students' clinical experiences-value-added clinical systems learning roles-that provides students with opportunities to make meaningful contributions to patient care while learning health systems science at the patient and population level. Finally, the authors discuss implications for professional role formation and anticipated challenges to the design and implementation of value-added clinical systems learning roles.

Virtual patient design: exploring what works and why. A grounded theory study.

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Bateman, James; Allen, Maggie; Samani, Dipti; Kidd, Jane; Davies, David

2013-06-01

Virtual patients (VPs) are online representations of clinical cases used in medical education. Widely adopted, they are well placed to teach clinical reasoning skills. International technology standards mean VPs can be created, shared and repurposed between institutions. A systematic review has highlighted the lack of evidence to support which of the numerous VP designs may be effective, and why. We set out to research the influence of VP design on medical undergraduates. This is a grounded theory study into the influence of VP design on undergraduate medical students. Following a review of the literature and publicly available VP cases, we identified important design properties. We integrated them into two substantial VPs produced for this research. Using purposeful iterative sampling, 46 medical undergraduates were recruited to participate in six focus groups. Participants completed both VPs, an evaluation and a 1-hour focus group discussion. These were digitally recorded, transcribed and analysed using grounded theory, supported by computer-assisted analysis. Following open, axial and selective coding, we produced a theoretical model describing how students learn from VPs. We identified a central core phenomenon designated 'learning from the VP'. This had four categories: VP Construction; External Preconditions; Student-VP Interaction, and Consequences. From these, we constructed a three-layer model describing the interactions of students with VPs. The inner layer consists of the student's cognitive and behavioural preconditions prior to sitting a case. The middle layer considers the VP as an 'encoded object', an e-learning artefact and as a 'constructed activity', with associated pedagogic and organisational elements. The outer layer describes cognitive and behavioural change. This is the first grounded theory study to explore VP design. This original research has produced a model which enhances understanding of how and why the delivery and design of VPs

Towards socio-material approaches in simulation-based education: lessons from complexity theory.

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Fenwick, Tara; Dahlgren, Madeleine Abrandt

2015-04-01

Review studies of simulation-based education (SBE) consistently point out that theory-driven research is lacking. The literature to date is dominated by discourses of fidelity and authenticity - creating the 'real' - with a strong focus on the developing of clinical procedural skills. Little of this writing incorporates the theory and research proliferating in professional studies more broadly, which show how professional learning is embodied, relational and situated in social - material relations. A key concern for medical educators concerns how to better prepare students for the unpredictable and dynamic ambiguity of professional practice; this has stimulated the movement towards socio-material theories in education that address precisely this question. Among the various socio-material theories that are informing new developments in professional education, complexity theory has been of particular importance for medical educators interested in updating current practices. This paper outlines key elements of complexity theory, illustrated with examples from empirical study, to argue its particular relevance for improving SBE. Complexity theory can make visible important material dynamics, and their problematic consequences, that are not often noticed in simulated experiences in medical training. It also offers conceptual tools that can be put to practical use. This paper focuses on concepts of emergence, attunement, disturbance and experimentation. These suggest useful new approaches for designing simulated settings and scenarios, and for effective pedagogies before, during and following simulation sessions. Socio-material approaches such as complexity theory are spreading through research and practice in many aspects of professional education across disciplines. Here, we argue for the transformative potential of complexity theory in medical education using simulation as our focus. Complexity tools open questions about the socio-material contradictions inherent in

Non-medical influences on medical decision-making.

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McKinlay, J B; Potter, D A; Feldman, H A

1996-03-01

The influence of non-medical factors on physicians' decision-making has been documented in many observational studies, but rarely in an experimental setting capable of demonstrating cause and effect. We conducted a controlled factorial experiment to assess the influence of non-medical factors on the diagnostic and treatment decisions made by practitioners of internal medicine in two common medical situations. One hundred and ninety-two white male internists individually viewed professionally produced video scenarios in which the actor-patient, presenting with either chest pain or dyspnea, possessed various balanced combinations of sex, race, age, socioeconomic status, and health insurance coverage. Physician subjects were randomly drawn from lists of internists in private practice, hospital-based practice, and HMO's, at two levels of experience. The most frequent diagnoses for both chest pain and dyspnea were psychogenic origin and cardiac problems. Smoking cessation was the most frequent treatment recommendation for both conditions. Younger patients (all other factors being the same) were significantly more likely to receive the psychogenic diagnosis. Older patients were more likely to receive the cardiac diagnosis for chest pain, particularly if they were insured. HMO-based physicians were more likely to recommend a follow-up visit for chest pain. Several interactions of patient and physician factors were significant in addition to the main effects. The variability in decision-making evidenced by physicians in this experiment was not entirely accounted for by strictly rational Bayesian inference (the common prescriptive model for medical decision-making), in-as-much as non-medical factors significantly affected the decisions that they made. There is a need to supplement idealized medical schemata with considerations of social behavior in any comprehensive theory of medical decision-making.

Motivational foci and asthma medication tactics directed towards a functional day

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Lötvall Jan

2011-10-01

Full Text Available Abstract Background There appears to be an obvious gap between a medical and patient adherence perspective. Deviating from a medication prescription could be regarded as fairly irrational, but with respect to patients' goals and/or concerns it could be seen as understandable. Thus, the aim was to elucidate adherence reasoning in relation to asthma medication. Methods This was a qualitative study; data collection and analysis procedures were conducted according to Grounded Theory methodology. Eighteen persons, aged 22 with asthma and regular asthma medication treatment, were interviewed. Results The emerged theoretical model illustrated that adherence to asthma medication was motivated by three foci, all directed towards a desired outcome in terms of a functional day as desired by the patient. A promotive focus was associated with the ambition to achieve a positive asthma outcome by being adherent either to the received prescription or to a self-adjusted dosage. A preventive focus was intended to ensure avoidance of a negative asthma outcome either by sticking to the prescription or by preventively overusing the medication. A permissive focus was associated with unstructured adherence behaviour in which medication intake was primarily triggered by asthma symptoms. Conclusions As all participants had consciously adopted functioning medication tactics that directed them towards the desired goal of a functional day. In an effort to bridge the gap between a patient- and a medical adherence perspective, patients need support in defining their desired functionality and guidance in developing a person-based medication tactic.

[Medical professionalism-on social responsibilities viewed from historical perspective].

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Kim, Jang Han

2015-03-01

What is medical professionalism and does it matter to the patients? Medical professionals take responsibility for their judgements and the consequences that ensue. Traditionally medical professionalism is defined as a set of values, behaviors, and relationships which support the trust the public has in doctors. The public is well aware that absence of professionalism is harmful to their interests. However, the exercise of medical professionalism is endangered by the political and cultural environment. The values of professionalism have been changed throughout the medical history and the meaning of it was also changed according to social theories. Traditional medical professionalism was based on the virtue of autonomy, self-regulation and competency etc. However, in the new millenium era, the meaning of professionalism has changed under the concept of responsibility which includes the classical virtues. The meaning of professionalism nowadays is only based on the structure and conflicting theories which cannot solve all the issues surrounding professionalism in medical practice. The conditions of medical practice are critical determinants for the future of professionalism. The interaction between doctor and patient is central to the medical care, and medical professionalism has roots in almost every aspect of medical care. I argue that doctors have responsibility to act according to the values which have been determined by the medical profession, history and surrounding society. The new millennium medical professionalism which based on the responsibility could initiate a public dialogue about the role of the doctor in creating a fairer society.

Applying organizational behavior theory to primary care.

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Mullangi, Samyukta; Saint, Sanjay

2017-03-01

Addressing the mounting primary care shortage in the United States has been a focus of educators and policy makers, especially with the passage of the Affordable Care Act in 2010 and the Medicare Access and CHIP Reauthorization Act in 2015, placing increased pressure on the system. The Association of American Medical Colleges recently projected a shortage of as many as 65,000 primary care physicians by 2025, in part because fewer than 20% of medical students are picking primary care for a career. We examined the issue of attracting medical students to primary care through the lens of organizational behavior theory. Assuming there are reasons other than lower income potential for why students are inclined against primary care, we applied various principles of the Herzberg 2-factor theory to reimagine the operational flow and design of primary care. We conclude by proposing several solutions to enrich the job, such as decreasing documentation requirements, reducing the emphasis on specialty consultations, and elevating physicians to a supervisory role.

Design of Mobile Augmented Reality in Health Care Education: A Theory-Driven Framework.

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Zhu, Egui; Lilienthal, Anneliese; Shluzas, Lauren Aquino; Masiello, Italo; Zary, Nabil

2015-09-18

requirements of the learning environment form the foundation for AR to fill the gap between learning outcomes and medical learners' personal paradigms. With the design framework, the expected rational use of antibiotics by GPs is described and is easy to execute and evaluate. The comparison of specific expected abilities with the GP personal paradigm helps solidify the GP practical learning objectives and helps design the learning environment and activities. The learning environment and activities were supported by learning theories. This paper describes a framework for guiding the design, development, and application of mobile AR for medical education in the health care setting. The framework is theory driven with an understanding of the characteristics of AR and specific medical disciplines toward helping medical education improve professional development from knowledge to practice. Future research will use the framework as a guide for developing AR apps in practice to validate and improve the design framework.

儒家心性论的医德教育价值%Values of Confucianism Mind-nature Theory for Medical Ethics Education

Institute of Scientific and Technical Information of China (English)

郑佳琳; 张艳清

2017-01-01

As a core element of the Confucianism,mind-nature theory is full of the essence of Confucian mor-al education and has a profound influence on the Chinese national morality education.Confucianism mind-nature theory which takes Confucius and Mencius as representatives,after the continuous development of the future genera-tions,has been formed a complete ideological system.Confucianism mind-nature theory highly affirms the values of moral and unifies the values of life and moral.This article,by exploring the moral resources of Confucianism mind-nature theory,rethinks the ideas of contemporary ethics education and expounds how to enhance the effect of medical ethics education.%作为儒家学说核心内容之一的“心性论”思想,饱含着儒家德育思想的精髓,对中华民族道德教育影响深远.以孔孟为代表人物的儒家心性论历经后世的不断发展与完善,已经形成了一个完备的理论体系.儒家心性论高度肯定道德的价值,把人生价值与道德价值统一起来.通过挖掘其中的道德资源,来反思当代德育理念、提升医德教育效果.

Disclosing medical mistakes: a communication management plan for physicians.

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Petronio, Sandra; Torke, Alexia; Bosslet, Gabriel; Isenberg, Steven; Wocial, Lucia; Helft, Paul R

2013-01-01

There is a growing consensus that disclosure of medical mistakes is ethically and legally appropriate, but such disclosures are made difficult by medical traditions of concern about medical malpractice suits and by physicians' own emotional reactions. Because the physician may have compelling reasons both to keep the information private and to disclose it to the patient or family, these situations can be conceptualized as privacy dilemmas. These dilemmas may create barriers to effectively addressing the mistake and its consequences. Although a number of interventions exist to address privacy dilemmas that physicians face, current evidence suggests that physicians tend to be slow to adopt the practice of disclosing medical mistakes. This discussion proposes a theoretically based, streamlined, two-step plan that physicians can use as an initial guide for conversations with patients about medical mistakes. The mistake disclosure management plan uses the communication privacy management theory. The steps are 1) physician preparation, such as talking about the physician's emotions and seeking information about the mistake, and 2) use of mistake disclosure strategies that protect the physician-patient relationship. These include the optimal timing, context of disclosure delivery, content of mistake messages, sequencing, and apology. A case study highlighted the disclosure process. This Mistake Disclosure Management Plan may help physicians in the early stages after mistake discovery to prepare for the initial disclosure of a medical mistakes. The next step is testing implementation of the procedures suggested.

String theory as a quantum theory of gravity

International Nuclear Information System (INIS)

Horowitz, G.T.

1990-01-01

First, the connection between string theory and gravity is discussed - at first sight the theory of strings seem to have nothing to do with gravity but an intimate connection is shown. Then the quantum perturbation expansion is discussed. Thirdly, string theory is considered as a classical theory of gravity and finally recent speculation about a phase of string theory which is independent of a spacetime metric is discussed. (author)

Newly-graduated midwives transcending barriers: a grounded theory study.

Science.gov (United States)

Barry, Michele J; Hauck, Yvonne L; O'Donoghue, Thomas; Clarke, Simon

2013-12-01

Midwifery has developed its own philosophy to formalise its unique identity as a profession. Newly-graduated midwives are taught, and ideally embrace, this philosophy during their education. However, embarking in their career within a predominantly institutionalised and the medically focused health-care model may challenge this application. The research question guiding this study was as follows: 'How do newly graduated midwives deal with applying the philosophy of midwifery in their first six months of practice?' The aim was to generate a grounded theory around this social process. This Western Australian grounded theory study is conceptualised within the social theory of symbolic interactionism. Data were collected by means of in-depth, semi-structured interviews with 11 recent midwifery graduates. Participant and interviewer's journals provided supplementary data. The 'constant comparison' approach was used for data analysis. The substantive theory of transcending barriers was generated. Three stages in transcending barriers were identified: Addressing personal attributes, Understanding the 'bigger picture', and finally, 'Evaluating, planning and acting' to provide woman-centred care. An overview of these three stages provides the focus of this article. The theory of transcending barriers provides a new perspective on how newly-graduated midwives deal with applying the philosophy of midwifery in their first six months of practice. A number of implications for pre and post registration midwifery education and policy development are suggested, as well as recommendations for future research. Copyright © 2013 Elsevier Ltd. All rights reserved.

Methods of Medical Guidelines Modelling in GLIF.

Czech Academy of Sciences Publication Activity Database

Buchtela, David; Anger, Z.; Peleška, Jan (ed.); Tomečková, Marie; Veselý, Arnošt; Zvárová, Jana

2005-01-01

Roč. 11, - (2005), s. 1529-1532 ISSN 1727-1983. [EMBEC'05. European Medical and Biomedical Conference /3./. Prague, 20.11.2005-25.11.2005] Institutional research plan: CEZ:AV0Z10300504 Keywords : medical guidelines * knowledge modelling * GLIF model Subject RIV: BD - Theory of Information

Introduction of the transtheoretical model and organisational development theory in weight management: A narrative review.

Science.gov (United States)

Wu, Ya-Ke; Chu, Nain-Feng

2015-01-01

Overweight and obesity are serious public health and medical problems among children and adults worldwide. Behavioural change has been demonstrably contributory to weight management programs. Behavioural change-based weight loss programs require a theoretical framework. We will review the transtheoretical model and the organisational development theory in weight management. The transtheoretical model is a behaviour theory of individual level frequently used for weight management programs. The organisational development theory is a more complicated behaviour theory that applies to behavioural change on the system level. Both of these two theories have their respective strengths and weaknesses. In this manuscript, we try to introduce the transtheoretical model and the organisational development theory in the context of weight loss programs among population that are overweight or obese. Ultimately, we wish to present a new framework/strategy of weight management by integrating these two theories together. Copyright © 2015 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

A Dual Hesitant Fuzzy Multigranulation Rough Set over Two-Universe Model for Medical Diagnoses

Science.gov (United States)

Zhang, Chao; Li, Deyu; Yan, Yan

2015-01-01

In medical science, disease diagnosis is one of the difficult tasks for medical experts who are confronted with challenges in dealing with a lot of uncertain medical information. And different medical experts might express their own thought about the medical knowledge base which slightly differs from other medical experts. Thus, to solve the problems of uncertain data analysis and group decision making in disease diagnoses, we propose a new rough set model called dual hesitant fuzzy multigranulation rough set over two universes by combining the dual hesitant fuzzy set and multigranulation rough set theories. In the framework of our study, both the definition and some basic properties of the proposed model are presented. Finally, we give a general approach which is applied to a decision making problem in disease diagnoses, and the effectiveness of the approach is demonstrated by a numerical example. PMID:26858772

Back surgery: Modern medical pitfall.

Science.gov (United States)

Smith, Jc

2002-01-01

Medical iatrogenesis is at an all-time high with increasing deaths, disability, and costs compounded by unnecessary and ineffective surgeries despite the warnings from WHO, the US Public Health Service, and the Institute of Medicine. One area in particular, failed back surgeries, has drawn increasing attention by researchers due to disproved medical theories and surgical treatments. Paradoxically, while spinal manipulative therapy has been shown to achieve better results for this epidemic of low back pain in particular, medical and insurance programs often limit or boycott this inexpensive and effective treatment, indicating the solution to lowering medical costs and iatrogenesis now rests with political and economic factors primarily.

Electronic health record training in undergraduate medical education: bridging theory to practice with curricula for empowering patient- and relationship-centered care in the computerized setting.

Science.gov (United States)

Wald, Hedy S; George, Paul; Reis, Shmuel P; Taylor, Julie Scott

2014-03-01

While electronic health record (EHR) use is becoming state-of-the-art, deliberate teaching of health care information technology (HCIT) competencies is not keeping pace with burgeoning use. Medical students require training to become skilled users of HCIT, but formal pedagogy within undergraduate medical education (UME) is sparse. How can medical educators best meet the needs of learners while integrating EHRs into medical education and practice? How can they help learners preserve and foster effective communication skills within the computerized setting? In general, how can UME curricula be devised for skilled use of EHRs to enhance rather than hinder provision of effective, humanistic health care?Within this Perspective, the authors build on recent publications that "set the stage" for next steps: EHR curricula innovation and implementation as concrete embodiments of theoretical underpinnings. They elaborate on previous calls for maximizing benefits and minimizing risks of EHR use with sufficient focus on physician-patient communication skills and for developing core competencies within medical education. The authors describe bridging theory into practice with systematic longitudinal curriculum development for EHR training in UME at their institution, informed by Kern and colleagues' curriculum development framework, narrative medicine, and reflective practice. They consider this innovation within a broader perspective-the overarching goal of empowering undergraduate medical students' patient- and relationship-centered skills while effectively demonstrating HCIT-related skills.

The Role of Medical Expenditure Risk in Portfolio Allocation Decisions.

Science.gov (United States)

Ayyagari, Padmaja; He, Daifeng

2017-11-01

Economic theory suggests that medical spending risk affects the extent to which households are willing to accept financial risk, and consequently their investment portfolios. In this study, we focus on the elderly for whom medical spending represents a substantial risk. We exploit the exogenous reduction in prescription drug spending risk because of the introduction of Medicare Part D in the U.S. in 2006 to identify the causal effect of medical spending risk on portfolio choice. Consistent with theory, we find that Medicare-eligible persons increased risky investment after the introduction of prescription drug coverage, relative to a younger, ineligible cohort. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Teacher training program for medical students: improvements needed

Directory of Open Access Journals (Sweden)

van Diggele C

2015-04-01

Full Text Available Christie van Diggele,1 Annette Burgess,2 Craig Mellis21The University of Sydney, Sydney, NSW, Australia; 2Sydney Medical School – Central, The University of Sydney, Sydney, NSW, AustraliaIntroduction: Skills in peer teaching, assessment, and feedback are increasingly documented internationally as required graduate attributes in medicine. Yet these skills are rarely taught in medical schools. We sought to design and deliver a short but effective teacher training (TT program for medical students that could be easily integrated into the professional development curriculum. This study sought to evaluate such a pilot program, based on student perception.Methods: The study took place at a major metropolitan teaching hospital, where 38 medical students were invited to attend a voluntary, newly designed four-module TT program. In total, 23/38 (61% of invited students attended. Mixed methods were used for evaluation. Questionnaires were completed by 21/23 (91% of students, and 6/23 (26% of students participated in a focus group.Results: Students reported that as a result of the program they felt more confident to facilitate small group teaching activities and to provide feedback to peers using the suggested frameworks. Students would like the program to contain more in-depth educational theory and to allow a more time for small group learning activities. They would also like to see opportunities for participation across all clinical schools.Conclusion: The TT program was successful in increasing student awareness of educational theory and practice, thereby improving their confidence in teaching and assessing their peers and making them feel better prepared for their careers as medical practitioners. Key improvements to the program are needed in terms of more in-depth theory and more time spent on small group learning. This might be achieved by complementing the course with e-learning.Keywords: teacher training, medical students, peer teaching, peer

Testing knowledge of human gross anatomy in medical school: an applied contextual-learning theory method.

Science.gov (United States)

Clough, R W; Lehr, R P

1996-01-01

The traditional gross anatomy laboratory experience, with modifications in evaluations that we outline later, meets the criteria of contextual-learning theory, expands the repertoire of core objectives we identify for our students, and may increase the likelihood of cognitive permanence of anatomical data. Our subjects included approximately 54 first-year medical students from each of three sequential class years (1996, 1997, 1998). As an alternative to more typical written and practical exams, examinations in a major portion of our gross anatomy program consist of two approximately 30 minute oral expositions by each student to his or her peers and a faculty member. Students demonstrate specific detail on cadaver, x-ray, cross sections, or a model. Clinical applications, spatial relationships, nomenclature, and functions are strongly emphasized. The results of this teaching approach to the utilization of anatomical knowledge in clinical situations requires further assessment: however, new attributes have been afforded our students with implementation of the present program: First, students learn anatomical detail equally well as the students of the more traditional system (based on board exam results). Second, students who completed the program indicate that this approach provides a useful simulation of what is expected later in their training. Third, students gradually gain confidence in verbal presentation, they demonstrate cognitive synthesis of separate conceptual issues, they retain information, and they are quite visibly more enthusiastic about anatomy and its importance in medicine. Our program demonstrates that the learning of applicable human anatomy is facilitated in a contextual-learning environment. Moreover, by learning anatomy in this way, other equally beneficial attributes are afforded the medical student, including, but not limited to, increases in communication skills, confidence in verbal presentation, synthesis of anatomical concepts

M(atrix) theory: matrix quantum mechanics as a fundamental theory

International Nuclear Information System (INIS)

Taylor, Washington

2001-01-01

This article reviews the matrix model of M theory. M theory is an 11-dimensional quantum theory of gravity that is believed to underlie all superstring theories. M theory is currently the most plausible candidate for a theory of fundamental physics which reconciles gravity and quantum field theory in a realistic fashion. Evidence for M theory is still only circumstantial -- no complete background-independent formulation of the theory exists as yet. Matrix theory was first developed as a regularized theory of a supersymmetric quantum membrane. More recently, it has appeared in a different guise as the discrete light-cone quantization of M theory in flat space. These two approaches to matrix theory are described in detail and compared. It is shown that matrix theory is a well-defined quantum theory that reduces to a supersymmetric theory of gravity at low energies. Although its fundamental degrees of freedom are essentially pointlike, higher-dimensional fluctuating objects (branes) arise through the non-Abelian structure of the matrix degrees of freedom. The problem of formulating matrix theory in a general space-time background is discussed, and the connections between matrix theory and other related models are reviewed

Script-theory virtual case: A novel tool for education and research.

Science.gov (United States)

Hayward, Jake; Cheung, Amandy; Velji, Alkarim; Altarejos, Jenny; Gill, Peter; Scarfe, Andrew; Lewis, Melanie

2016-11-01

Context/Setting: The script theory of diagnostic reasoning proposes that clinicians evaluate cases in the context of an "illness script," iteratively testing internal hypotheses against new information eventually reaching a diagnosis. We present a novel tool for teaching diagnostic reasoning to undergraduate medical students based on an adaptation of script theory. We developed a virtual patient case that used clinically authentic audio and video, interactive three-dimensional (3D) body images, and a simulated electronic medical record. Next, we used interactive slide bars to record respondents' likelihood estimates of diagnostic possibilities at various stages of the case. Responses were dynamically compared to data from expert clinicians and peers. Comparative frequency distributions were presented to the learner and final diagnostic likelihood estimates were analyzed. Detailed student feedback was collected. Over two academic years, 322 students participated. Student diagnostic likelihood estimates were similar year to year, but were consistently different from expert clinician estimates. Student feedback was overwhelmingly positive: students found the case was novel, innovative, clinically authentic, and a valuable learning experience. We demonstrate the successful implementation of a novel approach to teaching diagnostic reasoning. Future study may delineate reasoning processes associated with differences between novice and expert responses.

Risk aversion in medical decision making: a survey

OpenAIRE

Liliana Chicaíza; Mario García; Giancarlo Romano

2011-01-01

This article surveys the literature on risk aversion in medical decision making. The search covered Econlit, Jstor Science Direct and Springer Link since 1985. The results are classified in three topics: Risk aversion in the frameworks of Expected Utility and Rank Dependent Expected Utility theories, and the methodologies for measuring risk aversion and its applications to clinical situations from the points of view of economics and psychology. It was found that, despite conceptual and method...

Medical Art Therapy

Directory of Open Access Journals (Sweden)

Birgul Aydin

2012-03-01

Full Text Available Art therapy is a form of expressive therapy that uses art materials. Art therapy combines traditional psychotherapeutic theories and techniques with an understanding of the psychological aspects of the creative process, especially the affective properties of the different art materials. Medical art therapy has been defined as the clinical application of art expression and imagery with individuals who are physically ill, experiencing physical trauma or undergoing invasive or aggressive medical procedures such as surgery or chemotherapy and is considered as a form of complementary or integrative medicine. Several studies have shown that patients with physical illness benefit from medical art therapy in different aspects. Unlike other therapies, art therapy can take the patients away from their illness for a while by means of creative activities during sessions, can make them forget the illness or lost abilities. Art therapy leads to re-experiencing normality and personal power even with short creative activity sessions. In this article definition, influence and necessity of medical art therapy are briefly reviewed.

An empirical assessment of high-performing medical groups: results from a national study.

Science.gov (United States)

Shortell, Stephen M; Schmittdiel, Julie; Wang, Margaret C; Li, Rui; Gillies, Robin R; Casalino, Lawrence P; Bodenheimer, Thomas; Rundall, Thomas G

2005-08-01

The performance of medical groups is receiving increased attention. Relatively little conceptual or empirical work exists that examines the various dimensions of medical group performance. Using a national database of 693 medical groups, this article develops a scorecard approach to assessing group performance and presents a theory-driven framework for differentiating between high-performing versus low-performing medical groups. The clinical quality of care, financial performance, and organizational learning capability of medical groups are assessed in relation to environmental forces, resource acquisition and resource deployment factors, and a quality-centered culture. Findings support the utility of the performance scorecard approach and identification of a number of key factors differentiating high-performing from low-performing groups including, in particular, the importance of a quality-centered culture and the requirement of outside reporting from third party organizations. The findings hold a number of important implications for policy and practice, and the framework presented provides a foundation for future research.

‘One of the Best Fathers until He Went Out of His Mind’: Paternal Child-Murder, 1864–1900

Science.gov (United States)

Shepherd, Jade

2013-01-01

Current scholarship suggests that when a mother murdered her child in Victorian England she was treated sympathetically by the press and in the courtroom. It is argued that because the crime was considered antithetical to womanhood it was viewed as an indication of insanity. This article examines newspaper reports, trial transcripts, medical literature and popular works on fatherhood, in order to explore the cases of sixty men committed to Broadmoor Criminal Lunatic Asylum between 1864 and 1900 for the murder of their children. It questions two assumptions of the literature on infanticide: first, the idea that it was only women who were thought to be going against nature if they killed their child; and second, that it was only women who regularly successfully pleaded insanity in such cases. The Broadmoor case studies not only demonstrate Victorian attitudes towards paternal child-murder but also provide valuable material illustrating affectionate models of Victorian fatherhood. In trial and press reports detailing the crimes it is clear that fathers were expected, and expected themselves, to be temperate, provide for, and protect their children. PMID:24764747

Can achievement emotions be used to better understand motivation, learning, and performance in medical education?

Science.gov (United States)

Artino, Anthony R; Holmboe, Eric S; Durning, Steven J

2012-01-01

In this article, we consider an emergent theory of human emotion. The overarching purpose of the article is to introduce medical education researchers to the notion of achievement emotions and provide a brief overview of how this work can inform the theory, research, and practice of medical education. First, we define achievement emotions and describe one of the leading contemporary theories of achievement emotions, control-value theory (Pekrun R. 2006. The control-value theory of achievement emotions: Assumptions, corollaries, and implications for educational research and practice. Educ Psychol Rev 18:315-341.). Next, we distinguish between different types of achievement emotions, their proximal causes, and their consequences for motivation, learning, and performance, and we discuss several implications for educational practice. Finally, we end with a call for more research on achievement emotions in medical education to facilitate our understanding of emotions and their impact on important educational outcomes.

Measuring hospital medical staff organizational structure.

Science.gov (United States)

Shortell, S M; Getzen, T E

1979-01-01

Based on organization theory and the work of Roemer and Friedman, seven dimensions of hospital medical staff organization structure are proposed and examined. The data are based on a 1973 nationwide survey of hospital medical staffs conducted by the American Hospital Association. Factor analysis yielded six relatively independent dimensions supporting a multidimensional view of medical staff organization structure. The six dimensions include 1) Resource Capability, 2) Generalist Physician Contractual Orientation, 3) Communication/Control, 4) Local Staff Orientation, 5) Participation in Decision Making, and 6) Hospital-Based Physician Contractual Orientation. It is suggested that these dimensions can be used to develop an empirical typology of hospital medical staff organization structure and to investigate the relationship between medical staff organization and public policy issues related to cost containment and quality assurance. PMID:511580

Project EASE: a study to test a psychosocial model of epilepsy medication managment.

Science.gov (United States)

DiIorio, Collen; Shafer, Patricia Osborne; Letz, Richard; Henry, Thomas R; Schomer, Donal L; Yeager, Kate

2004-12-01

The purpose of this study was to test a psychosocial model of medication self-management among people with epilepsy. This model was based primarily on social cognitive theory and included personal (self-efficacy, outcome expectations, goals, stigma, and depressive symptoms), social (social support), and provider (patient satisfaction and desire for control) variables. Participants for the study were enrolled at research sites in Atlanta, Georgia, and Boston, Massachusetts and completed computer-based assessments that included measures of the study variables listed above. The mean age of the 317 participants was 43.3 years; about 50% were female, and 81%white. Self-efficacy and patient satisfaction explained the most variance in medication management. Social support was related to self-efficacy; stigma to self-efficacy and depressive symptoms; and self-efficacy to outcome expectations and depressive symptoms. Findings reinforce that medication-taking behavior is affected by a complex set of interactions among psychosocial variables.

Formalized Medical Guidelines and a Structured Electronic Health Record.

Czech Academy of Sciences Publication Activity Database

Peleška, Jan; Anger, Z.; Buchtela, David; Šebesta, K.; Tomečková, Marie; Veselý, Arnošt; Zvára, K.; Zvárová, Jana

2005-01-01

Roč. 11, - (2005), s. 4652-4656 ISSN 1727-1983. [EMBEC'05. European Medical and Biomedical Conference /3./. Prague, 20.11.2005-25.11.2005] R&D Projects: GA AV ČR 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : formalization of guidelines in cardilogy * GLIF model * structure electronic health record * algorithm in cardiovascular diagnostics and treatment Subject RIV: BD - Theory of Information

Mapping the field of medical sociology: a comparative analysis of journals.

Science.gov (United States)

Seale, Clive

2008-07-01

A comparative keyword analysis of the content of nine leading journals is used to suggest potential new directions for medical sociology. The major British and American journals in sociology and medical sociology tend to publish authors based in their own countries, contrasting with the internationalism of other social science disciplines relevant to health, although Sociology of Health and Illness is an exception to this. Medical sociology journals on both sides of the Atlantic focus on individual experience more than general sociology journals, which focus more on social systems levels of analysis. While journal contents reveal British medical sociology to be relatively atheoretical when compared with British general sociology journals, American medical sociology appears relatively apolitical on the same comparison with American general journals. American journals of sociology publish more quantitative studies than their British equivalents, more studies concerning race and other social divisions in American society, and less work drawing on social constructionist perspectives or that is engaged with social theory. Analysis of health and health care at societal and global levels and a deeper engagement with the political and public issues that concern non-sociologists represents a possible future for a medical sociology that is internationally relevant and outward looking.

Transformational leadership in nursing and medication safety education: a discussion paper.

Science.gov (United States)

Vaismoradi, Mojtaba; Griffiths, Pauline; Turunen, Hannele; Jordan, Sue

2016-10-01

This paper discusses the application of transformational leadership to the teaching and learning of safe medication management. The prevalence of adverse drug events (ADEs) and medication-related hospitalisations (one hundred thousand each year in the USA) are of concern. This discussion is based on a narrative literature review and scrutiny of international nursing research to synthesise pedagogical strategies for the application of transformational leadership to teaching medication safety. The four elements relating transformational leadership to medication safety education are: 'Idealised influence' or role modelling, both actual and exemplary, 'Inspirational motivation' providing students with commitment to medication safety, 'Intellectual stimulation' encouraging students to value improvement and change, and 'Individualised consideration' of individual students' educational goals, practice development and patient outcomes. The model lends itself to experiential learning and a case-study approach to teaching, offering an opportunity to reduce nursing's theory-practice gap. Transformational leadership for medication safety education is characterised by a focus on the role of nurse educators and mentors in the development of students' abilities, creation of a supportive culture, and enhancement of students' creativity, motivation and ethical behaviour. This will prepare nursing graduates with the competencies necessary to be diligent about medication safety and the prevention of errors. Teaching medication safety through transformational leadership requires the close collaboration of educators, managers and policy makers. Investigation of strategies to reduced medication errors and consequent patient harm should include exploration of the application of transformational leadership to education and its impact on the number and severity of medication errors. © 2016 John Wiley & Sons Ltd.

Insane anti-Membranes?

International Nuclear Information System (INIS)

Giecold, Gregory; Orsi, Francesco; Puhm, Andrea

2014-01-01

The backreactions of anti-branes on a variety of supergravity backgrounds have been shown in a recent series of papers to be riled by some unexplained flux singularities. All of the situations studied so far involve backgrounds with (close to) AdS-asymptotics. It is the purpose of this work to study the backreaction of anti-M2 branes on a background exhibiting a different UV behavior: the so-called A 8 regular solution of eleven-dimensional supergravity that we consider has “Taub-NUT type' asymptotics. As it turns out, some subleading infrared singularities are inevitable; they cannot be naturally ascribed to the anti-branes backreacting on this background. Moreover, our configuration does not involve smeared branes. This lends further credence to the work of Bena et al. http://dx.doi.org/10.1007/JHEP09(2013)142 suggesting that the singularities encountered are in no way remnants of smearing that would wash away once brane polarization is taken into account

A Theory-Based Study of Factors Explaining General Practitioners' Intention to Use and Participation in Electronic Continuing Medical Education.

Science.gov (United States)

Hadadgar, Arash; Changiz, Tahereh; Dehghani, Zahra; Backheden, Magnus; Mirshahzadeh, Nahidalsadat; Zary, Nabil; Masiello, Italo

2016-01-01

Electronic modes of continuing medical education (eCME) can provide an appropriate and scalable way of updating the knowledge and skills of general practitioners (GPs). To optimize the adoption of eCME and develop efficient and cost-effective eCME programs, factors explaining GPs' intention to use eCME must first be elucidated. Using the Theory of Planned Behavior as a framework, we developed a questionnaire and administered it to GPs in seven CME seminars in Isfahan, Iran, in 2014. Three domains of GPs' intention to use eCME were measured: attitudes, perceived behavioral control, and subjective norms. We used linear and logistic regression to identify the main predictors of intention and behavior. GPs who had high score in perceived behavioral control and a more positive attitude toward e-learning had a higher intention to adopt it for CME. In contrast, subjective norms (eg, social pressures to use eCME) were not a predictor. Attitude toward usefulness of eCME was the main predictor of being an actual eCME user. Perceived behavioral control and attitude constitute the main predictors of the intention to use eCME. Establishing discussions forums and strengthening organizational support for eCME through an increased awareness among clinical superiors and CME managers would be expected to increase GPs' intention to use eCME.

The Application of Catastrophe Theory to Medical Image Analysis

NARCIS (Netherlands)

Kuijper, Arjan; Florack, L.M.J.

2001-01-01

In order to investigate the deep structure of Gaussian scale space images, one needs to understand the behaviour of critical points under the influence of blurring. We show how the mathematical framework of catastrophe theory can be used to describe the various different types of

Kant on mental disorder. Part 2: philosophical implications of Kant's account.

Science.gov (United States)

Frierson, Patrick

2009-09-01

This paper considers various philosophical problems arising from Kant's account of mental disorder. Starting with the reasons why Kant considered his theory of mental disorder important, I then turn to the implications of this theory of Kant's metaphysics, epistemology and ethics. Given Kant's account of insanity as 'a totally different standpoint... from which one sees all objects differently' (7: 216), the Critique of Pure Reason should be read as offering a more social epistemology than typically recognized. Also, mental disorders that seem to undermine human freedom and rationality raise problems for Kant's moral philosophy that his pragmatic anthropology helps to mitigate. Finally, I propose some implications of Kant's account of mental disorder for contemporary work on mental illness.

Evaluation of doctors' performance as facilitators in basic medical science lecture classes in a new Malaysian medical school

Directory of Open Access Journals (Sweden)

Ismail S

2015-03-01

Full Text Available Salwani Ismail,1 Abdus Salam,2 Ahmed G Alattraqchi,1 Lakshmi Annamalai,1 Annamalai Chockalingam,1 Wan Putri Elena,3 Nor Iza A Rahman,1 Abdullahi Rabiu Abubakar,1 Mainul Haque1 1Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia; 2Department of Medical Education, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; 3School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia Background: Didactic lecture is the oldest and most commonly used method of teaching. In addition, it is considered one of the most efficient ways to disseminate theories, ideas, and facts. Many critics feel that lectures are an obsolete method to use when students need to perform hands-on activities, which is an everyday need in the study of medicine. This study evaluates students' perceptions regarding lecture quality in a new medical school. Methods: This was a cross-sectional study conducted of the medical students of Universiti Sultan Zainal Abidin. The study population was 468 preclinical medical students from years 1 and 2 of academic year 2012–2013. Data were collected using a validated instrument. There were six different sections of questions using a 5-point Likert scale. The data were then compiled and analyzed, using SPSS version 20. Results: The response rate was 73%. Among 341 respondents, 30% were male and 70% were female. Eighty-five percent of respondents agree or strongly agree that the lectures had met the criteria with regard to organization of lecture materials. Similarly, 97% of students agree or strongly agree that lecturers maintained adequate voices and gestures. Conclusion: Medical students are quite satisfied with the lecture classes and the lectures. However, further research is required to identify student-centered teaching and learning methods to promote active learning. Keywords: lecture, effectiveness, evaluation, undergraduate medical

[Rational choice, prediction, and medical decision. Contribution of severity scores].

Science.gov (United States)

Bizouarn, P; Fiat, E; Folscheid, D

2001-11-01

The aim of this study was to determine what type of representation the medical doctor adopted concerning the uncertainty about the future in critically ill patients in the context of preoperative evaluation and intensive care medicine and to explore through the representation of the patient health status the different possibilities of choice he was able to make. The role played by the severity classification systems in the process of medical decision-making under probabilistic uncertainty was assessed according to the theories of rational behaviour. In this context, a medical rationality needed to be discovered, going beyond the instrumental status of the objective and/or subjective constructions of rational choice theories and reaching a dimension where means and expected ends could be included.

The Pathway to a Safe and Effective Spaceflight Medication Formulary: Expert Review Panel Recommendations

Science.gov (United States)

Daniels, V. R.; Bayuse, T. M.; Mulcahy, R. A.; McGuire, R. K. M.; Antonsen, E. L.

2018-01-01

Exploration spaceflight poses several challenges to the provision of a comprehensive medication formulary. This formulary must accommodate the size and space limitations of the spacecraft, while addressing individual medication needs and preferences of the crew, consequences of a degrading inventory over time, the inability to resupply used or expired medications, and the need to forecast the best possible medication candidates to treat conditions that may occur. The Exploration Medical Capability (ExMC) Element's Pharmacy Project Team has developed a research plan (RP) that is focused on evidence-based models and theories as well as new diagnostic tools, treatments, or preventive measures aimed to ensure an available, safe, and effective pharmacy sufficient to manage potential medical threats during exploration spaceflight. Here, we will discuss the ways in which the ExMC Pharmacy Project Team pursued expert evaluation and guidance, and incorporated acquired insight into an achievable research pathway, reflected in the revised RP.

[Self-Determination in Medical Rehabilitation - Development of a Conceptual Model for Further Theoretical Discussion].

Science.gov (United States)

Senin, Tatjana; Meyer, Thorsten

2018-01-22

Aim was to gather theoretical knowledge about self-determination and to develop a conceptual model for medical rehabilitation- which serves as a basis for discussion. We performed a literature research in electronic databases. Various theories and research results were adopted and transferred to the context of medical rehabilitation and into a conceptual model. The conceptual model of self-determination reflects on a continuum which forms of self-determination may be present in situations of medical rehabilitation treatments. The location on the continuum depends theoretically on the manifestation of certain internal and external factors that may influence each other. The model provides a first conceptualization of self-determination focusing on medical rehabilitation which should be further refined and tested empirically. © Georg Thieme Verlag KG Stuttgart · New York.

Framing medical tourism: an examination of appeal, risk, convalescence, accreditation, and interactivity in medical tourism web sites.

Science.gov (United States)

Mason, Alicia; Wright, Kevin B

2011-02-01

This exploratory study analyzed the content of medical tourism Web sites in an attempt to examine how they convey information about benefits and risks of medical procedures, how they frame credibility, and the degree to which these Web sites include interactive features for consumers. Drawing upon framing theory, the researchers content analyzed a sample of 66 medical tourism Web sites throughout the world. The results indicated that medical tourism Web sites largely promote the benefits of medical procedures while downplaying the risks, and relatively little information regarding the credibility of these services appears. In addition, the presentation of benefits/risks, credibility, and Web site interactivity were found to differ by region and type of facility. The authors discuss the implications of these findings concerning the framing of medical tourism Web site content, future directions for research, and limitations.

Predicting medical professionals' intention to allow family presence during resuscitation: A cross sectional survey.

Science.gov (United States)

Lai, Meng-Kuan; Aritejo, Bayu Aji; Tang, Jing-Shia; Chen, Chien-Liang; Chuang, Chia-Chang

2017-05-01

Family presence during resuscitation is an emerging trend, yet it remains controversial, even in countries with relatively high acceptance of family presence during resuscitation among medical professionals. Family presence during resuscitation is not common in many countries, and medical professionals in these regions are unfamiliar with family presence during resuscitation. Therefore, this study predicted the medical professionals' intention to allow family presence during resuscitation by applying the theory of planned behaviour. A cross-sectional survey. A single medical centre in southern Taiwan. Medical staffs including physicians and nurses in a single medical centre (n=714). A questionnaire was constructed to measure the theory of planned behaviour constructs of attitudes, subjective norms, perceived behavioural control, and behavioural intentions as well as the awareness of family presence during resuscitation and demographics. In total, 950 questionnaires were distributed to doctors and nurses in a medical centre. Among the 714 valid questionnaires, only 11 participants were aware of any association in Taiwan that promotes family presence during resuscitation; 94.7% replied that they were unsure (30.4%) or that their unit did not have a family presence during resuscitation policy (74.8%). Regression analysis was performed to predict medical professionals' intention to allow family presence during resuscitation. The results indicated that only positive attitudes and subjective norms regarding family presence during resuscitation and clinical tenure could predict the intention to allow family presence during resuscitation. Because Family presence during resuscitation practice is not common in Taiwan and only 26.19% of the participants agreed to both items measuring the intention to allow family presence during resuscitation, we recommend the implementation of a family presence during resuscitation education program that will enhance the positive beliefs