Medical data transmission system for remote healthcare centres

International Nuclear Information System (INIS)

Gonzalez, E A; Cagnolo, F J; Olmos, C E; Centeno, C A; Riva, G G; Zerbini, C A

2007-01-01

The main motivation of this project is to improve the healthcare centres equipment and human resources efficiency, enabling those centres for transmission of parameters of medical interest. This system facilitates remote consultation, in particular between specialists and remote healthcare centres. Likewise it contributes to the qualification of professionals. The electrocardiographic (ECG) and electroencephalographic (EEG) signals are acquired, processed and then sent, fulfilling the effective norms, for application in the hospital network of Cordoba Province, which has nodes interconnected by phone line. As innovative aspects we emphasized the low cost of development and maintenance, great versatility and handling simplicity with a modular design for interconnection with diverse data transmission media (Wi-Fi, GPRS, etc.). Successfully experiences were obtained during the acquisition of the signals and transmissions on wired LAN networks. As improvements, we can mention: energy consumption optimization and mobile communication systems usage, in order to offer more autonomy

Proposed medical applications of the National Accelerator Centre facilities

International Nuclear Information System (INIS)

Jones, D.T.L.

1982-01-01

The National Accelerator Centre is at present under construction at Faure, near Cape Town. The complex will house a 200 MeV separated-sector cyclotron which will provide high quality beams for nuclear physics and related diciplines as well as high intensity beams for medical use. The medical aspects catered for will include particle radiotherapy, isotope production and possibly proton radiography. A 30-bed hospital is to be constructed on the site. Building operations are well advanced and the medical facilities should be available for use by the end of 1984

Patient participation in the medical specialist encounter: does physicians' patient-centred communication matter?

NARCIS (Netherlands)

Zandbelt, Linda C.; Smets, Ellen M. A.; Oort, Frans J.; Godfried, Mieke H.; de Haes, Hanneke C. J. M.

2007-01-01

OBJECTIVE: Physicians' patient-centred communication is assumed to stimulate patients' active participation, thus leading to more effective and humane exchange in the medical consultation. We investigated the relationship between physicians' patient-centred communication and patient participation in

Theory-based practice in a major medical centre.

Science.gov (United States)

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.

Isolates from wound infections at federal medical centre, bida ...

African Journals Online (AJOL)

A total of 589 wound swabs from 334 patients in Federal Medical Centre, Bida were studied. Samples were collected between Jan 2002 to Dec. 2003. Swabs were plated within one hour after collection unto blood, chocolate and Mac Conkey after plate, and incubated aerobically for 24hrs. The chocolate plated swabs were ...

It's more than money: policy options to secure medical specialist workforce for regional centres.

Science.gov (United States)

May, Jennifer; Walker, Judi; McGrail, Mathew; Rolley, Fran

2017-12-01

Objectives Regional centres and their rural hinterlands support significant populations of non-metropolitan Australians. Despite their importance in the settlement hierarchy and the key medical services provided from these centres, little research has focused on their issues of workforce supply and long-term service requirements. In addition, they are a critical component of the recent growth of 'regional' hub-and-spoke specialist models of service delivery. Methods The present study interviewed 62 resident specialists in four regional centres, seeking to explore recruitment and retention factors important to their location decision making. The findings were used to develop a framework of possible evidence-informed policies. Results This article identifies key professional, social and locational factors, several of which are modifiable and amenable to policy redesign, including work variety, workplace culture, sense of community and spousal employment; these factors that can be targeted through initiatives in selection, training and incentives. Conclusions Commonwealth, state and local governments in collaboration with communities and specialist colleges can work synergistically, with a multiplicity of interdigitating strategies, to ensure a positive approach to the maintenance of a critical mass of long-term rural specialists. What is known about the topic? Rural origin increases likelihood of long-term retention to rural locations, with rural clinical school training associated with increased rural intent. Recruitment and retention policy has been directed at general practitioners in rural communities, with little focus on regional centres or medical specialists. What does this study add? Rural origin is associated with regional centre recruitment. Professional, social and locational factors are all moderately important in both recruitment and retention. Specialist medical training for regional centres ideally requires both generalist and subspecialist skills

Statistical Modeling of the Trends Concerning the Number of Hospitals and Medical Centres in Romania

Directory of Open Access Journals (Sweden)

Gabriela OPAIT

2017-04-01

Full Text Available This study reveals the technique for to achive the shapes of the mathematical models which put in evidence the distributions of the values concerning the number of Hospitals, respectively Medical Centres, in our country, in the time horizon 2005-2014. In the same time, we can to observe the algorithm applied for to construct forecasts about the evolutions regarding the number of Hospitals and Medical Centres in Romania.

Carnivalesque Enactment at the Children's Medical Centre of Rabin Hospital.

Science.gov (United States)

Lev-Aladgem, Shulamith

2000-01-01

Describes the basic characteristics of the "carnivalesque enactment" and its therapeutic potential. Explains a case study of the drama project at the Rabin Children's Medical Centre, how the carnivalesque enactment was developed step by step, and the kind of effect it stimulated among the children. Suggests new theatrical experiments with…

Medical Students and Patient-Centred Clinical Practice: The Case for More Critical Work in Medical Schools

Science.gov (United States)

Donetto, Sara

2012-01-01

In the last two decades, undergraduate medical education in the United Kingdom has undergone several important changes. Many of these have revolved around a paradigmatic shift from "paternalistic" to "patient-centred" approaches to healthcare. Adopting a Foucauldian understanding of power and borrowing from Freire's critical…

Person-centred interactions between nurses and patients during medication activities in an acute hospital setting: qualitative observation and interview study.

Science.gov (United States)

Bolster, Danielle; Manias, Elizabeth

2010-02-01

There is increasing emphasis on person-centred care within the literature and the health care context. It is suggested that a person-centred approach to medication activities has the potential to improve patient experiences and outcomes. This study set out to examine how nurses and patients interact with each other during medication activities in an acute care environment with an underlying philosophy of person-centred care. A qualitative approach was used comprising naturalistic observation and semi-structured interviews. The study setting was an acute care ward with a collaboratively developed philosophy of person-centre care, in an Australian metropolitan hospital. Eleven nurses of varying levels of experience were recruited to participate in observations and interviews. Nurses were eligible to participate if they were employed on the study ward in a role that incorporated direct patient care, including medication activities. A stratified sampling technique ensured that nurses with a range of years of clinical experience were represented. Patients who were being cared for by participating nurses during the observation period were recruited to participate unless they met the following exclusion criteria: those less than 18 years of age, non-English speaking patients, and those who were unable to give informed consent. Twenty-five patients were observed and 16 of those agreed to be interviewed. The results of the study generated insights into the nature of interactions between nurses and patients where person-centred care is the underlying philosophy of care. Three major themes emerged from the findings: provision of individualised care, patient participation and contextual barriers to providing person-centred care. While the participating nurses valued a person-centred approach and perceived that they were conducting medication activities in a person-centred way, some nurse-patient interactions during medication activities were centred on routines rather than

Patients' attitudes to medical and psychosocial aspects of care in fertility clinics: Findings from the Copenhagen Multi-centre Psychosocial Infertility (COMPI) Research Programme

DEFF Research Database (Denmark)

Schmidt, L; Holstein, B E; Boivin, J

2003-01-01

among infertile people. METHODS: We conducted an epidemiological study based on questionnaires among all new couples attending five fertility clinics with a response rate of 80.0% and a total of 2250 patients. RESULTS: The vast majority of both men and women considered a high level of medical......BACKGROUND: The aims were (i) to identify gender differences in motivations to seek assisted reproduction and gender differences in expectations about medical and psychosocial services and (ii) to examine factors that predict the perceived importance of, and intention to use, psychosocial services...... information and patient-centred care as important. Fewer respondents (women 10.0-20.8%, men 4.1-8.9%) felt that professional psychosocial services were important and/or had the intention to use these services. The main predictor of perceived importance of patient-centred care and professional psychosocial...

Corrigendum to: It's more than money: policy options to secure medical specialist workforce for regional centres.

Science.gov (United States)

May, Jennifer; Walker, Judi; McGrail, Mathew; Rolley, Fran

2017-12-01

Objectives Regional centres and their rural hinterlands support significant populations of non-metropolitan Australians. Despite their importance in the settlement hierarchy and the key medical services provided from these centres, little research has focused on their issues of workforce supply and long-term service requirements. In addition, they are a critical component of the recent growth of 'regional' hub-and-spoke specialist models of service delivery. Methods The present study interviewed 62 resident specialists in four regional centres, seeking to explore recruitment and retention factors important to their location decision making. The findings were used to develop a framework of possible evidence-informed policies. Results This article identifies key professional, social and locational factors, several of which are modifiable and amenable to policy redesign, including work variety, workplace culture, sense of community and spousal employment; these factors that can be targeted through initiatives in selection, training and incentives. Conclusions Commonwealth, state and local governments in collaboration with communities and specialist colleges can work synergistically, with a multiplicity of interdigitating strategies, to ensure a positive approach to the maintenance of a critical mass of long-term rural specialists. What is known about the topic? Rural origin increases likelihood of long-term retention to rural locations, with rural clinical school training associated with increased rural intent. Recruitment and retention policy has been directed at general practitioners in rural communities, with little focus on regional centres or medical specialists. What does this study add? Rural origin is associated with regional centre recruitment. Professional, social and locational factors are all moderately important in both recruitment and retention. Specialist medical training for regional centres ideally requires both generalist and subspecialist skills

Tetanus in adult males, Bugando Medical Centre, United Republic of Tanzania.

Science.gov (United States)

Aziz, Riaz; Peck, Robert N; Kalluvya, Samuel; Kenemo, Bernard; Chandika, Alphonce; Downs, Jennifer A

2017-11-01

In the United Republic of Tanzania, the incidence of non-neonatal circumcision-related tetanus is probably underreported. We analysed charts and extracted information on outcome and wound location for non-neonatal cases of tetanus admitted to the intensive care unit of Bugando Medical Centre between 2001 and 2016. Bugando Medical Centre, which is one of four teaching referral hospitals in the United Republic of Tanzania, has a 13-bed intensive care unit that manages all admitted patients with tetanus. Within the United Republic of Tanzania, formal programmes of tetanus immunization are targeted at infants or women. From our inpatient logs, we identified six patients with non-neonatal tetanus among male patients with a recent history of circumcision. Only one of these patients had been circumcised within a subnational programme of voluntary medical male circumcision. The other five had been circumcised outside of the programme - e.g. at small rural dispensaries or by a traditional provider with no formal medical training. The six patients were aged 11-55 years and five (83%) of them died in hospital - all of overwhelming sepsis. Within the Tanzanian programme of voluntary medical male circumcision, education on wound hygiene probably helps to reduce the incidence of non-neonatal circumcision-related tetanus. The corresponding incidence among the boys and men who are circumcised beyond this subnational programme is probably higher. The training of all circumcision providers in wound care and a vaccination programme to ensure that male Tanzanians receive tetanus immunization post-infancy are recommended.

The epidemiology and type of medication errors reported to the National Poisons Information Centre of Ireland.

Science.gov (United States)

Cassidy, Nicola; Duggan, Edel; Williams, David J P; Tracey, Joseph A

2011-07-01

Medication errors are widely reported for hospitalised patients, but limited data are available for medication errors that occur in community-based and clinical settings. Epidemiological data from poisons information centres enable characterisation of trends in medication errors occurring across the healthcare spectrum. The objective of this study was to characterise the epidemiology and type of medication errors reported to the National Poisons Information Centre (NPIC) of Ireland. A 3-year prospective study on medication errors reported to the NPIC was conducted from 1 January 2007 to 31 December 2009 inclusive. Data on patient demographics, enquiry source, location, pharmaceutical agent(s), type of medication error, and treatment advice were collated from standardised call report forms. Medication errors were categorised as (i) prescribing error (i.e. physician error), (ii) dispensing error (i.e. pharmacy error), and (iii) administration error involving the wrong medication, the wrong dose, wrong route, or the wrong time. Medication errors were reported for 2348 individuals, representing 9.56% of total enquiries to the NPIC over 3 years. In total, 1220 children and adolescents under 18 years of age and 1128 adults (≥ 18 years old) experienced a medication error. The majority of enquiries were received from healthcare professionals, but members of the public accounted for 31.3% (n = 736) of enquiries. Most medication errors occurred in a domestic setting (n = 2135), but a small number occurred in healthcare facilities: nursing homes (n = 110, 4.68%), hospitals (n = 53, 2.26%), and general practitioner surgeries (n = 32, 1.36%). In children, medication errors with non-prescription pharmaceuticals predominated (n = 722) and anti-pyretics and non-opioid analgesics, anti-bacterials, and cough and cold preparations were the main pharmaceutical classes involved. Medication errors with prescription medication predominated for adults (n = 866) and the major medication

The epidemiology and type of medication errors reported to the National Poisons Information Centre of Ireland.

LENUS (Irish Health Repository)

Cassidy, Nicola

2012-02-01

INTRODUCTION: Medication errors are widely reported for hospitalised patients, but limited data are available for medication errors that occur in community-based and clinical settings. Epidemiological data from poisons information centres enable characterisation of trends in medication errors occurring across the healthcare spectrum. AIM: The objective of this study was to characterise the epidemiology and type of medication errors reported to the National Poisons Information Centre (NPIC) of Ireland. METHODS: A 3-year prospective study on medication errors reported to the NPIC was conducted from 1 January 2007 to 31 December 2009 inclusive. Data on patient demographics, enquiry source, location, pharmaceutical agent(s), type of medication error, and treatment advice were collated from standardised call report forms. Medication errors were categorised as (i) prescribing error (i.e. physician error), (ii) dispensing error (i.e. pharmacy error), and (iii) administration error involving the wrong medication, the wrong dose, wrong route, or the wrong time. RESULTS: Medication errors were reported for 2348 individuals, representing 9.56% of total enquiries to the NPIC over 3 years. In total, 1220 children and adolescents under 18 years of age and 1128 adults (>\\/= 18 years old) experienced a medication error. The majority of enquiries were received from healthcare professionals, but members of the public accounted for 31.3% (n = 736) of enquiries. Most medication errors occurred in a domestic setting (n = 2135), but a small number occurred in healthcare facilities: nursing homes (n = 110, 4.68%), hospitals (n = 53, 2.26%), and general practitioner surgeries (n = 32, 1.36%). In children, medication errors with non-prescription pharmaceuticals predominated (n = 722) and anti-pyretics and non-opioid analgesics, anti-bacterials, and cough and cold preparations were the main pharmaceutical classes involved. Medication errors with prescription medication predominated for

The medical social centres in support of Roma in Greece

DEFF Research Database (Denmark)

Andrioti, Despena; Kotrotsou, Christina; Tsakatara, Vanta

2013-01-01

. Medical social centres operate in 33 Roma settlements all over the country. These centres provide vaccination, health promotion, disease prevention and health education services, as well as support in issuing documents and making appointments with health and social services. We recommend that the National......Roma people form the largest ethnic-minority group in Europe. They account for around 10 to 12 million people, and they face racism, discrimination and social exclusion in most countries. The Roma population of Greece currently numbers around 250 000 individuals. They have Greek nationality...... and enjoy the same rights, privileges and responsibilities as any other Greek citizens. Nevertheless, Roma in Greece face multiple inequalities and social exclusion in terms of housing, employment, education, and health and social services. In this report we present the outcome of a bestpractice initiative...

Emotional intelligence predicts success in medical school.

Science.gov (United States)

Libbrecht, Nele; Lievens, Filip; Carette, Bernd; Côté, Stéphane

2014-02-01

Accumulating evidence suggests that effective communication and interpersonal sensitivity during interactions between doctors and patients impact therapeutic outcomes. There is an important need to identify predictors of these behaviors, because traditional tests used in medical admissions offer limited predictions of "bedside manners" in medical practice. This study examined whether emotional intelligence would predict the performance of 367 medical students in medical school courses on communication and interpersonal sensitivity. One of the dimensions of emotional intelligence, the ability to regulate emotions, predicted performance in courses on communication and interpersonal sensitivity over the next 3 years of medical school, over and above cognitive ability and conscientiousness. Emotional intelligence did not predict performance on courses on medical subject domains. The results suggest that medical schools may better predict who will communicate effectively and show interpersonal sensitivity if they include measures of emotional intelligence in their admission systems. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Bodies or organisms? Medical encounter as a control apparatus at a primary care centre in Barcelona

Directory of Open Access Journals (Sweden)

Alejandro Zaballos Samper

2013-07-01

Full Text Available Medical practice is driven by technology, discourses, and knowledge about health and illness. This has resulted in its gaining a dominating position in power relations achieved by means of diagnosis, medicalization, and habit and conduct creation and maintenance. Interaction at primary care centres is built on mainstream biomedical views of both the medical discourse and the social practices related to health, illness and the human body. Moreover, it is also rooted on the ideologies conveyed by those social concepts, which in turn, permeate interaction all through with power relations. The present paper takes ethnographic data and in-depth interviews as a departing point to analyse how diagnosis, medicalization, and biopolicies for health prevention and improvement carried out in primary care centres in Barcelona make up a control apparatus. Furthermore, this essay also explores how the apparatus is developed in the medical encounter and turns the body into an organism.

Recognition of out-of-hospital cardiac arrest by medical dispatchers in emergency medical dispatch centres in two countries

DEFF Research Database (Denmark)

Møller, Thea Palsgaard; Andréll, Cecilia; Viereck, Søren

2016-01-01

in two steps; registry data were merged with electronically registered emergency call data from the emergency medical dispatch centres in the two regions. Cases with missing or non-OHCA dispatch codes were analysed further by auditing emergency call recordings using a uniform data collection template......INTRODUCTION: Survival after out-of-hospital cardiac arrest (OHCA) remains low. Early recognition by emergency medical dispatchers is essential for an effective chain of actions, leading to early cardiopulmonary resuscitation, use of an automated external defibrillator and rapid dispatching...... of the emergency medical services. AIM: To analyse and compare the accuracy of OHCA recognition by medical dispatchers in two countries. METHOD: An observational register-based study collecting data from national cardiac arrest registers in Denmark and Sweden during a six-month period in 2013. Data were analysed...

Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre: a retrospective, observational study.

Science.gov (United States)

Andersen, Kasper; Mikkelsen, Søren; Jørgensen, Gitte; Zwisler, Stine Thorhauge

2018-01-05

Little is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies. We performed a retrospective, observational study on paediatric medical emergency calls managed by the EMDC in the Region of Southern Denmark in February 2016. We reviewed audio recordings of emergency calls and ambulance records to identify calls concerning patients ≤ 15 years. We examined EMDC dispatch records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics. Of a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤ 15 years. We excluded 19 and analysed the remaining 466. The reported medical issues were commonly classified as: "seizures" (22.1%), "sick child" (18.9%) and "unclear problem" (12.9%). The overall most common pre-hospital response was immediate dispatch of an ambulance with sirens and lights with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age. We believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered medical issues, such as the symptoms and conditions pertaining to the symptom categories "seizures" and "sick child". Furthermore, the results could prove useful in hypothesis generation for future studies examining paediatric medical emergency calls. Almost 7% of all calls concerned patients ≤ 15 years. Medical issues pertaining to the symptom categories "seizures", "sick child" and "unclear problem" were common and the calls commonly resulted in urgent pre-hospital responses.

Knowledge and perceptions of physicians from private medical centres towards generic medicines: a nationwide survey from Malaysia.

Science.gov (United States)

Kumar, Rohit; Hassali, Mohamed Azmi; Saleem, Fahad; Alrasheedy, Alian A; Kaur, Navneet; Wong, Zhi Yen; Kader, Muhamad Ali Sk Abdul

2015-01-01

Generic medicine prescribing has become a common practice in public hospitals. However, the trend in private medical centres seems to be different. The objective of this study was to investigate knowledge, perceptions and behavior of physicians from private medical centres in Malaysia regarding generic medicines. This study was a cross-sectional nationwide survey targeting physicians from private medical centres in Malaysia. The survey was conducted using questionnaire having (i) background and demographic data of the physicians, volume of prescription in a day, stock of generic medicines in their hospital pharmacy etc. (ii) their knowledge about bioequivalence (iii) prescribing behavior (iv) physicians' knowledge of quality, safety and efficacy of generic medicines, and their cost (v) perceptions of physicians towards issues pertaining to generic medicines utilization. A total of 263 questionnaires out of 735 were received, giving a response rate of 35.8%. Of the respondents, 214 (81.4%) were male and 49 (18.6%) were females. The majority of the participants were in the age range of 41-50 years and comprised 49.0% of the respondents. Only 2.3% of physicians were aware of the regulatory limits of bioequivalence standards in Malaysia. Of the respondents, 23.2% agreed that they 'always' write their prescriptions using originator product name whereas 50.2% do it 'usually'. A number of significant associations were found between their knowledge, perceptions about generic medicines and their demographic characteristics. The majority of the physicians from private medical centres in Malaysia had negative perceptions about safety, quality and the efficacy of generic medicines. These negative perceptions could be the cause of the limited use of generic medicines in the private medical centres. Therefore, in order to facilitate their use, it is recommended that the physicians need to be reassured and educated about the drug regulatory authority approval system of generic

Predictive medical information and underwriting.

Science.gov (United States)

Dodge, John H

2007-01-01

Medical underwriting involves the application of actuarial science by analyzing medical information to predict the future risk of a claim. The objective is that individuals with like risk are treated in a like manner so that the premium paid is proportional to the risk of future claim.

Teachers' conceptions of learning and teaching in student-centred medical curricula: the impact of context and personal characteristics

NARCIS (Netherlands)

Jacobs, J.C.G.; Luijk, S.J. van; Vleuten, C.P.M. van der; Kusurkar, R.A.; Croiset, G.; Scheele, F.

2016-01-01

BACKGROUND: Gibbs and Coffey (2004) have reported that teaching practices are influenced by teachers' conceptions of learning and teaching. In our previous research we found significant differences between teachers' conceptions in two medical schools with student-centred education. Medical school

Acute care in Tanzania: Epidemiology of acute care in a small community medical centre

Directory of Open Access Journals (Sweden)

Rachel M. Little

2013-12-01

Discussion: Respiratory infections, malaria, and skin or soft tissue infections are leading reasons for seeking medical care at a small community medical centre in Arusha, Tanzania, highlighting the burden of infectious diseases in this type of facility. Males may be more likely to present with trauma, burns, and laceration injuries than females. Many patients required one or no procedures to determine their diagnosis, most treatments administered were inexpensive, and most patients were discharged home, suggesting that providing acute care in this setting could be accomplished with limited resources.

Needlestick injuries and infectious patients in a major academic medical centre from 2003 to 2010

NARCIS (Netherlands)

Frijstein, G.; Hortensius, J.; Zaaijer, H. L.

2011-01-01

To implement adequate preventive measures in a hospital, the number and nature of occupational exposures to blood must be known. In the Amsterdam Academic Medical Centre a standardised procedure was used to assess all reported occupational exposures to blood from 2003 to 2010. 1601 incidents were

Acute renal failure in the medical ICU still predictive of high mortality ...

African Journals Online (AJOL)

Background. We aimed to determine the outcome and certain predictors of outcome for acute renal failure (ARF) in the medical intensive care unit (ICU) at Tygerberg Hospital. Method. We conducted a retrospective, single-centre cohort study over 12 months comprising all patients admitted to the medical ICU with all causes ...

Gender and injuries predict stimulant medication

DEFF Research Database (Denmark)

Dalsgaard, Søren; Leckman, James F.; Nielsen, Helena Skyt

2014-01-01

Objective: The purpose of this article was to examine whether injuries in early childhood and gender predict prescriptions of stimulant medication in three groups of children: With attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and other psychiatric disorders (OPD...... follow-up of all cases. We found that the number of injuries prior to diagnosis was associated with initiation of stimulant treatment in all three groups of patients. In addition, male gender predicted treatment with ADHD medications. Our results suggest that the number of injuries early in life prior...

The predictive value of early molecular response in chronic myeloid leukaemia patients treated with imatinib in a single real-world medical centre in a developing country.

Science.gov (United States)

Bee, Ping Chong; Sekaran, Veera; Ng, Richard Rui Jie; Kweh, Ting Yi; Gan, Gin Gin

2017-03-01

The prognosis of patients with chronic myeloid leukaemia (CML) has improved since the introduction of imatinib. However, patients who do not achieve complete cytogenetic response (CCyR) and major molecular response (MMR) have poorer prognosis. Recent clinical trials have demonstrated that early and deeper cytogenetic and molecular responses predict a better long-term outcome. This study aimed to analyse the relationship between early molecular response and clinical outcome in a real-life setting. This retrospective study included all patients with CML, in chronic or accelerated phase, who were treated with imatinib at University of Malaya Medical Centre, Malaysia. A total of 70 patients were analysed. The median follow-up duration was 74 months, and the cumulative percentages of patients with CCyR and MMR were 80.0% and 65.7%, respectively. Overall survival (OS) and event-free survival (EFS) at ten years were 94.3% and 92.9%, respectively. Patients who achieved CCyR and MMR had significantly better OS and EFS than those who did not. At six months, patients who had a BCR-ABL level ≤ 10% had significantly better OS and EFS than those who had a BCR-ABL level > 10%. The target milestone of CCyR at 12 months and MMR at 18 months showed no survival advantage in our patients. Our data showed that imatinib is still useful as first-line therapy. However, vigilant monitoring of patients who have a BCR-ABL level > 10% at six months of treatment should be implemented so that prompt action can be taken to provide the best outcome for these patients. Copyright: © Singapore Medical Association

Outcome Prediction after Radiotherapy with Medical Big Data.

Science.gov (United States)

Magome, Taiki

2016-01-01

Data science is becoming more important in many fields. In medical physics field, we are facing huge data every day. Treatment outcomes after radiation therapy are determined by complex interactions between clinical, biological, and dosimetrical factors. A key concept of recent radiation oncology research is to predict the outcome based on medical big data for personalized medicine. Here, some reports, which are analyzing medical databases with machine learning techniques, were reviewed and feasibility of outcome prediction after radiation therapy was discussed. In addition, some strategies for saving manual labors to analyze huge data in medical physics were discussed.

How to predict a high rate of inappropriateness for upper endoscopy in an endoscopic centre?

Science.gov (United States)

Buri, L; Bersani, G; Hassan, C; Anti, M; Bianco, M A; Cipolletta, L; Di Giulio, E; Di Matteo, G; Familiari, L; Ficano, L; Loriga, P; Morini, S; Pietropaolo, V; Zambelli, A; Grossi, E; Intraligi, M; Tessari, F; Buscema, M

2010-09-01

Inappropriateness of upper endoscopy (EGD) indication causes decreased diagnostic yield. Our aim of was to identify predictors of appropriateness rate for EGD among endoscopic centres. A post-hoc analysis of two multicentre cross-sectional studies, including 6270 and 8252 patients consecutively referred to EGD in 44 (group A) and 55 (group B) endoscopic Italian centres in 2003 and 2007, respectively, was performed. A multiple forward stepwise regression was applied to group A, and independently validated in group B. A <70% threshold was adopted to define inadequate appropriateness rate clustered by centre. discrete variability of clustered appropriateness rates among the 44 group A centres was observed (median: 77%; range: 41-97%), and a <70% appropriateness rate was detected in 11 (25%). Independent predictors of centre appropriateness rate were: percentage of patients referred by general practitioners (GP), rate of urgent examinations, prevalence of relevant diseases, and academic status. For group B, sensitivity, specificity and area under receiver operating characteristic curve of the model in detecting centres with a <70% appropriateness rate were 54%, 93% and 0.72, respectively. A simple predictive rule, based on rate of patients referred by GPs, rate of urgent examinations, prevalence of relevant diseases and academic status, identified a small subset of centres characterised by a high rate of inappropriateness. These centres may be presumed to obtain the largest benefit from targeted educational programs. Copyright (c) 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

The joint cardiovascular research profile of the university medical centres in the Netherlands.

Science.gov (United States)

van Welie, S D; van Leeuwen, T N; Bouma, C J; Klaassen, A B M

2016-05-01

Biomedical scientific research in the Netherlands has a good reputation worldwide. Quantitatively, the university medical centres (UMCs) deliver about 40 % of the total number of scientific publications of this research. Analysis of the bibliometric output data of the UMCs shows that their research is highly cited. These output-based analyses also indicate the high impact of cardiovascular scientific research in these centres, illustrating the strength of this research in the Netherlands. A set of six joint national cardiovascular research topics selected by the UMCs can be recognised. At the top are heart failure, rhythm disorder research and atherosclerosis. National collaboration of top scientists in consortia in these three areas is successful in acquiring funding of large-scale programs. Our observations suggest that funding national consortia of experts focused on a few selected research topics may increase the international competitiveness of cardiovascular research in the Netherlands.

Effects of unstratified and centre-stratified randomization in multi-centre clinical trials.

Science.gov (United States)

Anisimov, Vladimir V

2011-01-01

This paper deals with the analysis of randomization effects in multi-centre clinical trials. The two randomization schemes most often used in clinical trials are considered: unstratified and centre-stratified block-permuted randomization. The prediction of the number of patients randomized to different treatment arms in different regions during the recruitment period accounting for the stochastic nature of the recruitment and effects of multiple centres is investigated. A new analytic approach using a Poisson-gamma patient recruitment model (patients arrive at different centres according to Poisson processes with rates sampled from a gamma distributed population) and its further extensions is proposed. Closed-form expressions for corresponding distributions of the predicted number of the patients randomized in different regions are derived. In the case of two treatments, the properties of the total imbalance in the number of patients on treatment arms caused by using centre-stratified randomization are investigated and for a large number of centres a normal approximation of imbalance is proved. The impact of imbalance on the power of the study is considered. It is shown that the loss of statistical power is practically negligible and can be compensated by a minor increase in sample size. The influence of patient dropout is also investigated. The impact of randomization on predicted drug supply overage is discussed. Copyright © 2010 John Wiley & Sons, Ltd.

CLINICIAN SENSITIZATION ON INTEGRATED DISEASE SURVEILLANCE AND RESPONSE IN FEDERAL MEDICAL CENTRE OWO, ONDO STATE, NIGERIA, 2016

Directory of Open Access Journals (Sweden)

Olayinka Stephen Ilesanmi

2017-06-01

Full Text Available Background: For effective Integrated Disease Surveillance and Response (IDSR all health care workers involvement is required. Most trainings have often neglected the clinicians. Aim: This study aimed to identify gaps requiring capacity building in preventing infectious disease outbreak among health care workers in Federal Medical Centre, Owo, Ondo State. Methods: A cross sectional study of clinicians at the Federal Medical Centre, Owo was done. Data was collected using semi structured interviewer administered questionnaire. Data collected were analysed with SPSS version 21. Summary statistics was conducted to identify training need requirements. Results: The mean age of participant was 43 ± 5.9 years, 14(70% were male. Respondents who have worked for 10 years and above were 12(60%. In all, 5(25% respondent understood disease surveillance to be systematic collection of data and analysis in order to prevent diseases. Regarding respondent’s knowledge of notifiable diseases. Only 4(20% of the respondents knew malaria as a notifiable disease, Cholera knew by 11(55%, Ebola by 15(75% and Lassa by 13(65%. The main factor identified to be affecting prompt disease notification in Federal Medical Centre, Owo was lack of adequate training 12(60% while communication gap was identified by 7(35%. In all, 18(90% felt they do not know all that they needed about disease surveillance. Conclusion: Rapid notification of infectious diseases is essential for prompt public health action and for monitoring of disease trends. Trainings that will improve the level of knowledge of clinician and communication channels will improve disease surveillance and notification.

Asthma Medication Ratio Predicts Emergency Depart...

Data.gov (United States)

U.S. Department of Health & Human Services — According to findings reported in Asthma Medication Ratio Predicts Emergency Department Visits and Hospitalizations in Children with Asthma, published in Volume 3,...

Is cost-effective healthcare compatible with publicly financed academic medical centres?

Science.gov (United States)

Chia, Whay Kuang; Toh, Han Chong

2013-01-01

Probably more than any country, Singapore has made significant investment into the biomedical enterprise as a proportion of its economy and size. This focus recently witnessed a shift towards a greater emphasis on translational and clinical development. Key to the realisation of this strategy will be Academic Medical Centres (AMCs), as a principal tool to developing and applying useful products for the market and further improving health outcomes. Here, we explore the principal value proposition of the AMC to Singapore society and its healthcare system. We question if the values inherent within academic medicine--that of inquiry, innovation, pedagogy and clinical exceptionalism--can be compatible with the seemingly paradoxical mandate of providing cost-effective or rationed healthcare.

Educational Research Centre of the Joint Institute for Nuclear Research and students training on the 'Medical Physics' speciality

International Nuclear Information System (INIS)

Ivanova, S.P.; )

2005-01-01

The Educational Research Centre (ERC) of the Joint Institute for Nuclear Research is the place of joint activity of the JINR, Moscow State University (MSU) and Moscow Engineering Physical Institute (MEFI) on students training by a broadened circle of specialities with introduction of new educational forms. Active application of medical accelerator beams of the JINR Laboratory of Nuclear Beams becomes a reason for implementation of a new training chair in the MEFI on the JINR base - the Physical methods in applied studies in the medicine chair. For the 'medical physics' trend development in 2003 the workshop on discussion both curricula and teaching methodic by the speciality was held. One the Educational Research Centre main activities is both organization and conducting an international scientific schools and training courses. The International student School 'Nuclear-Physical Methods and Accelerators is the most popular and traditional. The principal aim of these schools and courses is familiarization of students and postgraduates with last achievement and and contemporary problems of applied medical physics. The school audience is a students and postgraduates of ERC, MSU, MEFI, and an institutes of Poland, Hungary, Slovakia, France, Czech and Bulgaria

Predictive Analytics In Healthcare: Medications as a Predictor of Medical Complexity.

Science.gov (United States)

Higdon, Roger; Stewart, Elizabeth; Roach, Jared C; Dombrowski, Caroline; Stanberry, Larissa; Clifton, Holly; Kolker, Natali; van Belle, Gerald; Del Beccaro, Mark A; Kolker, Eugene

2013-12-01

Children with special healthcare needs (CSHCN) require health and related services that exceed those required by most hospitalized children. A small but growing and important subset of the CSHCN group includes medically complex children (MCCs). MCCs typically have comorbidities and disproportionately consume healthcare resources. To enable strategic planning for the needs of MCCs, simple screens to identify potential MCCs rapidly in a hospital setting are needed. We assessed whether the number of medications used and the class of those medications correlated with MCC status. Retrospective analysis of medication data from the inpatients at Seattle Children's Hospital found that the numbers of inpatient and outpatient medications significantly correlated with MCC status. Numerous variables based on counts of medications, use of individual medications, and use of combinations of medications were considered, resulting in a simple model based on three different counts of medications: outpatient and inpatient drug classes and individual inpatient drug names. The combined model was used to rank the patient population for medical complexity. As a result, simple, objective admission screens for predicting the complexity of patients based on the number and type of medications were implemented.

Frequency of ectopic pregnancy in a medical centre, Kingdom of Saudi Arabia

International Nuclear Information System (INIS)

Aziz, S.; Wafi, B.A.; Swadi, H.A.

2011-01-01

To asses the frequency of ectopic pregnancy and to evaluate the relevance of the risk factors in a Medical Center, Kingdom of Saudi Arabia (KSA). This retrospective study was done in Royal Commission Medical Centre, Yanbu Industrial City, KSA over a period of four years, where the medical records of patients with the diagnosis of ectopic pregnancy were reviewed. Data was collected on initial presentation, chief medical complaints, socio demographic characteristics, past obstetrics and gynaecological history, history of previous surgeries (tubal, ovarian and/or uterine), history of infertility and use of ovulation induction and history of contraception was obtained. A total of 66 cases were included in the study. Results: The frequency of ectopic pregnancy was 0.58% .Mean age was 30 +- 4 years. Multiparous women were found to be more prone to ectopic pregnancy (64%).Most frequent gestational age was 6-8 weeks. Majority (37.8%) of the patients had previous medical induced or spontaneous abortion. 18% had previous pelvic surgery, 15% used different treatments for infertility including ovulation induction, Intrauterine Insemination (IUI), and In vitro Fertilization (IVF) and 9% of patients had history of ectopic pregnancy, 4.5% of patients had Intrautrine Contraceptive Device (IUCD) in situ. 3% of patients had uterine fibroids. Conclusion: Study has found that previous abortions are major etiological factor for ectopic pregnancy. Further more the other factors were IUCD use, previous pelvic surgeries, infertility, previous ectopic and induced conception cycles which may be the result of a previous pelvic infection that may cause tubal sequelae. (author)

Safety and predictability of conscious sedation in dentistry -- a multi-centre regional audit: South and West Wales experience.

Science.gov (United States)

Muthukrishnan, A; McGregor, J; Thompson, S

2013-10-01

There are no previously published reports of audits in conscious sedation from a group comprising the general dental services (GDS), community dental services (CDS) and hospital dental services (HDS). The main aim of this audit was to assess current practice within the group in relation to the safety and predictability of dental treatment undertaken with the aid of conscious sedation. A total of nine centres collected data prospectively on 1,037 sedation episodes over the course of one year. Audit standards were locally agreed based on current evidence and local experience. They were set at a completion rate of 90% and an adverse incident rate of 2% or less. Based on the data collected, a completion rate of 92% and a minor adverse incident rate of 2.6% were recorded. The participating centres met the standards set locally for this audit. Current practice in the participating centres was found to be safe and predictable. The audit tool is being refined to improve the quality of data collection. Further research and service evaluation is recommended.

[Medical Rehabilitation as an Attractive Field of Work for Medical Doctors? - A Qualitative Survey].

Science.gov (United States)

Lederle, Mareike; Kotzjan, Priscilla Simone; Niehues, Christiane; Brüggemann, Silke; Bitzer, Eva-Maria

2017-10-01

In the German Health system there is an increasing competition in the recruitment of specialised staff, especially for rehabilitation centres, which are deemed less attractive. Therefore, this study examines the attractiveness of the field of medical rehabilitation from the point of view of medical professionals. We conducted 16 semi-structured interviews with doctors from 7 rehabilitation centres with different medical specialisations. The interviews were digitized and transcribed. A structured content analysis was carried out using the software MAXQDA 11. 745 codes were identified and assigned to the categories "attractiveness", "unfavourable aspects" and "special features" of rehabilitation. Regarding medical rehabilitation, the interviewees appreciated especially the predictable, flexible working environment with little time pressure. Other than working with rehabilitative patients working as part of an interdisciplinary team was of high importance for the interviewees. Among the special features of rehabilitation in comparison with acute care were the higher relevance of the bio-psycho-social model of health and illness as well as the higher proportion of communication and organisation. Medical rehabilitation in Germany is an attractive field of work for medical doctors. This fact should be considered more with regards to rehabilitation's public image. © Georg Thieme Verlag KG Stuttgart · New York.

Perceived Medical School stress of undergraduate medical students predicts academic performance: an observational study.

Science.gov (United States)

Kötter, Thomas; Wagner, Josefin; Brüheim, Linda; Voltmer, Edgar

2017-12-16

Medical students are exposed to high amounts of stress. Stress and poor academic performance can become part of a vicious circle. In order to counteract this circularity, it seems important to better understand the relationship between stress and performance during medical education. The most widespread stress questionnaire designed for use in Medical School is the "Perceived Medical School Stress Instrument" (PMSS). It addresses a wide range of stressors, including workload, competition, social isolation and financial worries. Our aim was to examine the relation between the perceived Medical School stress of undergraduate medical students and academic performance. We measured Medical School stress using the PMSS at two different time points (at the end of freshman year and at the end of sophomore year) and matched stress scores together with age and gender to the first medical examination (M1) grade of the students (n = 456). PMSS scores from 2 and 14 months before M1 proved to be significant predictors for medical students' M1 grade. Age and gender also predict academic performance, making older female students with high stress scores a potential risk group for entering the vicious circle of stress and poor academic performance. PMSS sum scores 2 and 14 months before the M1 exam seem to have an independent predictive validity for medical students' M1 grade. More research is needed to identify potential confounders.

Predicting complex acute wound healing in patients from a wound expertise centre registry: a prognostic study

OpenAIRE

Ubbink, Dirk T; Lindeboom, Robert; Eskes, Anne M; Brull, Huub; Legemate, Dink A; Vermeulen, Hester

2015-01-01

It is important for caregivers and patients to know which wounds are at risk of prolonged wound healing to enable timely communication and treatment. Available prognostic models predict wound healing in chronic ulcers, but not in acute wounds, that is, originating after trauma or surgery. We developed a model to detect which factors can predict (prolonged) healing of complex acute wounds in patients treated in a large wound expertise centre (WEC). Using Cox and linear regression analyses, we ...

Discussion on the Implementation of the Patient Centred Medical Home model - Experiences from Australia

Directory of Open Access Journals (Sweden)

Safa Majidi Rahbar

2017-07-01

Full Text Available Introduction: Different practitioners and academics have been working on the application of the Patient Centred Medical Home (PCMH model within the Australian context for many years. In early 2016, the Commonwealth government of Australia announced plans to establish Health Care Homes throughout the country based off the PCMH model, beginning with trial sites focused on the bundling of payments. As a result, the number of Primary Health Networks, policy makers and general practices receptive to establishing Health Care Homes is growing rapidly. The time is ripe to identify how best the elements of the model translate into the Australian context and how to implement its elements with success. As a contribution to the opportunity for a widespread implementation, the North Coast Primary Health Network is engaged in a project to build capacity in general practices to transition into Health Care Homes. The main outcomes of this project include: 1. Preparing “The Australian Handbook for Transitioning to Health Care Homes” A resource which will provide a rationale for transitioning to a HCH, milestones for transitioning along a continuum and tools for practice and practice support for establishing the model in general practice. Thus developing capacity to train ‘change facilitators’ to work to accompany transitioning practices. 2. Establishment of a National Network of Patient Centred HCH Collaborators Made up of PHN representatives, experts and policy makers working in the PCMH development space. Focused on improving advocacy effectiveness, knowledge sharing and keeping stakeholders up to date with unfolding developments. 3. Increasing local preparedness and interest for establishing HCHs Focused on propagation of development of interest locally for transitioning practices into HCHs. A local network of practitioners and collaborators informed of project updates and HCH learning and development opportunities in the region. 4. Local trial and

Evaluating and Predicting Patient Safety for Medical Devices With Integral Information Technology

Science.gov (United States)

2005-01-01

323 Evaluating and Predicting Patient Safety for Medical Devices with Integral Information Technology Jiajie Zhang, Vimla L. Patel, Todd R...errors are due to inappropriate designs for user interactions, rather than mechanical failures. Evaluating and predicting patient safety in medical ...the users on the identified trouble spots in the devices. We developed two methods for evaluating and predicting patient safety in medical devices

Pain Scores Are Not Predictive of Pain Medication Utilization

Directory of Open Access Journals (Sweden)

Suzanne Galloway

2011-01-01

Full Text Available Objective. To compare Visual Analogue Scale (VAS scores with overall postoperative pain medication requirements including cumulative dose and patterns of medication utilization and to determine whether VAS scores predict pain medication utilization. Methods. VAS scores and pain medication data were collected from participants in a randomized trial of the utility of phenazopyridine for improved pain control following gynecologic surgery. Results. The mean age of the 219 participants was 54 (range19 to 94. We did not detect any association between VAS and pain medication utilization for patient-controlled anesthesia (PCA or RN administered (intravenous or oral medications. We also did not detect any association between the number of VAS scores recorded and mean pain scores. Conclusion. Postoperative VAS scores do not predict pain medication use in catheterized women inpatients following gynecologic surgery. Increased pain severity, as reflected by higher VAS scores, is not associated with an increase in pain assessment. Our findings suggest that VAS scores are of limited utility for optimal pain control. Alternative or complimentary methods may improve pain management.

Predictive value of Borrelia burgdorferi IgG antibody levels in patients referred to a tertiary Lyme centre.

Science.gov (United States)

Zwerink, M; Zomer, T P; van Kooten, B; Blaauw, G; van Bemmel, T; van Hees, B C; Vermeeren, Y M; Landman, G W

2018-03-01

A two-step testing strategy is recommended in serological testing for Lyme borreliosis; positive and indeterminate enzyme-linked immunosorbent assay (ELISA) results are confirmed with immunoblots. Several ELISAs quantify the concentration of antibodies tested, however, no recommendation exists for an upper cut-off value at which an IgG ELISA is sufficient and the immunoblot can be omitted. The study objective was to determine at which IgG antibody level an immunoblot does not have any additional predictive value compared to ELISA results. Data of adult patients who visited a tertiary Lyme centre between 2008 and 2014 were analysed. Both an ELISA (Enzygnost Lyme link VlsE IgG) and immunoblot (recomLine blot Borrelia) were performed. Clinical data were extracted from the patient's digital medical record. Positive predictive values (PPVs) for either previous or active infection with Borrelia burgdorferi s.l. were calculated for different cut-off ELISA IgG antibody levels where the immunoblot was regarded as reference test. In total, 1454 patients were included. According to the two-step test strategy, 486 (33%), 69 (5%) and 899 (62%) patients had positive, indeterminate and negative Borrelia IgG serology, respectively. At IgG levels of 500 IU/ml and higher, all immunoblots were positive, resulting in a 100% PPV (95% CI: 97.0-100). At IgG levels of 200 IU/ml and higher, the PPV was 99.3% (95% CI: 97.4-99.8). In conclusion, at IgG levels of 200 IU/ml and higher, an ELISA was sufficient to detect antibodies to Borrelia burgdorferi s.l. At those IgG levels, a confirmatory immunoblot may be omitted in patients referred to a tertiary Lyme centre. Before these results can be implemented in routine diagnosis of Lyme borreliosis, confirmation of the results is necessary in other patient populations and using other quantitative ELISAs and immunoblots. Copyright © 2017 Elsevier GmbH. All rights reserved.

Poster - 26: Electronic Waiting Room Management for a busy Cancer Centre

Energy Technology Data Exchange (ETDEWEB)

Kildea, John; Hijal, Tarek [McGill University Health Center (Canada)

2016-08-15

We describe an electronic waiting room management system that we have developed and deployed in our cancer centre. Our system connects with our electronic medical records systems, gathers data for a machine learning algorithm to predict future patient waiting times, and is integrated with a mobile phone app. The system has been in operation for over nine months and has led to reduced lines, calmer waiting rooms and overwhelming patient and staff satisfaction.

Poster - 26: Electronic Waiting Room Management for a busy Cancer Centre

International Nuclear Information System (INIS)

Kildea, John; Hijal, Tarek

2016-01-01

We describe an electronic waiting room management system that we have developed and deployed in our cancer centre. Our system connects with our electronic medical records systems, gathers data for a machine learning algorithm to predict future patient waiting times, and is integrated with a mobile phone app. The system has been in operation for over nine months and has led to reduced lines, calmer waiting rooms and overwhelming patient and staff satisfaction.

Discharged of the nuclear wastes by health service centres

International Nuclear Information System (INIS)

Mazur, G.; Jednorog, S.

1993-01-01

In this paper Polish national regulation in radiation protection on nuclear medical domain was discussed. The method of utilized nuclear wastes in medical and science centres was deliberate. From many years activity of wastes from Nuclear Medicine Department of Central Clinical Hospital Armed Forces Medical Academy and Radiation Protection Department of Armed Forces Institute of Hygiene and Epidemiology was measured. In debate centres radiation monitoring was performed. In this purpose the beta global activity and gamma spectrometry measurement of discharged wastes occurred. From last year in discussed centres wastes activity do not increased permissible levels. (author). 3 refs, 5 tabs

[Structured care in an ISO certified centre for patients with cystic fibrosis and their families].

Science.gov (United States)

Ellemunter, H; Eder, J; Steinkamp, G

2011-10-01

Cystic fibrosis (CF) is a chronic, life-shortening disease of multiple organ systems. Guidelines recommend that patients should be treated in specialised CF centres with multi-professional teams. We describe the organisation of medical care at the CF centre of Innsbruck University as well as results of treatment. Procedures and delivery of multi-professional care have been elaborated and structured. Since 2006 the Centre has been repeatedly certified according to DIN ISO 9001:2000. The patient database is being used during the doctor's consultation and for the continuous monitoring of treatment results. In 2010, 71 of the 148 patients (48%) were between 18 and 56 years old. The total number of patients has doubled and the proportion of adults tripled since 1995. Nevertheless, median FEV1 remained stable (>80% of predicted) during the last 15 years. Compared with 18 CF centres of the German Benchmarking Group, patients treated in Innsbruck had favourable FEV1 values: 52% of adults had a normal FEV1 (>80% pred.) and only 23% an FEV1 <50% of predicted. A structured programme of multi-professional care was associated with favourable treatment results, both longitudinally and in comparison to other CF centres. © Georg Thieme Verlag KG Stuttgart · New York.

Predicting healthcare trajectories from medical records: A deep learning approach.

Science.gov (United States)

Pham, Trang; Tran, Truyen; Phung, Dinh; Venkatesh, Svetha

2017-05-01

Personalized predictive medicine necessitates the modeling of patient illness and care processes, which inherently have long-term temporal dependencies. Healthcare observations, stored in electronic medical records are episodic and irregular in time. We introduce DeepCare, an end-to-end deep dynamic neural network that reads medical records, stores previous illness history, infers current illness states and predicts future medical outcomes. At the data level, DeepCare represents care episodes as vectors and models patient health state trajectories by the memory of historical records. Built on Long Short-Term Memory (LSTM), DeepCare introduces methods to handle irregularly timed events by moderating the forgetting and consolidation of memory. DeepCare also explicitly models medical interventions that change the course of illness and shape future medical risk. Moving up to the health state level, historical and present health states are then aggregated through multiscale temporal pooling, before passing through a neural network that estimates future outcomes. We demonstrate the efficacy of DeepCare for disease progression modeling, intervention recommendation, and future risk prediction. On two important cohorts with heavy social and economic burden - diabetes and mental health - the results show improved prediction accuracy. Copyright © 2017 Elsevier Inc. All rights reserved.

Nuclear research centres - The Egyptian experiment

International Nuclear Information System (INIS)

Abdelrazek, I.D.

2001-01-01

The Atomic Energy Authority of Egypt has four research centres located at two sites. Its research reactors are devoted to the production of isotopes, neutron beam experiments, activation analysis and materials research. The accelerators are devoted to the production of short lived isotopes for medical applications and materials R and D. Irradiation technology is used for sterilization of medical supplies and food preservation. High level of expertise in those centres is also useful for other developmental activities in Egypt. (author)

Strengthening patient safety in transitions of care: an emerging role for local medical centres in Norway.

Science.gov (United States)

Kongsvik, Trond; Halvorsen, Kristin; Osmundsen, Tonje; Gjøsund, Gudveig

2016-08-30

Patient safety has gained less attention in primary care in comparison to specialised care. We explore how local medical centres (LMCs) can play a role in strengthening patient safety, both locally and in transitions between care levels. LMCs represent a form of intermediate care organisation in Norway that is increasingly used as a strategy for integrated care policies. The analysis is based on institutional theory and general safety theories. A qualitative design was applied, involving 20 interviews of nursing home managers, managers at local medical centres and administrative personnel. The LMCs mediate important information between care levels, partly by means of workarounds, but also as a result of having access to the different information and communications technology (ICT) systems in use. Their knowledge of local conditions is found to be a key asset. LMCs are providers of competence and training for the local level, as well as serving as quality assurers. As a growing organisational form in Norway, LMCs have to legitimise their role in the health care system. They represent an asset to the local level in terms of information, competence and quality assurance. As they have overlapping competencies, tasks and responsibilities with other parts of the health care system, they add to organisational redundancy and strengthen patient safety.

The role of the sexual assault centre.

LENUS (Irish Health Repository)

Eogan, Maeve

2013-02-01

Sexual Assault Centres provide multidisciplinary care for men and women who have experienced sexual crime. These centres enable provision of medical, forensic, psychological support and follow-up care, even if patients chose not to report the incident to the police service. Sexual Support Centres need to provide a ring-fenced, forensically clean environment. They need to be appropriately staffed and available 24 hours a day, 7 days a week to allow prompt provision of medical and supportive care and collection of forensic evidence. Sexual Assault Centres work best within the context of a core agreed model of care, which includes defined multi-agency guidelines and care pathways, close links with forensic science and police services, and designated and sustainable funding arrangements. Additionally, Sexual Assault Centres also participate in patient, staff and community education and risk reduction. Furthermore, they contribute to the development, evaluation and implementation of national strategies on domestic, sexual and gender-based violence.

Key performance indicators' assessment to develop best practices in an Emergency Medical Communication Centre.

Science.gov (United States)

Penverne, Yann; Leclere, Brice; Labady, Julien; Berthier, Frederic; Jenvrin, Joel; Javaudin, Francois; Batard, Eric; Montassier, Emmanuel

2017-05-17

Emergency Medical Communication Centre (EMCC) represents a pivotal link in the chain of survival for those requiring rapid response for out-of-hospital medical emergencies. Assessing and grading the performance of EMCCs are warranted as it can affect the health and safety of the served population. The aim of our work was to describe the activity on an EMCC and to explore the associations between different key performance indicators. We carried out our prospective observational study in the EMCC of Nantes, France, from 6 June 2011 to 6 June 2015. The EMCC performance was assessed with the following key performance indicators: answered calls, Quality of Service 20 s (QS20), occupation rate and average call duration. A total of 35 073 h of dispatch activity were analysed. 1 488 998 emergency calls were answered. The emergency call incidence varied slightly from 274 to 284 calls/1000 citizens/year between 2011 and 2015. The median occupation rate was 35% (25-44). QS20 was correlated negatively with the occupation rate (Spearman's ρ: -0.78). The structural equation model confirmed that the occupation rate was highly correlated with the QS20 (standardized coefficient: -0.89). For an occupation rate of 26%, the target value estimated by our polynomial model, the probability of achieving a QS20 superior or equal to 95% varied between 56 and 84%. The occupation rate appeared to be the most important factor contributing towards the QS20. Our data will be useful to develop best practices and guidelines in the field of emergency medicine communication centres.

Medication overuse headache and chronic migraine in a specialized headache centre: field-testing proposed new appendix criteria

DEFF Research Database (Denmark)

Zeeberg, P; Olesen, Jes; Jensen, R

2009-01-01

The classification subcommittee of the International Headache Society (IHS) has recently suggested revised criteria for medication overuse headache (MOH) and chronic migraine (CM). We field tested these revised criteria by applying them to the headache population at the Danish Headache Centre...... suggest that the IHS has succeeded in choosing new criteria for CM which are neither too strict, nor too loose. For MOH, a shift to the appendix criteria will increase the number of MOH patients, but take into account the possibility of permanent changes in pain perception due to medication overuse...... and the possibility of a renewed effect of prophylactic drugs due to medication withdrawal. We therefore recommend the implementation of the appendix criteria for both MOH and CM into the main body of the International Classification of Headache Disorders....

Childhood Mortality in Federal Medical Centre Umuahia, South Eastern Nigeria

Science.gov (United States)

Charles, Nwafor Chukwuemeka; Chuku, Abali; Anazodo, Nnoli Martin

2014-01-01

Objectives This study aimed to evaluate the mortality pattern in children seen at Federal Medical Centre Umuahia (FMCU) Abia state, South Eastern Nigeria. Methods A retrospective cross sectional descriptive study over a 5-year period from January 1, 2004 to December 31, 2008 using data retrieved from the hospital’s medical records department. Results A total of 3,814 children were admitted in the hospital and 434 of them died giving a mortality rate of 11%. The mean age was 1.7 (Std D of 3.19). Two hundred and thirty eight of them were males while 196 of them were females giving a sex ratio of 1.2:1. Majority of the mortality (49%) occurred within 24 hours of admission. The major causes of death during neonatal period were birth asphyxia (34%), prematurity (24%) and neonatal sepsis (24%). Malaria was the leading cause of death beyond the neonatal period accounting for 42% of cases. Other common mortality causes were pneumonia, septicaemia, diarrhea, HIV AIDS and meningitis each accounting for 10%, 10%, 7%, 7% and 5% respectively. The months of July, May and March accounted for most deaths (12%, 12% and 11% respectively). Conclusion Birth asphyxia and malaria associated deaths were responsible for most deaths during neonatal and beyond neonatal periods respectively. Presence of trained personal at all deliveries will help to reduce neonatal asphyxia. Efforts should be made to reinforce the existing effective malaria control tools. PMID:25337306

Childhood Mortality in Federal Medical Centre Umuahia, South Eastern Nigeria

Directory of Open Access Journals (Sweden)

Nwafor Chukwuemeka Charles

2014-09-01

Full Text Available Objective: This study aimed to evaluate the mortality pattern in children seen at Federal Medical Centre Umuahia (FMCU Abia state, South Eastern Nigeria. Methods: A retrospective cross sectional descriptive study over a 5-year period from January 1, 2004 to December 31, 2008 using data retrieved from the hospital’s medical records department. Results: A total of 3,814 children were admitted in the hospital and 434 of them died giving a mortality rate of 11%. The mean age was 1.7 (Std D of 3.19. Two hundred and thirty eight of them were males while 196 of them were females giving a sex ratio of 1.2:1. Majority of the mortality (49% occurred within 24 hours of admission. The major causes of death during neonatal period were birth asphyxia (34%, prematurity (24% and neonatal sepsis (24%. Malaria was the leading cause of death beyond the neonatal period accounting for 42% of cases. Other common mortality causes were pneumonia, septicaemia, diarrhea, HIV AIDS and meningitis each accounting for 10%, 10%, 7%, 7% and 5% respectively. The months of July, May and March accounted for most deaths (12%, 12% and 11% respectively. Conclusion: Birth asphyxia and malaria associated deaths were responsible for most deaths during neonatal and beyond neonatal periods respectively. Presence of trained personal at all deliveries will help to reduce neonatal asphyxia. Efforts should be made to reinforce the existing effective malaria control tools.

MO-DE-BRA-03: The Ottawa Medical Physics Institute (OMPI): A Practical Model for Academic Program Collaboration in a Multi-Centre City

Energy Technology Data Exchange (ETDEWEB)

McEwen, M [National Research Council Canada, Ottawa, ON (Canada); Rogers, D [Carleton University, Ottawa, ON (Canada); Johns, P

2016-06-15

Purpose: To build a world-class medical physics educational program that capitalizes on expertise distributed over several clinical, government, and academic centres. Few if any of these centres would have the critical mass to solely resource a program. Methods: In order to enable an academic program, stakeholders from five institutions made a proposal to Carleton University for a) a research network with defined membership requirements and a process for accepting new members, and b) a graduate specialization (MSc and PhD) in medical physics. Both proposals were accepted and the program has grown steadily. Our courses are taught by medical physicists from across the collaboration. Our students have access to physicists in: clinical radiotherapy (the Ottawa Cancer Centre treats 4500 new patients/y), radiology, cardiology and nuclear medicine, Canada’s primary standards dosimetry laboratory, radiobiology, and university-based medical physics research. Our graduate courses emphasize the foundational physics plus applied aspects of imaging, radiotherapy, and radiobiology. Active researchers in the city-wide volunteer-run network are appointed as adjunct professors by Physics, giving them access to national funding competitions and partial student funding through teaching assistantships while opening up facilities in their institutions for student thesis research. Results: The medical physics network has grown to ∼40 members from eight institutions and includes five full-time faculty in Physics and 17 adjunct research professors. The graduate student population is ∼20. Our graduates have proceeded to a spectrum of careers. Our alumni list includes a CCPM Past-President, the current COMP President, many clinical physicists, and the heads of at least three major clinical medical physics departments. Our PhD was Ontario’s first CAMPEP-accredited program. Conclusion: A self-governing volunteer network is the foundational element that enables an MSc/PhD medical

MO-DE-BRA-03: The Ottawa Medical Physics Institute (OMPI): A Practical Model for Academic Program Collaboration in a Multi-Centre City

International Nuclear Information System (INIS)

McEwen, M; Rogers, D; Johns, P

2016-01-01

Purpose: To build a world-class medical physics educational program that capitalizes on expertise distributed over several clinical, government, and academic centres. Few if any of these centres would have the critical mass to solely resource a program. Methods: In order to enable an academic program, stakeholders from five institutions made a proposal to Carleton University for a) a research network with defined membership requirements and a process for accepting new members, and b) a graduate specialization (MSc and PhD) in medical physics. Both proposals were accepted and the program has grown steadily. Our courses are taught by medical physicists from across the collaboration. Our students have access to physicists in: clinical radiotherapy (the Ottawa Cancer Centre treats 4500 new patients/y), radiology, cardiology and nuclear medicine, Canada’s primary standards dosimetry laboratory, radiobiology, and university-based medical physics research. Our graduate courses emphasize the foundational physics plus applied aspects of imaging, radiotherapy, and radiobiology. Active researchers in the city-wide volunteer-run network are appointed as adjunct professors by Physics, giving them access to national funding competitions and partial student funding through teaching assistantships while opening up facilities in their institutions for student thesis research. Results: The medical physics network has grown to ∼40 members from eight institutions and includes five full-time faculty in Physics and 17 adjunct research professors. The graduate student population is ∼20. Our graduates have proceeded to a spectrum of careers. Our alumni list includes a CCPM Past-President, the current COMP President, many clinical physicists, and the heads of at least three major clinical medical physics departments. Our PhD was Ontario’s first CAMPEP-accredited program. Conclusion: A self-governing volunteer network is the foundational element that enables an MSc/PhD medical

Predicting performance at medical school: can we identify at-risk students?

Directory of Open Access Journals (Sweden)

Shaban S

2011-05-01

Full Text Available Sami Shaban, Michelle McLeanDepartment of Medical Education, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab EmiratesBackground: The purpose of this study was to examine the predictive potential of multiple indicators (eg, preadmission scores, unit, module and clerkship grades, course and examination scores on academic performance at medical school, with a view to identifying students at risk.Methods: An analysis was undertaken of medical student grades in a 6-year medical school program at the Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates, over the past 14 years.Results: While high school scores were significantly (P < 0.001 correlated with the final integrated examination, predictability was only 6.8%. Scores for the United Arab Emirates university placement assessment (Common Educational Proficiency Assessment were only slightly more promising as predictors with 14.9% predictability for the final integrated examination. Each unit or module in the first four years was highly correlated with the next unit or module, with 25%–60% predictability. Course examination scores (end of years 2, 4, and 6 were significantly correlated (P < 0.001 with the average scores in that 2-year period (59.3%, 64.8%, and 55.8% predictability, respectively. Final integrated examination scores were significantly correlated (P < 0.001 with National Board of Medical Examiners scores (35% predictability. Multivariate linear regression identified key grades with the greatest predictability of the final integrated examination score at three stages in the program.Conclusion: This study has demonstrated that it may be possible to identify “at-risk” students relatively early in their studies through continuous data archiving and regular analysis. The data analysis techniques used in this study are not unique to this institution.Keywords: at-risk students, grade

PROSPECTIVE ANALYTICAL STUDY ON THE MEDICAL TERMINATION OF PREGNANCIES IN A TERTIARY CARE CENTRE

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S. Gayathriedevi Sellathamby

2017-06-01

Full Text Available BACKGROUND This study is carried out to estimate incidence of medical termination of pregnancies in a tertiary care centre, to analyse the causes of medical termination of pregnancies, to analyse the success of the methods of abortion and adoption family planning procedures in a tertiary care centre (Government Rajaji Hospital, Madurai. This may provide the baseline measures for safe abortion practices and to increase the awareness among men and women of reproductive age, the availability of safe abortion services at locality. The aim of the study is to know the incidence of medical termination of pregnancies in a tertiary level hospital, to study the causes for seeking MTP, to analyse the success of the methods of abortion and adoption of family planning methods. MATERIALS AND METHODS This study was carried out in Government Rajaji Hospital, Madurai, during the period of 12 months from September 2011- August 2012. Of 3516 patients attending the family planning OP, 496 women seek MTP. Among them, every 5 th women were selected and thus 100 cases were included in this study. Social parameters like age, education, residence, marital status, family pattern, number of living children, sex of the living children, obstetric parameters like parity, trimester of abortion, methods of abortion, causes for MTP, adoption of family planning methods, basic investigation like Hb%, BT, CT, urine albumin, RFT, blood sugar, blood grouping and typing and VCTC were included. RESULTS Induced abortions were common in women in 20-29-year age group, more in third gravid, Hindus, from rural areas, living in nuclear family, married and educated. Most of the women seek 1 st trimester abortion with underlying social cause. Majority had surgical abortion. Majority adopted transabdominal tubectomy as the concurrent family planning method. Second trimester abortions common in unmarried, uneducated women. CONCLUSION The variables analysed in this study bring into light the

Cognitive task load in a naval ship control centre: from identification to prediction.

Science.gov (United States)

Grootjen, M; Neerincx, M A; Veltman, J A

Deployment of information and communication technology will lead to further automation of control centre tasks and an increasing amount of information to be processed. A method for establishing adequate levels of cognitive task load for the operators in such complex environments has been developed. It is based on a model distinguishing three load factors: time occupied, task-set switching, and level of information processing. Application of the method resulted in eight scenarios for eight extremes of task load (i.e. low and high values for each load factor). These scenarios were performed by 13 teams in a high-fidelity control centre simulator of the Royal Netherlands Navy. The results show that the method provides good prediction of the task load that will actually appear in the simulator. The model allowed identification of under- and overload situations showing negative effects on operator performance corresponding to controlled experiments in a less realistic task environment. Tools proposed to keep the operator at an optimum task load are (adaptive) task allocation and interface support.

Key factors in work engagement and job motivation of teaching faculty at a university medical centre.

Science.gov (United States)

van den Berg, B A M; Bakker, Arnold B; Ten Cate, Th J

2013-11-01

This study reports about teacher motivation and work engagement in a Dutch University Medical Centre (UMC). We examined factors affecting the motivation for teaching in a UMC, the engagement of UMC Utrecht teaching faculty in their work, and their engagement in teaching compared with engagement in patient care and research. Based on a pilot study within various departments at the UMCU, a survey on teaching motivation and work engagement was developed and sent to over 600 UMCU teachers. About 50 % responded. Work engagement was measured by the Utrecht Work Engagement Scale, included in this survey. From a list of 22 pre-defined items, 5 were marked as most motivating: teaching about my own speciality, noticeable appreciation for teaching by my direct superior, teaching small groups, feedback on my teaching performance, and freedom to determine what I teach. Feedback on my teaching performance showed the strongest predictive value for teaching engagement. Engagement scores were relatively favourable, but engagement with patient care was higher than with research and teaching. Task combinations appear to decrease teaching engagement. Our results match with self-determination theory and the job demands-resources model, and challenge the policy to combine teaching with research and patient care.

Occupational radiation exposure at the self-shielded IBA CYCLONE 10/5, cyclotron of the Austin and Repatriation Medical Centre, Melbourne, Australia

International Nuclear Information System (INIS)

Tochon-Danguy, H.; Sachinidis, J.I.; U, P.; Egan, G.; Mukherjee, B.

1999-01-01

A series of health physics measurements was carried out at the IBA CYCLONE 10/5 Medical Cyclotron of the Austin and Repatriation Medical Centre, Melbourne. The neutron attenuation factor of the cyclotron shielding was estimated using the Superheated Bubble dosimeters. The neutron and gamma dose rates at various public access and radiation worker's area in the vicinity of the cyclotron facility were evaluated during the 11 C, 18 F, 13 N and 15 O production conditions. (authors)

Intrapartum prediction of birth weight using maternal anthropometric ...

African Journals Online (AJOL)

This prospective study was conducted at Federal Medical Centre, Owo, Nigeria, between April 1st and 31st of July, 2013 to predict birth weight in labour using four clinical methods and ultrasound scan independently and comparatively to determine which is closest to the actual birth weight. The four clinical methods are ...

Knowledge and Prevention of Nosocomial Infection among Ward Nurses at Federal Medical Centre, Umuahia, Nigeria

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Oti A. Aja

2017-08-01

Full Text Available This research was conducted for estimating the knowledge and prevention of nosocomial infection among ward nurses at Federal Medical Centre (FMC, Umuahia Abia state. Four objectives were set, and four questions were formulated. A descriptive survey research method was used for the study. A sample size of one hundred and fifty (150 nurses was drawn from eight wards (medical and surgical, at FMC, Umuahia. A self-developed questionnaire with seventeen (17 structured questions was the instrument of data collection. Data were collected, analyzed, and presented in tables, pie chart, bar chart, histogram, and percentages. The results revealed that the nurses were well knowledgeable about nosocomial infection, although little deficiencies existed in the area of infection control practice and compliance, such as hand washing frequency. This study therefore recommends continuing education/seminar/workshop for all health care givers, to sensitize them with the knowledge and practice of nosocomial infection.

Diagnostic x-ray in use in federal medical centre, case study Makurdi metropolis

International Nuclear Information System (INIS)

Onoja, R.A.; Fiase, J.O.

2009-01-01

Every year more than two thousand patients go for routine medical check-up at the Federal Medical Centre using diagnostic x-rays. This paper is based on a study to determine the entrance surface doses per radiograph of 108 patients that had diagnostic examinations at the Federal Medical Centre Makurdi. The examinations considered in this study are chest x-ray examinations, abdomen, skull and other extremities, for both adults and children. The results show that the mean entrance surface doses of PA chest x-ray for female range between 237-275μGy, for male is between 1183-297μGy, and for children range between 47-237μGy. The AP chest x-ray for female range between 1943-3440μGy, for male is between 1583-3484μGy and for children it ranges between 177-451μGy. The PA examination of the skull for adult female ranged between 117-787μGy, for male it ranged between 117-532μGy and children from 472-948μGy. Also for the AP examination for skull the adult female mean entrance surface doses range from 129-798μGy, for the male it range from 145-178μGy and for children 138-650μGy. The AP abdomen for adult female produces a mean entrance surface doses range between 620-682μGy, for the male is between 105-930μGy, and children it range between 144-398μGy. In the case of extremities AP examination are between the range of 173-468μGy for adult female, 300-595μGy for adult male and between 254-887μGy for the children. In the case of extremities PA examination mean entrance surface doses are between the range of 145-517μGy for adult female, 363-517μGy for adult male and between 130-566μGy for the children. The data shows that the entrance surface doses due to the x-ray examination for adult and children are within the ICRP guidance levels. These guidance levels of dose for diagnostic radiography for a typical adult patient are 10 mGy for AP abdomen, 0.4 mGy PA chest, 7 mGy for AP chest and 5 mGy for PA skull

Radiopharmaceuticals in positron emission tomography: Radioisotope productions and radiolabelling procedures at the Austin and Repatriation Medical Centre

International Nuclear Information System (INIS)

Tochon-Danguy, H.J.; Sachinidis, J.I.; Chan, J.G.; Cook, M.

1997-01-01

Positron Emission Tomography (PET) is a technique that utilizes positron-emitting radiopharmaceuticals to map the physiology, biochemistry and pharmacology of the human body. Positron-emitting radioisotopes produced in a medical cyclotron are incorporated into compounds that are biologically active in the body. A scanner measures radioactivity emitted from a patient's body and provides cross-sectional images of the distribution of these radiolabelled compounds in the body. It is the purpose of this paper to review the variety of PET radiopharmaceuticals currently produced at the Austin and Repatriation Medical Centre in Melbourne. Radioisotope production, radiolabelling of molecules and quality control of radiopharmaceuticals will be discussed. A few examples of their clinical applications will be shown as well. During the last five years we achieved a reliable routine production of various radiopharmaceuticals labelled with the four most important positron-emitters: oxygen-15 (t, 1/2 =2min), nitrogen-13 (t 1/2 = 10 min), carbon-11 (t 1/2 =20 min) and fluorine-18 (t 1/2 = 110 min). These radiopharmaceuticals include [ 15 O]oxygen, [ 15 O]carbon monoxide, [ 15 O]carbon dioxide, [ 15 O]water, [ 13 N]ammonia, [ 11 C]flumazenil, [ 11 C]SCH23390, [ 18 F]fluoromisonidazole and [ 18 F]fluoro-deoxy-glucose ([ 18 F]FDG). In addition, since the half life of [ 18 F] is almost two hours, regional distribution can be done, and the Austin and Repatriation Medical Centre is currently supplying [ 18 F]FDG in routine to other hospitals. Future new radiopharmaceuticals development include a [ 18 F]thymidine analog to measure cell proliferation and a [ 11 C]pyrroloisoquinoline to visualize serotonergic neuron abnormalities. (authors)

REAL PRACTICE OF STATINS USE AND ITS DEPENDENCE ON FOLLOW-UP IN THE SPECIALIZED MEDICAL CENTRE IN PATIENTS WITH HIGH CARDIOVASCULAR RISK (ACCORDING TO THE PROFILE REGISTER

Directory of Open Access Journals (Sweden)

S. Yu. Martsevich

2015-09-01

Full Text Available Aim. To analyze tactics of statins use in patients with high cardiovascular risk on the base of the PROFILE register data.Material and methods. Patients (n=274 who were enrolled into the PROFILE register from May, 1st till December, 31st, 2011 were divided into 3 groups: a control group (82 patients who sought medical care in the medical centre for the first time, the main group A (167 patients who were regularly followed-up in the medical centre and the main group B (25 patients who stopped follow-up in the medical centre over 2 years ago. The incidence rates of statins use and lipid target level achievement, as well as safety of statin therapy were studied in the groups.Results. 25.6, 70.7 and 52% of patients received statins in control group, main group A, and main group B, respectively. Target levels (according to the clinical guidelines of the low density cholesterol (LDC had been reached in 26.3% of patients in the main group A. This characteristic was not valid in the patients of control and main group B because of small size of these groups. Achievement of target LDC level was observed more often in use of statins in moderate and high doses, use of the original drugs, and use of rosu- vastatin. Safety of statin therapy (aspartate and alanine transaminases, creatine kinase activity, and total bilirubin was comparable in the groups of patients who reached or did not reach target LDC levels.Conclusion. High cardiovascular risk patients who were regularly followed-up in the specialized medical centre received statins therapy significantly more often. However statins use is often not correspond to the modern clinical guidelines.

PENGARUH KARAKTERISTIK BUDAYA ORGANISASI TERHADAP ORGANIZATIONAL CITIZENSHIP BEHAVIOR (Studi Kasus Rumah Sakit Umum Citra Bunda Medical Centre Padang

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Mareta Kemala Sari

2015-07-01

Full Text Available This study aimed to analyze the influence of organizational culture characteristic measured from the professionalism, the distance of the management, trust in colleagues, regularity, hostility and integration of the employees of the organization Behavior / Organizational Citizenship Behavior (OCB employees Citra Bunda Hospital Medical Centre Padang. OCB important to investigate the behavior of health workers due to the organization of health workers led to the success of public health care. All employees RSU Citra Bunda Medical Centre Padang many as 177 people are in this study population. The results showed that there was a significant positive influence and not variable professionalism of 0.184 with a significant value of 0.086> 0.05 and a variable distance from the management of a significant value of 0.089 with 0.286> 0.05 on OCB, there is a positive and significant impact on the trust variable associates amounted to 0467 with a significant value of 0.028 0.05 on OCB, there is a positive and significant influence amounted to 0.526 hostility variable with significant value 0.045 <0.05 against the OCB and there are positive influence and no significant integration variable of 0.207 with significant

Monitoring and regulation of learning in medical education: the need for predictive cues.

Science.gov (United States)

de Bruin, Anique B H; Dunlosky, John; Cavalcanti, Rodrigo B

2017-06-01

Being able to accurately monitor learning activities is a key element in self-regulated learning in all settings, including medical schools. Yet students' ability to monitor their progress is often limited, leading to inefficient use of study time. Interventions that improve the accuracy of students' monitoring can optimise self-regulated learning, leading to higher achievement. This paper reviews findings from cognitive psychology and explores potential applications in medical education, as well as areas for future research. Effective monitoring depends on students' ability to generate information ('cues') that accurately reflects their knowledge and skills. The ability of these 'cues' to predict achievement is referred to as 'cue diagnosticity'. Interventions that improve the ability of students to elicit predictive cues typically fall into two categories: (i) self-generation of cues and (ii) generation of cues that is delayed after self-study. Providing feedback and support is useful when cues are predictive but may be too complex to be readily used. Limited evidence exists about interventions to improve the accuracy of self-monitoring among medical students or trainees. Developing interventions that foster use of predictive cues can enhance the accuracy of self-monitoring, thereby improving self-study and clinical reasoning. First, insight should be gained into the characteristics of predictive cues used by medical students and trainees. Next, predictive cue prompts should be designed and tested to improve monitoring and regulation of learning. Finally, the use of predictive cues should be explored in relation to teaching and learning clinical reasoning. Improving self-regulated learning is important to help medical students and trainees efficiently acquire knowledge and skills necessary for clinical practice. Interventions that help students generate and use predictive cues hold the promise of improved self-regulated learning and achievement. This framework is

Comprehension through cooperation: Medical students and physiotherapy apprentices learn in teams - Introducing interprofessional learning at the University Medical Centre Mannheim, Germany.

Science.gov (United States)

Mette, Mira; Dölken, Mechthild; Hinrichs, Jutta; Narciß, Elisabeth; Schüttpelz-Brauns, Katrin; Weihrauch, Ute; Fritz, Harald M

2016-01-01

In order to better prepare future health care professionals for interprofessional cooperation, interprofessional learning sessions for medical students and physiotherapy apprentices were developed at the University Medical Centre Mannheim, Germany. The experience gained from designing, implementing and evaluating these learning sessions is presented and discussed. A total of 265 medical students and 43 physiotherapy apprentices attended five interprofessional learning sessions. Of these, 87-100% responded to closed and open-ended questions on a self-developed questionnaire (24 items). The responses regarding self-reported learning gains, benefit, motivation and satisfaction with the sessions were analyzed separately by professions. The learning sessions were well received by both groups. More than 75% of all participants were of the opinion that they could not have learned the new material in a better way. Significant differences between the medical students and the physiotherapy apprentices were mainly found with regard to perceived learning gains, which physiotherapy apprentices reported as being lower. Positive aspects of interprofessionalism were most often emphasized in the responses to the open-ended questions. Most frequently criticized were organizational aspects and a lack of perceived learning gains. The introduction of interprofessional learning entails great effort in terms of organizational and administrative challenges. However, the project is considered worthwhile because the interprofessional aspects of the learning sessions were indeed valued by the participants. Permanently including and expanding interprofessional learning in the curricula of both professions longitudinally is therefore something to strive for.

Predicting medical complications after spine surgery: a validated model using a prospective surgical registry.

Science.gov (United States)

Lee, Michael J; Cizik, Amy M; Hamilton, Deven; Chapman, Jens R

2014-02-01

The possibility and likelihood of a postoperative medical complication after spine surgery undoubtedly play a major role in the decision making of the surgeon and patient alike. Although prior study has determined relative risk and odds ratio values to quantify risk factors, these values may be difficult to translate to the patient during counseling of surgical options. Ideally, a model that predicts absolute risk of medical complication, rather than relative risk or odds ratio values, would greatly enhance the discussion of safety of spine surgery. To date, there is no risk stratification model that specifically predicts the risk of medical complication. The purpose of this study was to create and validate a predictive model for the risk of medical complication during and after spine surgery. Statistical analysis using a prospective surgical spine registry that recorded extensive demographic, surgical, and complication data. Outcomes examined are medical complications that were specifically defined a priori. This analysis is a continuation of statistical analysis of our previously published report. Using a prospectively collected surgical registry of more than 1,476 patients with extensive demographic, comorbidity, surgical, and complication detail recorded for 2 years after surgery, we previously identified several risk factor for medical complications. Using the beta coefficients from those log binomial regression analyses, we created a model to predict the occurrence of medical complication after spine surgery. We split our data into two subsets for internal and cross-validation of our model. We created two predictive models: one predicting the occurrence of any medical complication and the other predicting the occurrence of a major medical complication. The final predictive model for any medical complications had a receiver operator curve characteristic of 0.76, considered to be a fair measure. The final predictive model for any major medical complications had

Medical assistance in case of nuclear accident

International Nuclear Information System (INIS)

Dodig, D.; Tezak, S.; Kasal, B.; Huic, D.; Medvedec, M.; Loncaric, S.; Grosev, D.; Rozman, B.; Popovic, S.

1996-01-01

Medical service is a prerequisite for work license of nuclear installation. Every nuclear installation incorporate in their safety procedure also medical emergency plan. Usually the medical emergency plan consists of several degrees of action: 1. First aid, 2. First medical treatment, 3. Treatment in regional hospital, 4. Treatment in special institution (centre for radiation medicine). This paper discusses organization and activities of Centre for Radiation Medicine and Protection - Clinical Hospital Centre Zagreb

Analysis of Factors that Predict Clinical Performance in Medical School

Science.gov (United States)

White, Casey B.; Dey, Eric L.; Fantone, Joseph C.

2009-01-01

Academic achievement indices including GPAs and MCAT scores are used to predict the spectrum of medical student academic performance types. However, use of these measures ignores two changes influencing medical school admissions: student diversity and affirmative action, and an increased focus on communication skills. To determine if GPA and MCAT…

Radiopharmaceuticals in positron emission tomography: Radioisotope productions and radiolabelling procedures at the Austin and Repatriation Medical Centre

Energy Technology Data Exchange (ETDEWEB)

Tochon-Danguy, H.J.; Sachinidis, J.I.; Chan, J.G.; Cook, M. [Austin and Repatriation Medical Centre, Melbourne, VIC (Australia). Centre for Positron Emission Tomography

1997-10-01

Positron Emission Tomography (PET) is a technique that utilizes positron-emitting radiopharmaceuticals to map the physiology, biochemistry and pharmacology of the human body. Positron-emitting radioisotopes produced in a medical cyclotron are incorporated into compounds that are biologically active in the body. A scanner measures radioactivity emitted from a patient`s body and provides cross-sectional images of the distribution of these radiolabelled compounds in the body. It is the purpose of this paper to review the variety of PET radiopharmaceuticals currently produced at the Austin and Repatriation Medical Centre in Melbourne. Radioisotope production, radiolabelling of molecules and quality control of radiopharmaceuticals will be discussed. A few examples of their clinical applications will be shown as well. During the last five years we achieved a reliable routine production of various radiopharmaceuticals labelled with the four most important positron-emitters: oxygen-15 (t,{sub 1/2}=2min), nitrogen-13 (t{sub 1/2}= 10 min), carbon-11 (t{sub 1/2}=20 min) and fluorine-18 (t{sub 1/2}= 110 min). These radiopharmaceuticals include [{sup 15}O]oxygen, [{sup 15}O]carbon monoxide, [{sup 15}O]carbon dioxide, [{sup 15}O]water, [{sup 13}N]ammonia, [{sup 11}C]flumazenil, [{sup 11}C]SCH23390, [{sup 18}F]fluoromisonidazole and [{sup 18}F]fluoro-deoxy-glucose ([{sup 18}F]FDG). In addition, since the half life of [{sup 18}F] is almost two hours, regional distribution can be done, and the Austin and Repatriation Medical Centre is currently supplying [{sup 18}F]FDG in routine to other hospitals. Future new radiopharmaceuticals development include a [{sup 18}F]thymidine analog to measure cell proliferation and a [{sup 11}C]pyrroloisoquinoline to visualize serotonergic neuron abnormalities. (authors) 23 refs., 2 tabs.

Radiological work in a university centre

International Nuclear Information System (INIS)

Westerman, B.

1982-01-01

In this paper the author outlines the problems of the industrial doctor's tasks in a university centre with physics laboratories and a hospital with medical laboratories. An inventory of problems is presented. The solutions are not easy because of the interdependence of medical, physical and technical inspectors. The health hazards appear to be low. (Auth.)

Victims' use of professional services in a Dutch sexual assault centre

NARCIS (Netherlands)

Bicanic, I.; Snetselaar, H.; de Jongh, A.; van de Putte, E.

2014-01-01

Background: Prior research endorsed the establishment of sexual assault centres in the Netherlands because of the potential benefit for victims’ mental recovery. In 2012, the first Dutch sexual assault centre was founded at the University Medical Center Utrecht. The aim of the centre is to provide

Comprehension through cooperation: Medical students and physiotherapy apprentices learn in teams – Introducing interprofessional learning at the University Medical Centre Mannheim, Germany

Science.gov (United States)

Mette, Mira; Dölken, Mechthild; Hinrichs, Jutta; Narciß, Elisabeth; Schüttpelz-Brauns, Katrin; Weihrauch, Ute; Fritz, Harald M.

2016-01-01

Aim: In order to better prepare future health care professionals for interprofessional cooperation, interprofessional learning sessions for medical students and physiotherapy apprentices were developed at the University Medical Centre Mannheim, Germany. The experience gained from designing, implementing and evaluating these learning sessions is presented and discussed. Method: A total of 265 medical students and 43 physiotherapy apprentices attended five interprofessional learning sessions. Of these, 87-100% responded to closed and open-ended questions on a self-developed questionnaire (24 items). The responses regarding self-reported learning gains, benefit, motivation and satisfaction with the sessions were analyzed separately by professions. Results: The learning sessions were well received by both groups. More than 75% of all participants were of the opinion that they could not have learned the new material in a better way. Significant differences between the medical students and the physiotherapy apprentices were mainly found with regard to perceived learning gains, which physiotherapy apprentices reported as being lower. Positive aspects of interprofessionalism were most often emphasized in the responses to the open-ended questions. Most frequently criticized were organizational aspects and a lack of perceived learning gains. Conclusion: The introduction of interprofessional learning entails great effort in terms of organizational and administrative challenges. However, the project is considered worthwhile because the interprofessional aspects of the learning sessions were indeed valued by the participants. Permanently including and expanding interprofessional learning in the curricula of both professions longitudinally is therefore something to strive for. PMID:27280142

Activities of the International Radio Medical Centre (C.I.R.M.) in Rome during the last five years (1996-2000). Centro Internazionale Radio Medico.

Science.gov (United States)

Amenta, F; Dauri, A

2001-01-01

This paper reviews medical activity provided from 1996 to 2000 by the International Radio Medical Centre (Centro Internazionale Radio Medico, C.I.R.M.). C.I.R.M. is a non-profit organization headquartered in Rome and providing freely telemedical advice to ships flying of any flag navigating on all seas of the world, to civil airplanes and to small Italian islands. From 1996 to 2000 C.I.R.M. has assisted 4,982 patients, 4,686 of which (94%) on board ships, 85 on airplanes and 206 on small Italian islands. More than 65% of requests of telemedical advice received by C.I.R.M. were from non-Italian ships. This indicates the really international nature of C.I.R.M.'s activity. The largest number of medical requests come from the Atlantic Ocean, followed by the Mediterranean sea, Indian Ocean and Pacific Ocean. In terms of pathologies assisted, accidents took the first place, followed as main pathologies by gastrointestinal disorders, cardiovascular pathologies, respiratory disorders, infectious and parasitic diseases and nervous system complaints. Analysis of the outcome of C.I.R.M.'s medical activity showed that more than 50% of patients assisted were recovered or improved while assisted by the Centre.

Examining patterns in medication documentation of trade and generic names in an academic family practice training centre.

Science.gov (United States)

Summers, Alexander; Ruderman, Carly; Leung, Fok-Han; Slater, Morgan

2017-09-22

Studies in the United States have shown that physicians commonly use brand names when documenting medications in an outpatient setting. However, the prevalence of prescribing and documenting brand name medication has not been assessed in a clinical teaching environment. The purpose of this study was to describe the use of generic versus brand names for a select number of pharmaceutical products in clinical documentation in a large, urban academic family practice centre. A retrospective chart review of the electronic medical records of the St. Michael's Hospital Academic Family Health Team (SMHAFHT). Data for twenty commonly prescribed medications were collected from the Cumulative Patient Profile as of August 1, 2014. Each medication name was classified as generic or trade. Associations between documentation patterns and physician characteristics were assessed. Among 9763 patients prescribed any of the twenty medications of interest, 45% of patient charts contained trade nomenclature exclusively. 32% of charts contained only generic nomenclature, and 23% contained a mix of generic and trade nomenclature. There was large variation in use of generic nomenclature amongst physicians, ranging from 19% to 93%. Trade names in clinical documentation, which likely reflect prescribing habits, continue to be used abundantly in the academic setting. This may become part of the informal curriculum, potentially facilitating undue bias in trainees. Further study is needed to determine characteristics which influence use of generic or trade nomenclature and the impact of this trend on trainees' clinical knowledge and decision-making.

Radiation safety status at a bio medical research centre

International Nuclear Information System (INIS)

Mishra, S.K.

1998-01-01

Radioisotopes are being used for biomedical research purpose at School of Life Science, Jawaharlal Nehru University for the last twenty five years. Present paper analyses the overall status of radiation safety at this Centre

Communication between general practitioners and the emergency medical dispatch centre in urgent cases

DEFF Research Database (Denmark)

Mieritz, Hanne Beck; Rønnow, Camilla; Jørgensen, Gitte

2018-01-01

, and we found that these calls were more likely to contain problematic communication (odds ratio = 5.1). In 18% (n = 236) of the cases, there was not sufficient information to assess if the physician-manned mobile emergency care unit (MECU) should have been dispatched along with the ambulance......INTRODUCTION: When general practitioners (GPs) order an ambulance, their calls are handled by staff at the emergency medical dispatch centre (EMDC) who then select an appropriate response. There are currently no data evaluating this mode of communication between the GPs and the staff at the EMDC....... 
RESULTS: We found problematic communication in less than 2% (n = 25) of the evaluated calls. In 68% of the 25 problematic cases transactional analysis showed that the staff at the EMDC initiated the problematic communication. In 4% (n = 51) of the calls, the GP delegated the call to a secretary or nurse...

Differences in care burden of patients undergoing dialysis in different centres in the netherlands.

Science.gov (United States)

de Kleijn, Ria; Uyl-de Groot, Carin; Hagen, Chris; Diepenbroek, Adry; Pasker-de Jong, Pieternel; Ter Wee, Piet

2017-06-01

A classification model was developed to simplify planning of personnel at dialysis centres. This model predicted the care burden based on dialysis characteristics. However, patient characteristics and different dialysis centre categories might also influence the amount of care time required. To determine if there is a difference in care burden between different categories of dialysis centres and if specific patient characteristics predict nursing time needed for patient treatment. An observational study. Two hundred and forty-two patients from 12 dialysis centres. In 12 dialysis centres, nurses filled out the classification list per patient and completed a form with patient characteristics. Nephrologists filled out the Charlson Comorbidity Index. Independent observers clocked the time nurses spent on separate steps of the dialysis for each patient. Dialysis centres were categorised into four types. Data were analysed using regression models. In contrast to other dialysis centres, academic centres needed 14 minutes more care time per patient per dialysis treatment than predicted in the classification model. No patient characteristics were found that influenced this difference. The only patient characteristic that predicted the time required was gender, with more time required to treat women. Gender did not affect the difference between measured and predicted care time. Differences in care burden were observed between academic and other centres, with more time required for treatment in academic centres. Contribution of patient characteristics to the time difference was minimal. The only patient characteristics that predicted care time were previous transplantation, which reduced the time required, and gender, with women requiring more care time. © 2017 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Predictive validity of pre-admission assessments on medical student performance.

Science.gov (United States)

Dabaliz, Al-Awwab; Kaadan, Samy; Dabbagh, M Marwan; Barakat, Abdulaziz; Shareef, Mohammad Abrar; Al-Tannir, Mohamad; Obeidat, Akef; Mohamed, Ayman

2017-11-24

To examine the predictive validity of pre-admission variables on students' performance in a medical school in Saudi Arabia. In this retrospective study, we collected admission and college performance data for 737 students in preclinical and clinical years. Data included high school scores and other standardized test scores, such as those of the National Achievement Test and the General Aptitude Test. Additionally, we included the scores of the Test of English as a Foreign Language (TOEFL) and the International English Language Testing System (IELTS) exams. Those datasets were then compared with college performance indicators, namely the cumulative Grade Point Average (cGPA) and progress test, using multivariate linear regression analysis. In preclinical years, both the National Achievement Test (p=0.04, B=0.08) and TOEFL (p=0.017, B=0.01) scores were positive predictors of cGPA, whereas the General Aptitude Test (p=0.048, B=-0.05) negatively predicted cGPA. Moreover, none of the pre-admission variables were predictive of progress test performance in the same group. On the other hand, none of the pre-admission variables were predictive of cGPA in clinical years. Overall, cGPA strongly predict-ed students' progress test performance (p<0.001 and B=19.02). Only the National Achievement Test and TOEFL significantly predicted performance in preclinical years. However, these variables do not predict progress test performance, meaning that they do not predict the functional knowledge reflected in the progress test. We report various strengths and deficiencies in the current medical college admission criteria, and call for employing more sensitive and valid ones that predict student performance and functional knowledge, especially in the clinical years.

Rapid health assessments of evacuation centres in areas affected by Typhoon Haiyan

Directory of Open Access Journals (Sweden)

Ruth Alma Ramos

2015-11-01

Full Text Available Introduction: Typhoon Haiyan caused thousands of deaths and catastrophic destruction, leaving many homeless in Region 8 of the Philippines. A team from the Philippine Field Epidemiology Training Program conducted a rapid health assessment survey of evacuation centres severely affected by Haiyan. Methods: A descriptive study was conducted whereby a convenience sample of evacuation centres were assessed on the number of toilets per evacuee, sanitation, drinking-water, food supply source and medical services. Results: Of the 20 evacuation centres assessed, none had a designated manager. Most were located in schools (70% with the estimated number of evacuees ranging from 15 to 5000 per centre. Only four (20% met the World Health Organization standard for number of toilets per evacuee; none of the large evacuation centres had even half the recommended number of toilets. All of the evacuation centres had available drinking-water. None of the evacuation centres had garbage collection, vector control activities or standby medical teams. Fourteen (70% evacuation centres had onsite vaccination activities for measles, tetanus and polio virus. Many evacuation centres were overcrowded. Conclusion: Evacuation centres are needed in almost every disaster. They should be safely located and equipped with the required amenities. In disaster-prone areas such as the Philippines, schools and community centres should not be designated as evacuation centres unless they are equipped with adequate sanitation services.

Addiction research centres and the nurturing of creativity: National Drug Dependence Treatment Centre, India--a profile.

Science.gov (United States)

Ray, Rajat; Dhawan, Anju; Chopra, Anita

2013-10-01

The National Drug Dependence Treatment Centre (NDDTC) is a part of the All India Institute of Medical Sciences, a premier autonomous medical university in India. This article provides an account of its origin and its contribution to the field of substance use disorder at the national and international levels. Since its establishment, the NDDTC has played a major role in the development of various replicable models of care, the training of post-graduate students of psychiatry, research, policy development and planning. An assessment of the magnitude of drug abuse in India began in the early 1990s and this was followed by a National Survey on Extent, Patterns and Trends of Drug Abuse in 2004. Several models of clinical care have been developed for population subgroups in diverse settings. The centre played an important role in producing data and resource material which helped to scale up opioid substitution treatment in India. A nationwide database on the profile of patients seeking treatment (Drug Abuse Monitoring System) at government drug treatment centres has also been created. The centre has provided valuable inputs for the Government of India's programme planning. Besides clinical studies, research has also focused on pre-clinical studies. Capacity-building is an important priority, with training curricula and resource material being developed for doctors and paramedical staff. Many of these training programmes are conducted in collaboration with other institutions in the country. The NDDTC has received funding from several national and international organizations for research and scientific meetings, and, most recently (2012), it has been designated as a World Health Organization Collaborating Centre on Substance Abuse. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

MAAGs (Medical Audit Advisory Groups): the Eli Lilly National Clinical Audit Centre.

Science.gov (United States)

Baker, R; Fraser, R

1993-01-01

Outlines the framework for promoting audit in general practice, created as one part of the health service reforms. Medical Audit Advisory Groups (MAAGs) were set up in each district with the aim of participation in audit of all general practitioners by April 1992. The activities undertaken have included those recommended by the Department of Health; the most significant of these being the appointment of lay facilitators who are able to assist general practitioners and primary care teams co-operate over efforts to improve the quality of care, and may offer one means of introducing some of the methods of total quality management into general practice. Discusses the problems which remain: audit is not yet sufficiently systematic, interface audit with secondary care is at a very early stage, the ways to involve managers and patients in audit remain to be clarified, and there is little evidence of the consequences of audit in terms of improved care. The Eli Lilly National Clinical Audit Centre has been set up within the Department of General Practice, University of Leicester, in order to address these issues.

The Ottawa ankle rules for the use of diagnostic X-ray in after hours medical centres in New Zealand.

Science.gov (United States)

Wynn-Thomas, Simon; Love, Tom; McLeod, Deborah; Vernall, Sue; Kljakovic, Marjan; Dowell, Antony; Durham, John

2002-09-27

The aims of this study were to measure baseline use of Ottawa ankle rules (OAR), validate the OAR and, if appropriate, explore the impact of implementing the Rules on X-ray rates in a primary care, after hours medical centre setting. General practitioners (GPs) were surveyed to find their awareness of ankle injury guidelines. Data concerning diagnosis and X-ray utilisation were collected prospectively for patients presenting with ankle injuries to two after hours medical centres. The OAR were applied retrospectively, and the sensitivity and specificity of the OAR were compared with GPs clinical judgement in ordering X-rays. The outcome measures were X-ray utilisation and diagnosis of fracture. Awareness of the OAR was low. The sensitivity of the OAR for diagnosis of fractures was 100% (95% CI: 75.3 - 100) and the specificity was 47% (95% CI: 40.5 - 54.5). The sensitivity of GPs clinical judgement was 100% (95% CI: 75.3 - 100) and the specificity was 37% (95% CI: 30.2 - 44.2). Implementing the OAR would reduce X-ray utilisation by 16% (95% CI: approx 10.8 - 21.3). The OAR are valid in a New Zealand primary care setting. Further implementation of the rules would result in some reduction of X-rays ordered for ankle injuries, but less than the reduction found in previous studies.

Factors predictive of successful learning in postgraduate medical education

NARCIS (Netherlands)

Smits, P. B. A.; Verbeek, J. H. A. M.; Nauta, M. C. E.; ten Cate, Th J.; Metz, J. C. M.; van Dijk, F. J. H.

2004-01-01

PURPOSE To establish which personal and contextual factors are predictive of successful outcomes in postgraduate medical education. METHOD We performed a follow-up study of 118 doctors on a postgraduate occupational health training programme on the management of mental health problems. The following

Clinical importance of re-interpretation of PET/CT scanning in patients referred to a tertiary care medical centre

DEFF Research Database (Denmark)

Löfgren, Johan; Loft, Annika; Barbosa de Lima, Vinicius Araújo

2017-01-01

had an external F-18-FDG PET/CT scan were included. Only information that had been available at the time of the initial reading at the external hospital was available at re-interpretation. Teams with one radiologist and one nuclear medicine physician working side by side performed the re......PURPOSE: To evaluate, in a controlled prospective manner with double-blind read, whether there are differences in interpretations of PET/CT scans at our tertiary medical centre, Rigshospitalet, compared to the external hospitals. METHODS: Ninety consecutive patients referred to our department who...

The Integrated Medical Model: A Probabilistic Simulation Model Predicting In-Flight Medical Risks

Science.gov (United States)

Keenan, Alexandra; Young, Millennia; Saile, Lynn; Boley, Lynn; Walton, Marlei; Kerstman, Eric; Shah, Ronak; Goodenow, Debra A.; Myers, Jerry G., Jr.

2015-01-01

The Integrated Medical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The Integrated Medical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting

The predictive validity of the BioMedical Admissions Test for pre-clinical examination performance.

Science.gov (United States)

Emery, Joanne L; Bell, John F

2009-06-01

Some medical courses in the UK have many more applicants than places and almost all applicants have the highest possible previous and predicted examination grades. The BioMedical Admissions Test (BMAT) was designed to assist in the student selection process specifically for a number of 'traditional' medical courses with clear pre-clinical and clinical phases and a strong focus on science teaching in the early years. It is intended to supplement the information provided by examination results, interviews and personal statements. This paper reports on the predictive validity of the BMAT and its predecessor, the Medical and Veterinary Admissions Test. Results from the earliest 4 years of the test (2000-2003) were matched to the pre-clinical examination results of those accepted onto the medical course at the University of Cambridge. Correlation and logistic regression analyses were performed for each cohort. Section 2 of the test ('Scientific Knowledge') correlated more strongly with examination marks than did Section 1 ('Aptitude and Skills'). It also had a stronger relationship with the probability of achieving the highest examination class. The BMAT and its predecessor demonstrate predictive validity for the pre-clinical years of the medical course at the University of Cambridge. The test identifies important differences in skills and knowledge between candidates, not shown by their previous attainment, which predict their examination performance. It is thus a valid source of additional admissions information for medical courses with a strong scientific emphasis when previous attainment is very high.

Prediction of late failure after medical abortion from serial beta-hCG measurements and ultrasonography

DEFF Research Database (Denmark)

Rørbye, C; Nørgaard, M; Nilas, Lisbeth

2004-01-01

on day 15 were greater among late failures than successes. Used as a predictive test, the positive predictive values of these variables were low. CONCLUSION: Neither beta-hCG nor endometrial thickness can be used clinically as diagnostic tests in predicting late failure after medical abortion.......BACKGROUND: Surgical treatment of failed medical abortion may be performed several weeks after initiation of the abortion. There are no recognized methods for early identification of these late failures. We assessed the prognostic values of beta-hCG and ultrasonography in predicting late failure...... thickness by ultrasonography was performed on day 15 after induction of medical abortion. Failures diagnosed after day 15 and within 15 weeks were identified and classified as late failures. All interventions in this group were due to bleeding problems. The predictive values of different absolute...

Patient knowledge and pulmonary medication adherence in adult patients with cystic fibrosis

Directory of Open Access Journals (Sweden)

Lin AH

2017-03-01

Full Text Available Ann Hsu-An Lin,1 Jennifer G Kendrick,2,3 Pearce G Wilcox,4,5 Bradley S Quon4,51Faculty of Medicine, 2Faculty of Pharmaceutical Sciences, University of British Columbia, 3Department of Pharmacy, Children’s and Women’s Health Centre of British Columbia, 4Department of Medicine, Division of Respiratory Medicine, University of British Columbia, 5Centre for Heart Lung Innovation, St Paul’s Hospital, Vancouver, BC, CanadaBackground and objectives: Patient knowledge of lung function (ie, forced expiratory volume in 1 s [FEV1]% predicted and the intended benefits of their prescribed pulmonary medications might play an important role in medication adherence, but this relationship has not been examined previously in patients with cystic fibrosis (CF.Methods: All patients diagnosed with CF and without prior lung transplantation were invited to complete knowledge and self-reported medication adherence questionnaires during routine outpatient visits to the Adult CF Clinic, St Paul’s Hospital, Vancouver, Canada from June 2013 to August 2014.Results: A total of 142 out of 167 (85% consecutive adults attending CF clinic completed patient knowledge and medication adherence survey questionnaires. Sixty-four percent of the patients recalled their last FEV1% predicted value within 5%, and 70% knew the intended benefits of all their prescribed medications. Self-reported adherence rates were highest for inhaled antibiotics (81%, azithromycin (87%, and dornase alpha (76% and lowest for hypertonic saline (47%. Individuals who knew their FEV1% predicted value within 5% were more likely to self-report adherence to dornase alpha (84% vs 62%, P=0.06 and inhaled antibiotics (88% vs 64%, P=0.06 compared to those who did not, but these associations were not statistically significant. There were no significant associations observed between patient knowledge of intended medication benefits and self-reported medication adherence.Conclusion: Contrary to our hypothesis

Changing trend of viral hepatitis -- 'A twenty one year report from Pakistan medical research council research centre, Jinnah Postgraduate Medical Centre, Karachi'

International Nuclear Information System (INIS)

Ahmed, W.; Qureshi, H.; Arif, A.; Alam, S.E.

2010-01-01

To determine the frequency and pattern of Hepatitis B and C over the past twenty one years, in a liver research unit of Karachi. Retrospective analysis of the records of PMRC, Research Centre, Jinnah Postgraduate Medical Centre, Karachi, from 1987 to 2007 were reviewed. A special flow sheet was made where information of all patients with viral liver disease was entered. Patients having complete information of viral markers were included in the analysis. Cases with HBsAg, Anti HBc IgM positive and raised ALT were considered as acute Hepatitis B. HBs Ag/ Anti HBc IgG positive were considered as chronic Hepatitis B. Delta antibody positive with or without HBsAg were considered as Delta Hepatitis. Anti HCV positive and raised ALT more than ten times for less than 6 months were considered as acute Hepatitis C, whereas Anti HCV and HCV-RNA positive with or without raised ALT for more than six months were considered as chronic Hepatitis C. Anti HEV IgM and Anti HAV IgM positive were considered as acute Hepatitis E and A respectively. A total of 5193 cases fulfilling all criteria of viral hepatitis were seen in the past 21 years. Of the total 3247 (62.5 %) were males and 1946 (37.5 %) females giving a male to female ratio of 1.7:1 Hepatitis C was the most common infection seen in 2896 cases (55.8 %), followed by Hepatitis B in 1691 cases (32.6 %). Seventy five percent cases of Hepatitis B were males and 25 % females while 55% Hepatitis C cases were males and 45 % females. Hepatitis B was seen a decade earlier in different age groups than hepatitis C. Overall, out of the total 5193 cases, 2294 (44.2%) were of chronic hepatitis, 1430 (27.5%) cirrhosis, 1083 (20.8%) carriers and 346 (6.7%) had acute hepatitis (hepatitis B; 214 (61.8%), hepatitis C; 21 (6.0%). While hepatitis B and hepatitis C both were present in 3 (1.3%). Hepatitis E was 70 (20.2%) hepatitis A 12 (3.5%) and all markers were negative in 26 (7.5%) cases). Forty cases (0.8%) were of Hepatocellular carcinoma

EXPLORING SERVICE QUALITY IMPACTS ON CUSTOMER SATISFACTION IN MILITARY MEDICAL CENTRES: MODERATING ROLE OF PERCEIVED VALUE

Directory of Open Access Journals (Sweden)

Azman Ismail

2016-12-01

Full Text Available Much has been written about service quality impacts on customer satisfaction. However, little research on this perspective has been carried out in military settings. The aim of this study is to examine the relationship between service quality and customer satisfaction, and moderating effects of perceived value in military medical centre. A survey method was employed and data was collected from customers at medical centers under the administration of Malaysian army organization. Analysis was performed using SmartPLS path model analysis. The results show two important findings: first, the interaction between four service quality components (i.e., tangible, reliability, responsiveness and assurance and customers’ perceived value were significantly correlated with customer satisfaction. Second, the interaction between one service quality component (i.e., tangible were not significantly correlated with customer satisfaction. In overall, this result confirms that effect of tangible, reliability, responsiveness and assurance on customer satisfaction has been moderated by customers’ perceived value. Conversely, effect empathy on customer satisfaction has not been moderated by customers’ perceived value. Further, this study offers discussion, implications and conclusion.

Singapore's proposed graduate medical school--an expensive medical tutorial college or an opportunity for transforming Singapore medicine?

Science.gov (United States)

Soo, K C

2005-07-01

The proposed Graduate Medical School at the Outram Campus will open in 2007. The main value of this medical school is the transformation of the medical institutions in the campus and SingHealth into Academic Medical Centres. Such centres will train and host quality physicians and physician-scientists. It will help push the development of translational research, complementing the country's investment in Biopolis. It will also underpin Singapore's push into regional medical tourism and its development as an educational hub in the biomedical sciences.

Unintentional Pharmaceutical-Related Medication Errors Caused by Laypersons Reported to the Toxicological Information Centre in the Czech Republic.

Science.gov (United States)

Urban, Michal; Leššo, Roman; Pelclová, Daniela

2016-07-01

The purpose of the article was to study unintentional pharmaceutical-related poisonings committed by laypersons that were reported to the Toxicological Information Centre in the Czech Republic. Identifying frequency, sources, reasons and consequences of the medication errors in laypersons could help to reduce the overall rate of medication errors. Records of medication error enquiries from 2013 to 2014 were extracted from the electronic database, and the following variables were reviewed: drug class, dosage form, dose, age of the subject, cause of the error, time interval from ingestion to the call, symptoms, prognosis at the time of the call and first aid recommended. Of the calls, 1354 met the inclusion criteria. Among them, central nervous system-affecting drugs (23.6%), respiratory drugs (18.5%) and alimentary drugs (16.2%) were the most common drug classes involved in the medication errors. The highest proportion of the patients was in the youngest age subgroup 0-5 year-old (46%). The reasons for the medication errors involved the leaflet misinterpretation and mistaken dose (53.6%), mixing up medications (19.2%), attempting to reduce pain with repeated doses (6.4%), erroneous routes of administration (2.2%), psychiatric/elderly patients (2.7%), others (9.0%) or unknown (6.9%). A high proportion of children among the patients may be due to the fact that children's dosages for many drugs vary by their weight, and more medications come in a variety of concentrations. Most overdoses could be prevented by safer labelling, proper cap closure systems for liquid products and medication reconciliation by both physicians and pharmacists. © 2016 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

From the coliseum to the convention centre: a reflection on the current state of medical education conferences and conference-goers.

Science.gov (United States)

Blanchard, Rebecca D; Engle, Deborah L; Howley, Lisa D; Whicker, Shari A; Nagler, Alisa

2016-12-01

The advancement of knowledge and development of policy in the field of medical education require critical academic discourse among the most intelligent medical educators; and critical academic discourse requires coffee. In this essay, we reflect on the state of professional development conferences in the field of medical education and the rituals that surround their success. Having begun in ancient Greece, symposia were ripe with debauchery. Today, sedated by the light brown walls of hotel conference centres, symposia are more serious endeavours, engaging men and women in the sometimes turbulent waters of epistemological debate. The abstract submission process (summed up by: 'Yay! It was accepted for presentation' [Deep breath] 'Oh no…it was accepted for presentation'), the 'juggling act' of parent attendees, the acting prowess of abstract presenters and the unapologetic approach to buffet eating are all by-products of the collision of true intellects among medical education scholars. We hold these rituals in high regard and argue that they are required to advance the field of medical education. These rituals bind the walls supporting true progressive thought and innovative research, all fuelled by the glass of wine purchased with that one coveted drink ticket. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Assessing patient-centred communication in teaching: a systematic review of instruments

NARCIS (Netherlands)

Brouwers, M.H.; Rasenberg, E.M.C.; Weel, C. van; Laan, R.F.; Weel-Baumgarten, E.M. van

2017-01-01

CONTEXT: Patient-centred communication is a key component of patient centredness in medical care. Therefore, adequate education in and assessment of patient-centred communication skills are necessary. In general, feedback on communication skills is most effective when it is provided directly and is

Spectroscopic features of dimer and dangling bond E' centres in amorphous silica

International Nuclear Information System (INIS)

Mukhopadhyay, Sanghamitra; Sushko, Peter V; Mashkov, Vladimir A; Shluger, Alexander L

2005-01-01

We performed first-principle embedded cluster calculations of the hyperfine parameters, g-tensors and optical excitation energies for the dimer and back-projected configurations of the E' centre in amorphous silica. The optical transition energies of these defects are calculated for the first time. We predict a strong optical transition at about 6.3 eV for the dimer configuration and a relatively weak transition at 5.6 eV for the back-projected configuration of the E' centre. These predictions could be used for further experimental identification of these centres. Our results support the dimer model of the E' δ centre, and for the first time provide a full range of spectroscopic parameters for the back-projected configuration of the E' centre in amorphous silica

A person-centred approach in medicine to reduce the psychosocial and existential burden of chronic and life-threatening medical illness.

Science.gov (United States)

Grassi, Luigi; Mezzich, Juan E; Nanni, Maria Giulia; Riba, Michelle B; Sabato, Silvana; Caruso, Rosangela

2017-10-01

The psychiatric, psychosocial, and existential/spiritual pain determined by chronic medical disorders, especially if in advanced stages, have been repeatedly underlined. The right to approach patients as persons, rather than symptoms of organs to be repaired, has also been reported, from Paul Tournier to Karl Jaspers, in opposition and contrast with the technically-enhanced evidence-based domain of sciences that have reduced the patients to 'objects' and weakened the physician's identity deprived of its ethical value of meeting, listening, and treating subjects. The paper will discuss the main psychosocial and existential burden related to chronic and advanced medical illnesses, and the diagnostic and therapeutic implications for a dignity preserving care within a person-centred approach in medicine, examined in terms of care of the person (of the person's whole health), for the person (for the fulfilment of the person's health aspirations), by the person (with physicians extending themselves as total human beings), and with the person (working respectfully with the medically ill person).

Information Centre Radioactivity Switzerland; Beratungsstelle Radioaktivitaet Schweiz

Energy Technology Data Exchange (ETDEWEB)

Mosimann, N.; Balsiger, B.; Burger, M. [Bundesamt fuer Bevoelkerungsschutz (Switzerland). LABOR SPIEZ

2016-07-01

The Information Centre Radioactivity Switzerland is meant to assess the radiological condition and serves for psychological-medical care of affected members of the Swiss public following an event of increased radioactivity in the environment. The Centre is structured in a modular way consisting of the following modules: ''Entry Measurement'': The visitors are registered and measured for contamination, ''Decontamination'': Contaminated visitors are decontaminated, ''Additional Measurements'': If required, thyroid and whole body measurements are performed, ''Information'': The visitors are informed about radioactivity, radiation protection, the current situation and their individual next steps, ''Exit'': Administrative release from the Information Centre.

Teachers' conceptions of learning and teaching in student-centred medical curricula: the impact of context and personal characteristics.

Science.gov (United States)

Jacobs, Johanna C G; van Luijk, Scheltus J; van der Vleuten, Cees P M; Kusurkar, Rashmi A; Croiset, Gerda; Scheele, Fedde

2016-09-21

Gibbs and Coffey (2004) have reported that teaching practices are influenced by teachers' conceptions of learning and teaching. In our previous research we found significant differences between teachers' conceptions in two medical schools with student-centred education. Medical school was the most important predictor, next to discipline, gender and teaching experience. Our research questions for the current study are (1) which specific elements of medical school explain the effect of medical school on teachers' conceptions of learning and teaching? How? and (2) which contextual and personal characteristics are related to conceptions of learning and teaching? How? Individual interviews were conducted with 13 teachers of the undergraduate curricula in two medical schools. Previously their conceptions of learning and teaching were assessed with the COLT questionnaire. We investigated the meanings they attached to context and personal characteristics, in relation to their conceptions of learning and teaching. We used a template analysis. Large individual differences existed between teachers. Characteristics mentioned at the medical school and curriculum level were 'curriculum tradition', 'support by educational department' and 'management and finances'. Other contextual characteristics were 'leadership style' at all levels but especially of department chairs, 'affordances and support', 'support and relatedness', and 'students' characteristics'. Personal characteristics were 'agency', 'experience with PBL (as a student or a teacher)','personal development', 'motivation and work engagement'and 'high content expertise'. Several context and personal characteristics associated with teachers' conceptions were identified, enabling a broader view on faculty development with attention for these characteristics, next to teaching skills.

Student-centred learning in Community Medicine: An experience from Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry.

Science.gov (United States)

Kar, S S; Premarajan, K C; L, Subitha; Archana, R; Iswarya, S; A, Sujiv

2014-01-01

Student-centred learning (SCL) places the student at the centre of policies, practices and decision-making in the teaching-learning process. SCL methodology also advocates active involvement of students in the curriculum planning, selection of teaching-learning methods and assessment process. We planned an education innovation project to assess the perception of fifth semester undergraduate medical students towards implementation of an SCL methodology. The study was done among 87 fifth semester undergraduate medical students (batch of 2010-11) in the noncommunicable disease epidemiology section of Community Medicine at the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry. The students divided themselves into seven groups and developed the learning objectives, selected teaching-learning methods and assessment process for each session. The facilitators had 3-5 rounds of interaction with each group before the session. Qualitative analysis of feedback collected from students and external faculty after each session was done. The effect of implementing the SCL methodology was assessed by the reaction level of Kirkpatrick's training evaluation model by using a rating scale Results. Of the 87 eligible students, 73 (83.9%) returned the forms for evaluation. All seven groups were able to formulate the learning objectives. Most of the groups had used PowerPoint slides and videos as a teaching-learning tool. Innovative assessment methods such as crosswords and 'chocopati' were used by some groups. In general, the perception of students was favourable towards SCL compared to conventional methods and they felt that this methodology should be adopted more often. Time management and organization of sessions were the main problems encountered by the students. The mean (SD) score for the items 'sessions were useful', 'sessions were enjoyable' and 'sessions improved my knowledge' were 6.2 (1.8), 7.1 (1.8) and 6.3 (1.9), respectively. The

The Integrated Medical Model: A Probabilistic Simulation Model for Predicting In-Flight Medical Risks

Science.gov (United States)

Keenan, Alexandra; Young, Millennia; Saile, Lynn; Boley, Lynn; Walton, Marlei; Kerstman, Eric; Shah, Ronak; Goodenow, Debra A.; Myers, Jerry G.

2015-01-01

The Integrated Medical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The Integrated Medical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting

An antenatal prediction model for adverse birth outcomes in an urban population: The contribution of medical and non-medical risks.

Science.gov (United States)

Posthumus, A G; Birnie, E; van Veen, M J; Steegers, E A P; Bonsel, G J

2016-07-01

in the Netherlands the perinatal mortality rate is high compared to other European countries. Around eighty percent of perinatal mortality cases is preceded by being small for gestational age (SGA), preterm birth and/or having a low Apgar-score at 5 minutes after birth. Current risk detection in pregnancy focusses primarily on medical risks. However, non-medical risk factors may be relevant too. Both non-medical and medical risk factors are incorporated in the Rotterdam Reproductive Risk Reduction (R4U) scorecard. We investigated the associations between R4U risk factors and preterm birth, SGA and a low Apgar score. a prospective cohort study under routine practice conditions. six midwifery practices and two hospitals in Rotterdam, the Netherlands. 836 pregnant women. the R4U scorecard was filled out at the booking visit. after birth, the follow-up data on pregnancy outcomes were collected. Multivariate logistic regression was used to fit models for the prediction of any adverse outcome (preterm birth, SGA and/or a low Apgar score), stratified for ethnicity and socio-economic status (SES). factors predicting any adverse outcome for Western women were smoking during the first trimester and over-the-counter medication. For non-Western women risk factors were teenage pregnancy, advanced maternal age and an obstetric history of SGA. Risk factors for high SES women were low family income, no daily intake of vegetables and a history of preterm birth. For low SES women risk factors appeared to be low family income, non-Western ethnicity, smoking during the first trimester and a history of SGA. the presence of both medical and non-medical risk factors early in pregnancy predict the occurrence of adverse outcomes at birth. Furthermore the risk profiles for adverse outcomes differed according to SES and ethnicity. to optimise effective risk selection, both medical and non-medical risk factors should be taken into account in midwifery and obstetric care at the booking visit

The Australian centre for RF bioeffects research (ACRBR) - an NHMRC centre of research excellence

International Nuclear Information System (INIS)

Wood, A.; Croft, R.; Abramson, M.; Anderson, V.; Cosic, I.; Finnie, J.; McKenzie, R.

2004-01-01

Full text: The Australian Centre for Radiofrequency Bioeffects Research (ACRBR) is a newly established multi-institutional research centre which seeks to research questions pertaining to possible health effects of exposure to radiofrequency devices, such as mobile phones and which is funded under the Australian National Health and Medical Research Council (NHMRC) Centres of Research Excellence funding program. The Centre of Research Excellence in Electromagnetic Energy is combining the efforts of engineers, epidemiologists, physicists, psychophysiologists and veterinary pathologists from RMIT University, the Institute of Medical and Veterinary Science in South Australia (IMVS), Monash University, Swinburne University of Technology and Telstra Research Laboratories (TRL). The centre is funded at $2.5 M over five years and will undertake a program of research to address the issue of exposure to radiofrequency (RF) devices and health. It will also train new scientists, keep the community informed of ongoing developments and help the development of government policies in this area of considerable public concern. The 5-year program has the following components: Neurobiology: One important area where there is a perceived research gap is in the area of potential neurological effects, which will hence be a major focus of this Centre. The proposed studies range from in vitro and in vivo research studies of RF effects on neuron and neural system functioning in rodents, to that of RF effects on simple neural function, cognition and subjective report in humans. The latter series of studies have been developed to account for the consensus view that more emphasis needs to be placed on possible differences in RF population sensitivity (e.g. youth versus aged, and ' electromagnetic hypersensitives'). Epidemiological studies are an important tool in studying the impact on public health from exposure of whole populations to modern radio technologies. Cancer outcomes in this area of

[Interdisciplinary healthcare centres--a way of organising healthcare in the future from a health insurer's perspective].

Science.gov (United States)

Hecke, Torsten L; Hoyer, Jens Martin

2009-01-01

The German healthcare system modernization act enables healthcare providers to fund interdisciplinary healthcare centres. The Techniker Krankenkasse (TK) is a statutory health sickness fund that has contracted with some of the interdisciplinary healthcare centres named ATRIO-MED to achieve high-quality medical care and healthcare management. A range of patient-centred services is described in the cooperation agreement; in addition to central medical patient records one of the core competencies includes integrated pathways for defined diagnosis. The concept of the interdisciplinary healthcare centre is highly accepted among patients. It will serve as a platform for future TK healthcare policies.

Descriptive epidemiology of colorectal cancer in University Malaya Medical Centre, 2001 to 2010.

Science.gov (United States)

Magaji, Bello Arkilla; Moy, Foong Ming; Roslani, April Camilla; Law, Chee Wei

2014-01-01

Colorectal cancer is the second most frequent cancer in Malaysia. Nevertheless, there is little information on treatment and outcomes nationally. We aimed to determine the demographic, clinical and treatment characteristics of colorectal cancer patients treated at the University Malaya Medical Centre (UMMC) as part of a larger project on survival and quality of life outcomes. Medical records of 1,212 patients undergoing treatment in UMMC between January 2001 and December 2010 were reviewed. A retrospective-prospective cohort study design was used. Research tools included the National Cancer Patient Registration form. Statistical analysis included means, standard deviations (SD), proportions, chi square, t-test/ ANOVA. P-value significance was set at 0.05. The male: female ratio was 1.2:1. The mean age was 62.1 (SD12.4) years. Patients were predominantly Chinese (67%), then Malays (18%), Indians (13%) and others (2%). Malays were younger than Chinese and Indians (mean age 57 versus 62 versus 62 years, p<0.001). More females (56%) had colon cancers compared to males (44%) (p=0.022). Malays (57%) had more rectal cancer compared to Chinese (45%) and Indians (49%) (p=0.004). Dukes' stage data weres available in 67%, with Dukes' C and D accounting for 64%. Stage was not affected by age, gender, ethnicity or tumor site. Treatment modalities included surgery alone (40%), surgery and chemo/radiotherapy 32%, chemo and radiotherapy (8%) and others (20%). Significant ethnic differences in age and site distribution, if verified in population-based settings, would support implementation of preventive measures targeting those with the greatest need, at the right age.

Knowledge and attitudes of nurses in community health centres about electronic medical records

Directory of Open Access Journals (Sweden)

Don O’Mahony

2014-03-01

Full Text Available Background: Nurses in primary healthcare record data for the monitoring and evaluation of diseases and services. Information and communications technology (ICT can improve quality in healthcare by providing quality medical records. However, worldwide, the majority of health ICT projects have failed. Individual user acceptance is a crucial factor in successful ICT implementation. Objectives: The aim of this study is to explore nurses’ knowledge, attitudes and perceptions regarding ICT so as to inform the future implementation of electronic medical record (EMR systems. Methods: A qualitative design was used. Semi-structured interviews were undertaken with nurses at three community health centres (CHCs in the King Sabata Dalyindyebo Local Municipality. The interview guide was informed by the literature on user acceptance of ICT. Interviews were recorded and analysed using content analysis. Results: Many nurses knew about health ICT and articulated clearly the potential benefits of an EMR such as fewer errors, more complete records, easier reporting and access to information. They thought that an EMR system would solve the challenges they identified with the current paper-based record system, including duplication of data, misfiling, lack of a chronological patient record, excessive time in recording and reduced time for patient care. For personal ICT needs, approximately half used cellphone Internet-based services and computers. Conclusions: In this study, nurses identified many challenges with the current recording methods. They thought that an EMR should be installed at CHCs. Their knowledge about EMR, positive attitudes to ICT and personal use of ICT devices increase the likelihood of successful EMR implementation at CHCs.

Can we predict podiatric medical school grade point average using an admission screen?

Science.gov (United States)

Shaw, Graham P; Velis, Evelio; Molnar, David

2012-01-01

Most medical school admission committees use cognitive and noncognitive measures to inform their final admission decisions. We evaluated using admission data to predict academic success for podiatric medical students using first-semester grade point average (GPA) and cumulative GPA at graduation as outcome measures. In this study, we used linear multiple regression to examine the predictive power of an admission screen. A cross-validation technique was used to assess how the results of the regression model would generalize to an independent data set. Undergraduate GPA and Medical College Admission Test score accounted for only 22% of the variance in cumulative GPA at graduation. Undergraduate GPA, Medical College Admission Test score, and a time trend variable accounted for only 24% of the variance in first-semester GPA. Seventy-five percent of the individual variation in cumulative GPA at graduation and first-semester GPA remains unaccounted for by admission screens that rely on only cognitive measures, such as undergraduate GPA and Medical College Admission Test score. A reevaluation of admission screens is warranted, and medical educators should consider broadening the criteria used to select the podiatric physicians of the future.

Predictive Psychiatric Genetic Testing in Minors: An Exploration of the Non-Medical Benefits.

Science.gov (United States)

Manzini, Arianna; Vears, Danya F

2018-03-01

Predictive genetic testing for susceptibility to psychiatric conditions is likely to become part of standard practice. Because the onset of most psychiatric diseases is in late adolescence or early adulthood, testing minors could lead to early identification that may prevent or delay the development of these disorders. However, due to their complex aetiology, psychiatric genetic testing does not provide the immediate medical benefits that current guidelines require for testing minors. While several authors have argued non-medical benefits may play a crucial role in favour of predictive testing for other conditions, little research has explored such a role in psychiatric disorders. This paper outlines the potential non-medical benefits and harms of psychiatric genetic testing in minors in order to consider whether the non-medical benefits could ever make such testing appropriate. Five non-medical themes arise in the literature: psychological impacts, autonomy/self-determination, implications of the biomedical approach, use of financial and intellectual resources, and discrimination. Non-medical benefits were prominent in all of them, suggesting that psychiatric genetic testing in minors may be appropriate in some circumstances. Further research needs to empirically assess these potential non-medical benefits, incorporate minors in the debate, and include normative reflection to evaluate the very purposes and motivations of psychiatric genetic testing in minors.

Early perception of medication benefit predicts subsequent antipsychotic response in schizophrenia: "the consumer has a point" revisited.

Science.gov (United States)

Ascher-Svanum, Haya; Weiden, Peter; Nyhuis, Allen W; Faries, Douglas E; Stauffer, Virginia; Kollack-Walker, Sara; Kinon, Bruce J

2014-07-01

An easy-to-administer tool for predicting response to antipsychotic treatment could improve the acute management of patients with schizophrenia. We assessed whether a patient's perception of medication benefit early in treatment could predict subsequent response or nonresponse to continued use of the same treatment. This post hoc analysis used data from a randomized, open-label trial of antipsychotics for treatment of schizophrenia in which attitudes about medication adherence were assessed after two weeks of antipsychotic treatment using the Rating of Medication Influences (ROMI) scale. The analysis included 439 patients who had Positive and Negative Syndrome Scale (PANSS) and ROMI scale data at Weeks 2 and 8. Scores on the ROMI subscale Perceived Medication Benefit factor were used to predict subsequent antipsychotic response at Week 8, defined as a .20% reduction from baseline on the PANSS. Logistic regression was used to identify a cut-off score for the Perceived Medication Benefit factor that could accurately identify antipsychotic responders vs. nonresponders at Week 8. A score of .2.75 (equal to a mean subscale score of .11.00) on the ROMI scale Perceived Medication Benefit factor at Week 2 predicted response at Week 8 with high specificity (72%) and negative predictive value (70%), moderate sensitivity (44%) and positive predictive value (47%), and with a 38% misclassification rate. A brief assessment of the patient's perception of medication benefit at two weeks into treatment appears to be a good predictor of subsequent response and nonresponse after eight weeks of treatment with the same antipsychotic.

Creating opportunities for interdisciplinary collaboration and patient-centred care: how nurses, doctors, pharmacists and patients use communication strategies when managing medications in an acute hospital setting.

Science.gov (United States)

Liu, Wei; Gerdtz, Marie; Manias, Elizabeth

2016-10-01

This paper examines the communication strategies that nurses, doctors, pharmacists and patients use when managing medications. Patient-centred medication management is best accomplished through interdisciplinary practice. Effective communication about managing medications between clinicians and patients has a direct influence on patient outcomes. There is a lack of research that adopts a multidisciplinary approach and involves critical in-depth analysis of medication interactions among nurses, doctors, pharmacists and patients. A critical ethnographic approach with video reflexivity was adopted to capture communication strategies during medication activities in two general medical wards of an acute care hospital in Melbourne, Australia. A mixed ethnographic approach combining participant observations, field interviews, video recordings and video reflexive focus groups and interviews was employed. Seventy-six nurses, 31 doctors, 1 pharmacist and 27 patients gave written consent to participate in the study. Data analysis was informed by Fairclough's critical discourse analytic framework. Clinicians' use of communication strategies was demonstrated in their interpersonal, authoritative and instructive talk with patients. Doctors adopted the language discourse of normalisation to standardise patients' illness experiences. Nurses and pharmacists employed the language discourses of preparedness and scrutiny to ensure that patient safety was maintained. Patients took up the discourse of politeness to raise medication concerns and question treatment decisions made by doctors, in their attempts to challenge decision-making about their health care treatment. In addition, the video method revealed clinicians' extensive use of body language in communication processes for medication management. The use of communication strategies by nurses, doctors, pharmacists and patients created opportunities for improved interdisciplinary collaboration and patient-centred medication

A South African outpatient drug treatment centre | Karassellos ...

African Journals Online (AJOL)

The Cape Town Drug Counselling Centre is an outpatient drug treatment ... Management of clients, which includes psychotherapy with an emphasis on ... medical intervention, is described, and proposed areas for further research are outlined.

Palliative care and the arts: vehicles to introduce medical students to patient-centred decision-making and the art of caring.

Science.gov (United States)

Centeno, Carlos; Robinson, Carole; Noguera-Tejedor, Antonio; Arantzamendi, María; Echarri, Fernando; Pereira, José

2017-12-16

Medical Schools are challenged to improve palliative care education and to find ways to introduce and nurture attitudes and behaviours such as empathy, patient-centred care and wholistic care. This paper describes the curriculum and evaluation results of a unique course centred on palliative care decision-making but aimed at introducing these other important competencies as well. The 20 h-long optional course, presented in an art museum, combined different learning methods, including reflections on art, case studies, didactic sessions, personal experiences of faculty, reflective trigger videos and group discussions. A mixed methods approach was used to evaluate the course, including a) a post-course reflective exercise; b) a standardized evaluation form used by the University for all courses; and c) a focus group. Twenty students (2nd to 6th years) participated. The course was rated highly by the students. Their understanding of palliative care changed and misconceptions were dispelled. They came to appreciate the multifaceted nature of decision-making in the palliative care setting and the need to individualize care plans. Moreover, the course resulted in a re-conceptualization of relationships with patients and families, as well as their role as future physicians. Palliative care decision-making therefore, augmented by the visual arts, can serve as a vehicle to address several competencies, including the introduction of competencies related to being patient-centred and empathic.

The outcome of the first 1000 cases of LASIK performed at the king Hussein Medical Center

Energy Technology Data Exchange (ETDEWEB)

Abdallat, W [King Hussein Medical Centre, Amman (Jordan). Dept. of Ophthalmology

2011-07-01

The current study evaluates the refractive and visual outcome of patients who had laser in situ keratomileusis (LASIK) performed at the refractive center at King Hussein Medical centre in Jordan. The predictability of LASIK surgery in terms of refractive and visual outcome results is very good with mild regression in refraction over time. (author).

The outcome of the first 1000 cases of LASIK performed at the king Hussein Medical Center

International Nuclear Information System (INIS)

Abdallat, W

2011-01-01

The current study evaluates the refractive and visual outcome of patients who had laser in situ keratomileusis (LASIK) performed at the refractive center at King Hussein Medical centre in Jordan. The predictability of LASIK surgery in terms of refractive and visual outcome results is very good with mild regression in refraction over time. (author).

How valid are commercially available medical simulators?

Directory of Open Access Journals (Sweden)

Stunt JJ

2014-10-01

Full Text Available JJ Stunt,1 PH Wulms,2 GM Kerkhoffs,1 J Dankelman,2 CN van Dijk,1 GJM Tuijthof1,2 1Orthopedic Research Center Amsterdam, Department of Orthopedic Surgery, Academic Medical Centre, Amsterdam, the Netherlands; 2Department of Biomechanical Engineering, Faculty of Mechanical, Materials and Maritime Engineering, Delft University of Technology, Delft, the Netherlands Background: Since simulators offer important advantages, they are increasingly used in medical education and medical skills training that require physical actions. A wide variety of simulators have become commercially available. It is of high importance that evidence is provided that training on these simulators can actually improve clinical performance on live patients. Therefore, the aim of this review is to determine the availability of different types of simulators and the evidence of their validation, to offer insight regarding which simulators are suitable to use in the clinical setting as a training modality. Summary: Four hundred and thirty-three commercially available simulators were found, from which 405 (94% were physical models. One hundred and thirty validation studies evaluated 35 (8% commercially available medical simulators for levels of validity ranging from face to predictive validity. Solely simulators that are used for surgical skills training were validated for the highest validity level (predictive validity. Twenty-four (37% simulators that give objective feedback had been validated. Studies that tested more powerful levels of validity (concurrent and predictive validity were methodologically stronger than studies that tested more elementary levels of validity (face, content, and construct validity. Conclusion: Ninety-three point five percent of the commercially available simulators are not known to be tested for validity. Although the importance of (a high level of validation depends on the difficulty level of skills training and possible consequences when skills are

Gender and psychiatric diagnosis: a 5-year retrospective study in a Nigerian Federal Medical Centre.

Science.gov (United States)

Agbir, T M; Oyigeya, M; Audu, M; Dapap, D D; Goar, S G

2010-01-01

The role of gender in psychiatry disorders is becoming increasingly important. This study is therefore, aimed at identifying gender pattern of admissions to a public mental health centre with regards to demographic characteristic, psychiatry diagnosis and length of stay on admission. In this retrospective study Hospital records of 388 patients admitted at the psychiatric section of the Federal Medical Centre (FMC) Makurdi, between January, 2004 and December, 2008 were studied for gender differences regarding demographic attributes, length of stay and psychiatry diagnoses. Findings revealed that more men than women were admitted overall. Most men (56%) were less than 30 years old whereas 60.6% of women were within 30-59 years aged bracket. For men the main diagnosis was schizophrenia (30.5%), followed by substance related disorders (16.5%) then depression (14.0%); for women the main diagnosis was also schizophrenia (30.3%), this was followed by depression (24.5%), only one woman was diagnosed with substance related disorder. A statistically significant association was also found between having a personality disorder and being a male (p = 0.009). Most female were single and belong to the lowest occupational group. There was no significant difference in the gender distribution of patients with respect to length of stay on admission (p = 0.161). The results revealed how psychiatry diagnosis is significantly influence by gender issues. We therefore recommend that; for a more effective psychiatry formulation, it is imperative to pay attention to gender issues that may affect the development of psychopathology.

Genetic Counselling for Predictive Testing in Huntington's Disease in One Centre since 1993. Gender-Specific Aspects of Decision-Making.

Science.gov (United States)

Arning, Larissa; Witt, Constantin N; Epplen, Jörg T; Stemmler, Susanne

2015-01-01

The discovery of the mutation causing Huntington's disease (HD) in 1993 allowed direct mutation analysis and predictive testing to identify currently unaffected carriers with a sensitivity and specificity of virtually 100%. The present study was designed to comprehensively profile the participants who sought predictive testing for HD between 1993 and 2009 in our Huntington centre. Using a retrospective design, we analysed the written documentation of the counselling sessions for all referrals for predictive mutation testing in this time span. Six hundred sixty-three individuals at risk for HD requested predictive testing. Roughly half (n = 333) completed the protocol and received their test result. In general our findings are in accordance with other reports: most participants share an a priori risk of 50% (91.1%); more females request testing (58.5%); and those who ask for the result are mostly in their 30 s (mean = 35.1 years). Of those at 50% or 25% prior risks, 47.4% and 22.7%, respectively, tested positive in accordance with the respective risk of inheriting HD. Generally, more participants with an affected mother than father sought genetic testing (52.5% versus 47.5%). Interestingly, this difference was especially evident in the group of females who finally withdrew from testing (59.1%, p = 0.040). Men, in particular those who decided in favour of the test, were more often accompanied by their partner in the pre-test counselling session than vice versa (67.9% versus 44.7%, p = 0.003). On the other hand, significantly more men who were being tested did not have a companion in the pre-test session as compared with men who decided against the test (40.0% versus 25.7%, p = 0.012). During the first four years of predictive testing (1993–1996) more participants completed the protocol and received their test result as in later years. Yet, in this early time span significantly fewer females finally decided in favour of the test (48.4%, p = 0.005). These findings

Knowledge and attitudes of nurses in community health centres about electronic medical records

Directory of Open Access Journals (Sweden)

Don O'Mahony

2014-02-01

Full Text Available Background: Nurses in primary healthcare record data for the monitoring and evaluation of diseases and services. Information and communications technology (ICT can improve quality in healthcare by providing quality medical records. However, worldwide, the majority of health ICT projects have failed. Individual user acceptance is a crucial factor in successful ICT implementation. Objectives: The aim of this study is to explore nurses’ knowledge, attitudes and perceptions regarding ICT so as to inform the future implementation of electronic medical record (EMR systems. Methods: A qualitative design was used. Semi-structured interviews were undertaken with nurses at three community health centres (CHCs in the King Sabata Dalyindyebo Local Municipality. The interview guide was informed by the literature on user acceptance of ICT. Interviews were recorded and analysed using content analysis. Results: Many nurses knew about health ICT and articulated clearly the potential benefits of an EMR such as fewer errors, more complete records, easier reporting and access to information. They thought that an EMR system would solve the challenges they identified with the current paper-based record system, including duplication of data, misfiling, lack of a chronological patient record, excessive time in recording and reduced time for patient care. For personal ICT needs, approximately half used cellphone Internet-based services and computers. Conclusions: In this study, nurses identified many challenges with the current recording methods. They thought that an EMR should be installed at CHCs. Their knowledge about EMR, positive attitudes to ICT and personal use of ICT devices increase the likelihood of successful EMR implementation at CHCs.

Comparative values of medical school assessments in the prediction of internship performance.

Science.gov (United States)

Lee, Ming; Vermillion, Michelle

2018-02-01

Multiple undergraduate achievements have been used for graduate admission consideration. Their relative values in the prediction of residency performance are not clear. This study compared the contributions of major undergraduate assessments to the prediction of internship performance. Internship performance ratings of the graduates of a medical school were collected from 2012 to 2015. Hierarchical multiple regression analyses were used to examine the predictive values of undergraduate measures assessing basic and clinical sciences knowledge and clinical performances, after controlling for differences in the Medical College Admission Test (MCAT). Four hundred eighty (75%) graduates' archived data were used in the study. Analyses revealed that clinical competencies, assessed by the USMLE Step 2 CK, NBME medicine exam, and an eight-station objective structured clinical examination (OSCE), were strong predictors of internship performance. Neither the USMLE Step 1 nor the inpatient internal medicine clerkship evaluation predicted internship performance. The undergraduate assessments as a whole showed a significant collective relationship with internship performance (ΔR 2  = 0.12, p < 0.001). The study supports the use of clinical competency assessments, instead of pre-clinical measures, in graduate admission consideration. It also provides validity evidence for OSCE scores in the prediction of workplace performance.

Predicting Urban Medical Services Demand in China: An Improved Grey Markov Chain Model by Taylor Approximation.

Science.gov (United States)

Duan, Jinli; Jiao, Feng; Zhang, Qishan; Lin, Zhibin

2017-08-06

The sharp increase of the aging population has raised the pressure on the current limited medical resources in China. To better allocate resources, a more accurate prediction on medical service demand is very urgently needed. This study aims to improve the prediction on medical services demand in China. To achieve this aim, the study combines Taylor Approximation into the Grey Markov Chain model, and develops a new model named Taylor-Markov Chain GM (1,1) (T-MCGM (1,1)). The new model has been tested by adopting the historical data, which includes the medical service on treatment of diabetes, heart disease, and cerebrovascular disease from 1997 to 2015 in China. The model provides a predication on medical service demand of these three types of disease up to 2022. The results reveal an enormous growth of urban medical service demand in the future. The findings provide practical implications for the Health Administrative Department to allocate medical resources, and help hospitals to manage investments on medical facilities.

Allergic rhinitis and its associated co-morbidities at Bugando Medical Centre in Northwestern Tanzania; A prospective review of 190 cases

Directory of Open Access Journals (Sweden)

Said Said A

2012-11-01

Full Text Available Abstract Background Allergic rhinitis is one of the commonest atopic diseases which contribute to significant morbidity world wide while its epidemiology in Tanzania remains sparse. There was paucity of information regarding allergic rhinitis in our setting; therefore it was important to conduct this study to describe our experience on allergic rhinitis, associated co-morbidities and treatment outcome in patients attending Bugando Medical Centre. Methods This was descriptive cross-sectional study involving all patients with a clinical diagnosis of allergic rhinitis at Bugando Medical Centre over a three-month period between June 2011 and August 2011. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software version 17.0. Results A total of 190 patients were studied giving the prevalence of allergic rhinitis 14.7%. The median age of the patients was 8.5 years. The male to female ratio was 1:1. Adenoid hypertrophy, tonsillitis, hypertrophy of inferior turbinate, nasal polyps, otitis media and sinusitis were the most common co-morbidities affecting 92.6% of cases and were the major reason for attending hospital services. Sleep disturbance was common in children with adenoids hypertrophy (χ2 = 28.691, P = 0.000. Allergic conjunctivitis was found in 51.9%. The most common identified triggers were dust, strong perfume odors and cold weather (P χ2 = 4.583, P = 0.032. In this study family history of allergic rhinitis was not a significant risk factor (P =0.423. The majority of patients (68.8% were treated surgically for allergic rhinitis co morbidities. Post operative complication and mortality rates were 2.9% and 1.6% respectively. The overall median duration of hospital stay of in-patients was 3 days (2 – 28 days. Most patients (98.4% had satisfactory results at discharge. Conclusion The study shows that allergic rhinitis is common in our settings representing 14.7% of all

Barriers and opportunities in assessing calls to emergency medical communication centre--a qualitative study.

Science.gov (United States)

Lindström, Veronica; Heikkilä, Kristiina; Bohm, Katarina; Castrèn, Maaret; Falk, Ann-Charlotte

2014-11-11

Previous studies have described the difficulties and the complexity of assessing an emergency call, and assessment protocols intended to support the emergency medical dispatcher's (EMD) assessment have been developed and evaluated in recent years. At present, the EMD identifies about 50-70 % of patients suffering from cardiac arrest, acute myocardial infarction or stroke. The previous research has primarily been focused on specific conditions, and it is still unclear whether there are any overall factors that may influence the assessment of the call to the emergency medical communication centre (EMCC). The aim of the study was to identify overall factors influencing the registered nurses' (RNs) assessment of calls to the EMCC. A qualitative study design was used; a purposeful selection of calls to the EMCC was analysed by content analysis. One hundred calls to the EMCC were analysed. Barriers and opportunities related to the RN or the caller were identified as the main factors influencing the RN's assessment of calls to the EMCC. The opportunities appeared in the callers' symptom description and the communication strategies used by the RN. The barriers appeared in callers' descriptions of unclear symptoms, paradoxes and the RN's lack of communication strategies during the call. Barriers in assessing the call to the EMCC were associated with contradictory information, the absence of a primary problem, or the structure of the call. Opportunities were associated with a clear symptom description that was also repeated, and the RN's use of different communication strategies such as closed loop communication.

A new risk prediction model for critical care: the Intensive Care National Audit & Research Centre (ICNARC) model.

Science.gov (United States)

Harrison, David A; Parry, Gareth J; Carpenter, James R; Short, Alasdair; Rowan, Kathy

2007-04-01

To develop a new model to improve risk prediction for admissions to adult critical care units in the UK. Prospective cohort study. The setting was 163 adult, general critical care units in England, Wales, and Northern Ireland, December 1995 to August 2003. Patients were 216,626 critical care admissions. None. The performance of different approaches to modeling physiologic measurements was evaluated, and the best methods were selected to produce a new physiology score. This physiology score was combined with other information relating to the critical care admission-age, diagnostic category, source of admission, and cardiopulmonary resuscitation before admission-to develop a risk prediction model. Modeling interactions between diagnostic category and physiology score enabled the inclusion of groups of admissions that are frequently excluded from risk prediction models. The new model showed good discrimination (mean c index 0.870) and fit (mean Shapiro's R 0.665, mean Brier's score 0.132) in 200 repeated validation samples and performed well when compared with recalibrated versions of existing published risk prediction models in the cohort of patients eligible for all models. The hypothesis of perfect fit was rejected for all models, including the Intensive Care National Audit & Research Centre (ICNARC) model, as is to be expected in such a large cohort. The ICNARC model demonstrated better discrimination and overall fit than existing risk prediction models, even following recalibration of these models. We recommend it be used to replace previously published models for risk adjustment in the UK.

Authorship issues in multi-centre clinical trials

DEFF Research Database (Denmark)

Rosenberg, Jacob; Burcharth, Jakob; Pommergaard, Hans-Christian

2015-01-01

to qualify for authorship as defined by the International Committee of Medical Journal Editors. Therefore, rules for authorship in multi-centre trials are strongly recommended. We propose two contracts to prevent conflicts regarding authorship; both are freely available for use without pay but with reference...... to the original source....

New and innovative exhibition concepts at science centres using communication technologies

DEFF Research Database (Denmark)

Quistgaard, Nana; Kahr-Højland, Anne

2010-01-01

Will new communication technologies mean the death of science centres, as Bradburne predicted 12 years ago-or are they alive and kicking? And if science centres do survive, what role could they possibly play in today's society? What mechanisms underlie the development of science centres...... direction, e.g., regarding the emphasised importance of facilitating scientific literacy and critical reflection. We argue that new communication technologies hold potential to accommodate new trends and that science centres have shown to be enterprising in their use of such technologies, e.g., mobile...

PRIME Partnerships in International Medical Education - Restoring a Christian ethos to medical education worldwide

Directory of Open Access Journals (Sweden)

Huw Morgan

2016-01-01

Full Text Available Modern medicine has developed from an essentially Christian world-view and in Western countries has been greatly influenced by the Christian tradition of hospitality and caring for the sick. However, during the 20th century, medical education became increasingly secularised and focussed on the bio-physical model of disease, losing sight of a holistic view of the person that includes awareness of a spiritual dimension. Former Communist countries in particular have little recent tradition of caring, and medical education there tends to be characterised by poor role-models and out-dated didactic teaching. In the resource poor countries of the global South there are many Christian hospitals and clinics but often a lack of experienced medical teachers. Partnerships in International Medical Education (PRIME’s vision and mission is to support health-care education worldwide to restore a Christian-based holistic approach to patients, and act as a resource where needed, tailoring medical educational programmes to meet the needs of overseas partners (or colleagues in the NHS. Using interactive leaner-centred and problem-based educational methods, PRIME tutors (all experienced and qualified Christian medical educators seek to model patient-centred care by using learner-centred teaching, valuing each person as a bearer of the image of God. Most of PRIME’s teaching involves the doctor-patient relationship, communication skills, compassion, ethics and professionalism, often based around particular clinical scenarios to suit the learners. Small teams of voluntary tutors visiting partner institutions and colleagues for a few weeks a year can have a surprisingly large impact, as those grasping the vision become advocates for positive change in their own situations. Training of trainers and teachers in learner-centred, androgogic methodology to build capacity and sustainability is also a major part of the work.

Self-medication among pregnant women attending antenatal clinic at Makongoro health centre in Mwanza, Tanzania: a challenge to health systems.

Science.gov (United States)

Marwa, Karol J; Njalika, Agnes; Ruganuza, Deodatus; Katabalo, Deogratias; Kamugisha, Erasmus

2018-01-08

Self-medication is a universal challenge that requires attention because of the potential threat not only to the pregnant women but also to unborn child. Data on self-medication practice and predictors among pregnant women is lacking in Tanzania. Information on the effects of this practice to the pregnant woman and the foetus globally is also scanty. This was a cross sectional study which was conducted using face to face interview with 372 pregnant women at Makongoro health centre. Semi-structured questionnaires were used. Data were analysed using STATA 13 (Statistical Corporation, College Station, Texas, US). A total of 372 pregnant women participated in the study. The prevalence of self-medication among pregnant women was 172 (46.24%). There was a significant statistical association between self-medication and occupation (P value =0.01), gestation age (P self-medication (P = 0.809, P = 0.243 and P = 0.922) respectively. When bivariate logistic regression was performed, occupation and education were the only determining factors for self-medication. Pregnant women who were unemployed, doing business and house wife were most likely to practice self-medication than employed pregnant women (P = 0.03; OR = 2.33; 95% CI, 1.06-5.31, P = 0.01; OR = 2.31; CI 1.21-4.41, P = self-medication than pregnant women with college or university education (P leading illness/symptoms which led to self-medication among pregnant women attending clinic were malaria 56 (32.56%, morning sickness 44 (25.55%) and headache 33(19.19%). Drugs commonly used in self-medication among pregnant women were ant malarial 42 (24.42%), antiemetics 59 (34.30%) and analgesics 33 (19.19%). Prevalence of self-medication among pregnant women is high in Tanzania. This is a threat to the safety of the developing foetus and the pregnant woman. Therefore there is a need of interventions to minimize the practice among pregnant women.

Helicopter emergency medical services (HEMS) over-triage and the financial implications for major trauma centres in NSW, Australia.

Science.gov (United States)

Taylor, Colman B; Curtis, Kate; Jan, Stephen; Newcombe, Mark

2013-07-01

In NSW Australia, a formal trauma system including the use of helicopter emergency medical services (HEMS) has existed for over 20 years. Despite providing many advantages in NSW, HEMS patients are frequently over-triaged; leading to financial implications for major trauma centres that receive HEMS patients. The aim of this study was to investigate the financial implications of HEMS over-triage from the perspective of major trauma centres in NSW. The study sample included all trauma patients transported via HEMS to 12 major trauma centres in NSW during the period: 1 July 2008 to 30 June 2009. Clinical data were gathered from individual hospital trauma registries and merged with financial information obtained from casemix units at respective hospitals. HEMS over-triage was estimated based on the local definition of minor to moderate trauma (ISS≤12) and hospital length of stay of less than 24 hrs. The actual treatment costs were determined and compared to state-wide peer group averages to obtain estimates of potential funding discrepancies. A total of 707 patients transported by HEMS were identified, including 72% pre-hospital (PH; n=507) and 28% inter-hospital (IH; n=200) transports. Over-triage was estimated at 51% for PH patients and 29% for IH patients. Compared to PH patients, IH patients were more costly to treat on average (IH: $42,604; PH: $25,162), however PH patients were more costly overall ($12,329,618 [PH]; $8,265,152 [IH]). When comparing actual treatment costs to peer group averages we found potential funding discrepancies ranging between 4% and 32% across patient groups. Using a sensitivity analysis, the potential funding discrepancy increased with increasing levels of over-triage. HEMS patients are frequently over-triaged in NSW, leading to funding implications for major trauma centres. In general, HEMS patient treatment costs are higher than the peer group average and the potential funding discrepancy varies by injury severity and the type of

The structure and dynamics of health centres in the Netherlands: an institutional analysis.

NARCIS (Netherlands)

Batenburg, R.; Eyck, A.

2011-01-01

Context: Health centres are seen as a preferred organization of the modernized and integrated primary care. they are expected to facilitate an accessible contact point for medical care as close to people’s homes. Also, health centres are expected to deliver care in an efficient and effective way,

Cardiac patients' perception of patient-centred care: a qualitative study.

Science.gov (United States)

Esmaeili, Maryam; Cheraghi, Mohammad A; Salsali, Mahvash

2016-03-01

The aim of this study was to explore cardiac patients' perception of patient-centred care. Despite patient's importance in the process of care, less attention has been paid to experiences and expectations of patients in definitions of patient-centred care. As patients are an important element in process of patient-centred care, organizing care programs according to their perceptions and expectations will lead to enhanced quality of care and greater patient satisfaction. This study is a descriptive qualitative study. Content analysis approach was performed for data analysis. Participants were 18 cardiac patients (10 women and 8 men) hospitalized in coronary care units of teaching hospitals affiliated to Tehran University of Medical Sciences. We collected the study data through conducting personal face-to-face semi-structured interviews. The participants' perceptions of patient-centred care fell into three main themes including managing patients uncertainty, providing care with more flexibility and establishing a therapeutic communication. The second theme consisted of two sub-themes: empathizing with patients and having the right to make independent decisions. Receiving patient-centred care is essential for cardiac patients. Attention to priorities and preferences of cardiac patients and making decisions accordingly is among effective strategies for achieving patient-centred care. Cardiac care unit nurses ought to be aware that in spite of technological developments and advances, it is still important to pay attention to patients' needs and expectations in order to achieve patient satisfaction. In planning care programs, they should consider accountability towards patients' needs, flexibility in process of care and establishing medical interactions as an effective strategy for improving quality of care. © 2014 British Association of Critical Care Nurses.

Advanced skin, scar and wound care centre for children: A new era of care

Directory of Open Access Journals (Sweden)

Andrew Burd

2012-01-01

Full Text Available Advanced wound care centres are now a well established response to the growing epidemic of chronic wounds in the adult population. Is the concept transferable to children? Whilst there is not the same prevalence of chronic wounds in children there are conditions affecting the integumentary system that do have a profound effect on the quality of life of both children and their families. We have identified conditions involving the skin, scars and wounds which contribute to a critical number of potential patients that can justify the setting up of an advanced skin, scar and wound care centre for children. The management of conditions such as giant naevi, extensive scarring and epidermolysis bullosa challenge medical professionals and lead to new and novel treatments to be developed. The variation between and within such conditions calls for a customizing of individual patient care that involves a close relationship between research scientists and clinicians. This is translational medicine of its best and we predict that this is the future of wound care particularly and specifically in children.

The use of gold markers and electronic portal imaging for radiotherapy verification in prostate cancer patients: Sweden Ghana Medical Centre experience

Directory of Open Access Journals (Sweden)

George Felix Acquah

2014-02-01

Full Text Available The success of radiotherapy cancer treatment delivery depends on the accuracy of patient setup for each fraction. A significant problem arises from reproducing the same patient position and prostate location during treatment planning for every fraction of the treatment process. To analyze the daily movements of the prostate, gold markers are implanted in the prostate and portal images taken and manually matched with reference images to locate the prostate. Geometrical and fiducial markers are annotated onto a highly quality generated digitally reconstructed radiographs, that are compared with portal images acquired right before treatment dose delivery. A 0 and 270 degree treatment fields are used to calculate prostate shifts for all prostate cancer patients undergoing treatment at the Sweden Ghana Medical Centre, using an iViewGT portal imaging device. After aligning of the marker positions onto the reference images, the set-up deviations corrections are displayed and an on-line correction procedure applied. The measured migrations of the prostate markers are below the threshold of 3 mm for the main plans and 2 mm for the boost plans. With daily electronic portal imaging combined with gold markers, provides an objective method for verifying and correcting the position of the prostate immediately prior to radiation delivery.--------------------------------------------Cite this article as: Acquah GF. The use of gold markers and electronic portal imaging for radiotherapy verification in prostate cancer patients: Sweden Ghana Medical Centre experience. Int J Cancer Ther Oncol 2014; 2(1:020112.DOI: http://dx.doi.org/10.14319/ijcto.0201.12

Same admissions tools, different outcomes: a critical perspective on predictive validity in three undergraduate medical schools.

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Edwards, Daniel; Friedman, Tim; Pearce, Jacob

2013-12-27

Admission to medical school is one of the most highly competitive entry points in higher education. Considerable investment is made by universities to develop selection processes that aim to identify the most appropriate candidates for their medical programs. This paper explores data from three undergraduate medical schools to offer a critical perspective of predictive validity in medical admissions. This study examined 650 undergraduate medical students from three Australian universities as they progressed through the initial years of medical school (accounting for approximately 25 per cent of all commencing undergraduate medical students in Australia in 2006 and 2007). Admissions criteria (aptitude test score based on UMAT, school result and interview score) were correlated with GPA over four years of study. Standard regression of each of the three admissions variables on GPA, for each institution at each year level was also conducted. Overall, the data found positive correlations between performance in medical school, school achievement and UMAT, but not interview. However, there were substantial differences between schools, across year levels, and within sections of UMAT exposed. Despite this, each admission variable was shown to add towards explaining course performance, net of other variables. The findings suggest the strength of multiple admissions tools in predicting outcomes of medical students. However, they also highlight the large differences in outcomes achieved by different schools, thus emphasising the pitfalls of generalising results from predictive validity studies without recognising the diverse ways in which they are designed and the variation in the institutional contexts in which they are administered. The assumption that high-positive correlations are desirable (or even expected) in these studies is also problematised.

Cyclotron-produced radioisotopes and their clinical use at the Austin PET Centre

International Nuclear Information System (INIS)

Tochon-Danguy, H.J.

1997-01-01

A Centre for Positron Emission Tomography (PET) has been established within the Department of Nuclear Medicine at the Austin and Repatriation Medical Centre in Melbourne. PET is a non-invasive technique based on the use of biologically relevant compounds labelled with short-lived positron-emitting radionuclides such as carbon-11, nitrogen-13, oxygen-15 and fluorine-18. The basic equipment consists of a medical cyclotron (10 MeV proton and 5 MeV deuteron), six lead-shielded hot cells with associated radiochemistry facilities and a whole body PET scanner. During its first five years of operation, the Melbourne PET Centre, has pursued a strong radiolabelling development program, leading to an ambitious clinical program in neurology, oncology and cardiology. This presentation will describe the basic principles of the PET technique and review the cyclotron-produced radioisotopes and radiopharmaceuticals. Radiolabelling development programs and clinical applications are also addressed

Predicting Species Distributions Using Record Centre Data: Multi-Scale Modelling of Habitat Suitability for Bat Roosts.

Science.gov (United States)

Bellamy, Chloe; Altringham, John

2015-01-01

Conservation increasingly operates at the landscape scale. For this to be effective, we need landscape scale information on species distributions and the environmental factors that underpin them. Species records are becoming increasingly available via data centres and online portals, but they are often patchy and biased. We demonstrate how such data can yield useful habitat suitability models, using bat roost records as an example. We analysed the effects of environmental variables at eight spatial scales (500 m - 6 km) on roost selection by eight bat species (Pipistrellus pipistrellus, P. pygmaeus, Nyctalus noctula, Myotis mystacinus, M. brandtii, M. nattereri, M. daubentonii, and Plecotus auritus) using the presence-only modelling software MaxEnt. Modelling was carried out on a selection of 418 data centre roost records from the Lake District National Park, UK. Target group pseudoabsences were selected to reduce the impact of sampling bias. Multi-scale models, combining variables measured at their best performing spatial scales, were used to predict roosting habitat suitability, yielding models with useful predictive abilities. Small areas of deciduous woodland consistently increased roosting habitat suitability, but other habitat associations varied between species and scales. Pipistrellus were positively related to built environments at small scales, and depended on large-scale woodland availability. The other, more specialist, species were highly sensitive to human-altered landscapes, avoiding even small rural towns. The strength of many relationships at large scales suggests that bats are sensitive to habitat modifications far from the roost itself. The fine resolution, large extent maps will aid targeted decision-making by conservationists and planners. We have made available an ArcGIS toolbox that automates the production of multi-scale variables, to facilitate the application of our methods to other taxa and locations. Habitat suitability modelling has the

Predictive Modeling of Physician-Patient Dynamics That Influence Sleep Medication Prescriptions and Clinical Decision-Making

Science.gov (United States)

Beam, Andrew L.; Kartoun, Uri; Pai, Jennifer K.; Chatterjee, Arnaub K.; Fitzgerald, Timothy P.; Shaw, Stanley Y.; Kohane, Isaac S.

2017-02-01

Insomnia remains under-diagnosed and poorly treated despite its high economic and social costs. Though previous work has examined how patient characteristics affect sleep medication prescriptions, the role of physician characteristics that influence this clinical decision remains unclear. We sought to understand patient and physician factors that influence sleep medication prescribing patterns by analyzing Electronic Medical Records (EMRs) including the narrative clinical notes as well as codified data. Zolpidem and trazodone were the most widely prescribed initial sleep medication in a cohort of 1,105 patients. Some providers showed a historical preference for one medication, which was highly predictive of their future prescribing behavior. Using a predictive model (AUC = 0.77), physician preference largely determined which medication a patient received (OR = 3.13 p = 3 × 10-37). In addition to the dominant effect of empirically determined physician preference, discussion of depression in a patient’s note was found to have a statistically significant association with receiving a prescription for trazodone (OR = 1.38, p = 0.04). EMR data can yield insights into physician prescribing behavior based on real-world physician-patient interactions.

Specific Components of Pediatricians' Medication-Related Care Predict Attention-Deficit/Hyperactivity Disorder Symptom Improvement.

Science.gov (United States)

Epstein, Jeffery N; Kelleher, Kelly J; Baum, Rebecca; Brinkman, William B; Peugh, James; Gardner, William; Lichtenstein, Phil; Langberg, Joshua M

2017-06-01

The development of attention-deficit/hyperactivity disorder (ADHD) care quality measurements is a prerequisite to improving the quality of community-based pediatric care of children with ADHD. Unfortunately, the evidence base for existing ADHD care quality metrics is poor. The objective of this study was to identify which components of ADHD care best predict patient outcomes. Parents of 372 medication-naïve children in grades 1 to 5 presenting to their community-based pediatrician (N = 195) for an ADHD-related concern and who were subsequently prescribed ADHD medication were identified. Parents completed the Vanderbilt ADHD Parent Rating Scale (VAPRS) at the time ADHD was raised as a concern and then approximately 12 months after starting ADHD medication. Each patient's chart was reviewed to measure 12 different components of ADHD care. Across all children, the mean decrease in VAPRS total symptom score during the first year of treatment was 11.6 (standard deviation 10.1). Of the 12 components of ADHD care, shorter times to first contact and more teacher ratings collected in the first year of treatment significantly predicted greater decreases in patient total symptom scores. Notably, it was timeliness of contacts, defined as office visits, phone calls, or email communication, that predicted more ADHD symptom decreases. Office visits alone, in terms of number or timeliness, did not predict patient outcomes. The magnitude of ADHD symptom decrease that can be achieved with the use of ADHD medications was associated with specific components of ADHD care. Future development and modifications of ADHD quality care metrics should include these ADHD care components. Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Comparison of planned menus and centre characteristics with foods and beverages served in New York City child-care centres.

Science.gov (United States)

Breck, Andrew; Dixon, L Beth; Kettel Khan, Laura

2016-10-01

The present study evaluated the extent to which child-care centre menus prepared in advance correspond with food and beverage items served to children. The authors identified centre and staff characteristics that were associated with matches between menus and what was served. Menus were collected from ninety-five centres in New York City (NYC). Direct observation of foods and beverages served to children were conducted during 524 meal and snack times at these centres between April and June 2010, as part of a larger study designed to determine compliance of child-care centres with city health department regulations for nutrition. Child-care centres were located in low-income neighbourhoods in NYC. Overall, 87 % of the foods and beverages listed on the menus or allowed as substitutions were served. Menu items matched with foods and beverages served for all major food groups by >60 %. Sweets and water had lower match percentages (40 and 32 %, respectively), but water was served 68 % of the time when it was not listed on the menu. The staff person making the food and purchasing decisions predicted the match between the planned or substituted items on the menus and the foods and beverages served. In the present study, child-care centre menus included most foods and beverages served to children. Menus planned in advance have potential to be used to inform parents about which child-care centre to send their child or what foods and beverages their enrolled children will be offered throughout the day.

Comparison of planned menus and centre characteristics with foods and beverages served in New York City child-care centres

Science.gov (United States)

Breck, Andrew; Dixon, L Beth; Khan, Laura Kettel

2016-01-01

Objective The present study evaluated the extent to which child-care centre menus prepared in advance correspond with food and beverage items served to children. The authors identified centre and staff characteristics that were associated with matches between menus and what was served. Design Menus were collected from ninety-five centres in New York City (NYC). Direct observation of foods and beverages served to children were conducted during 524 meal and snack times at these centres between April and June 2010, as part of a larger study designed to determine compliance of child-care centres with city health department regulations for nutrition. Setting Child-care centres were located in low-income neighbourhoods in NYC. Results Overall, 87% of the foods and beverages listed on the menus or allowed as substitutions were served. Menu items matched with foods and beverages served for all major food groups by > 60%. Sweets and water had lower match percentages (40 and 32%, respectively), but water was served 68% of the time when it was not listed on the menu. The staff person making the food and purchasing decisions predicted the match between the planned or substituted items on the menus and the foods and beverages served. Conclusions In the present study, child-care centre menus included most foods and beverages served to children. Menus planned in advance have potential to be used to inform parents about which child-care centre to send their child or what foods and beverages their enrolled children will be offered throughout the day. PMID:27280341

Splenic injuries at Bugando Medical Centre in northwestern Tanzania: a tertiary hospital experience

Directory of Open Access Journals (Sweden)

Chalya Phillipo L

2012-01-01

Full Text Available Abstract Background Splenic injuries constitute a continuing diagnostic and therapeutic challenge to the trauma or general surgeons practicing in developing countries where sophisticated imaging facilities are either not available or exorbitantly expensive. The purpose of this review was to describe our own experience in the management of the splenic injuries outlining the aetiological spectrum, injury characteristics and treatment outcome of splenic injuries in our local environment and to identify predictors of outcome among these patients. Methods A prospective descriptive study of splenic injury patients was carried out at Bugando Medical Centre in Northwestern Tanzania between March 2009 and February 2011. Statistical data analysis was done using SPSS software version 17.0. Results A total of 118 patients were studied. The male to female ratio was 6.4:1. Their ages ranged from 8 to 74 years with a median age of 22 years. The modal age group was 21-30 years. The majority of patients (89.8% had blunt trauma and road traffic accidents (63.6% were the most frequent cause of injuries. Most patients sustained grade III (39.0% and IV (38.1% splenic injuries. Majority of patients (86.4% were treated operatively with splenectomy (97.1% being the most frequently performed procedure. Postoperative complications were recorded in 30.5% of cases. The overall length of hospital stay (LOS ranged from 1 day to 120 days with a median of 18 days. Mortality rate was 19.5%. Patients who had severe trauma (Kampala Trauma Score II ≤ 6 and those with associated injuries stayed longer in the hospital (P 2000 mls, HIV infection with CD4 ≤ 200 cells/μl and presence of postoperative complications were significantly associated with mortality (P Conclusion Trauma resulting from road traffic accidents (RTAs remains the most common cause of splenic injuries in our setting. Most of the splenic injuries were Grade III & IV and splenectomy was performed in majority of

Length of stay in asylum centres and mental health in asylum seekers: a retrospective study from Denmark.

Science.gov (United States)

Hallas, Peter; Hansen, Anne R; Staehr, Mia A; Munk-Andersen, Ebbe; Jorgensen, Henrik L

2007-10-11

The length of stay in asylum centres is generally mentioned as a possible health risk to asylum seekers. Medical staff working with asylum seekers has claimed that long lengths of stay in asylum centres might cause or aggravate mental disorders. We used records from a large, multiethnic group of asylum seekers to study if the incidence of mental disorders increased with length of stay. The study population was asylum seekers in Danish asylum centres run by the Danish Red Cross. General medical care was provided by Red Cross staff who could refer selected cases to medical specialists. If an asylum seeker needed more than three specialist consultations for mental illness or five consultations for physical illness the referrals had to be approved by The Danish Immigration Service. Between July 2001 - December 2002 the Red Cross prospectively registered health related data on all new applications (n = 4516) to the Immigration Service regarding referrals to medical specialists. We used these records to analyse the association between length of stay in the asylum centres and overall rate of referral for mental disorders. Data was analysed using weighted linear regression. We found that referrals for mental disorders increased with length of stay in asylum centres in a large, multiethnic population of asylum seekers. The association was found in all the categories of psychiatric illness studied and for a majority of the nationality groups studied. Length of stay in asylum centres was associated with an increase in referrals for mental disorders in a large, multiethnic group of asylum seekers. The present study supports the view that prolonged length of stay in an asylum centre is a risk factor for mental health. The risk of psychiatric illness among asylum seekers should be addressed by political and humanitarian means, giving prevention of illness the highest priority.

Length of stay in asylum centres and mental health in asylum seekers: a retrospective study from Denmark

Directory of Open Access Journals (Sweden)

Stæhr Mia A

2007-10-01

Full Text Available Abstract Background The length of stay in asylum centres is generally mentioned as a possible health risk to asylum seekers. Medical staff working with asylum seekers has claimed that long lengths of stay in asylum centres might cause or aggravate mental disorders. We used records from a large, multiethnic group of asylum seekers to study if the incidence of mental disorders increased with length of stay. Methods The study population was asylum seekers in Danish asylum centres run by the Danish Red Cross. General medical care was provided by Red Cross staff who could refer selected cases to medical specialists. If an asylum seeker needed more than three specialist consultations for mental illness or five consultations for physical illness the referrals had to be approved by The Danish Immigration Service. Between July 2001 – December 2002 the Red Cross prospectively registered health related data on all new applications (n = 4516 to the Immigration Service regarding referrals to medical specialists. We used these records to analyse the association between length of stay in the asylum centres and overall rate of referral for mental disorders. Data was analysed using weighted linear regression. Results We found that referrals for mental disorders increased with length of stay in asylum centres in a large, multiethnic population of asylum seekers. The association was found in all the categories of psychiatric illness studied and for a majority of the nationality groups studied. Conclusion Length of stay in asylum centres was associated with an increase in referrals for mental disorders in a large, multiethnic group of asylum seekers. The present study supports the view that prolonged length of stay in an asylum centre is a risk factor for mental health. The risk of psychiatric illness among asylum seekers should be addressed by political and humanitarian means, giving prevention of illness the highest priority.

Supporting medical students with learning disabilities in Asian medical schools

OpenAIRE

Majumder, Md. Anwarul Azim; Rahman, Sayeeda; D?Souza, Urban JA; Elbeheri, Gad; Abdulrahman, Khalid Bin; Huq, M Muzaherul

2010-01-01

Md. Anwarul Azim Majumder1, Sayeeda Rahman2, Urban JA D’Souza3, Gad Elbeheri4, Khalid Bin Abdulrahman5, M Muzaherul Huq61,2Department of Clinical Sciences, School of Life Sciences, University of Bradford, West Yorkshire, Bradford, UK; 3School of Medicine, University Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia; 4Centre for Child Evaluation and Teaching, Kuwait; 5College of Medicine, Al-Imam University, Riyadh, Saudi Arabia; 6Centre for Medical Education (CME), Mohakhali, Dhaka, Ba...

Radioprotection in the medical sector: a new quality approach

International Nuclear Information System (INIS)

Prevot, S.

2008-01-01

The author describes how quality assurance is organized in the field of radioprotection in the Georges-Francois-Leclerc medical centre in Dijon. She also recalls how this organization has recently evolved because of legal but also technical and technological evolutions. She indicates the main attributions and missions of the radiation protection expert in this medical centre

Use of acupuncture therapy as a supplement to conventional medical treatments for acute ischaemic stroke patients in an academic medical centre in Korea.

Science.gov (United States)

Chang, Hyejung; Kwon, Young Dae; Yoon, Sung Sang

2011-10-01

Acupuncture has served as a major complementary and alternative therapy that supplements conventional medicine and is the subject of growing public interest. This study was conducted to estimate the usage rate of acupuncture as a supplemental treatment in acute ischaemic stroke patients and to identify factors associated with the choice to use this therapy. Using the registry of stroke patients admitted to an academic medical centre in Korea, the use of acupuncture therapy was recorded and analysed, along with the patients' socio-demographic characteristics, hospital access variables, risk factors for ischaemic stroke and clinical characteristics. The data were analysed using descriptive statistics, chi-square tests and multiple logistic regression analyses. Of 2167 patients, 18% received acupuncture therapy. The choice of acupuncture therapy was significantly associated with stroke severity as well as gender, age, geographical residence and previous history of stroke. After controlling for other significant factors, there was an approximately 3.4-fold greater usage in patients with moderately severe strokes (95% confidence interval (CI)=2.5-4.6) and 4.1-fold greater usage in patients with severe strokes (95% CI=2.7-6.4). The findings provide a better understanding of patients' utilization of acupuncture therapy as a supplement to conventional medical treatments and of factors associated with the utilization of acupuncture in patients with acute ischemic stroke. Strategic implications of acupuncture therapy are suggested for both health-care providers and policy makers. Copyright © 2011 Elsevier Ltd. All rights reserved.

Identifying and Predicting Profiles of Medical Noncompliance: Pediatric Caregivers' Antibiotic Stewardship.

Science.gov (United States)

Smith, Rachel A; Kim, Youllee; M'Ikanatha, Nkuchia M

2018-05-14

Sometimes compliance with medical recommendations is problematic. We investigated pediatric caregivers' (N = 606) patterns of noncompliance with antibiotic stewardship based on the obstacle hypothesis. We tested predictors of noncompliance framed by the obstacle hypothesis, dissonance theory, and psychological reactance. The results revealed four profiles of caregivers' stewardship: one marked by compliance (Stewards) and three marked by types of noncompliance (Stockers, Persuaders, and Dissenters). The covariate analysis showed that, although psychological reactance predicted being noncompliant, it was types of obstacles and discrepant experiences that predicted caregivers' patterns of noncompliance with antibiotic stewardship. Campaign planning often focuses on identifying the belief most associated with the targeted outcome, such as compliance. Noncompliance research, however, points out that persuaders may be successful to the extent to which they anticipate obstacles to compliance and address them in their influence attempts. A shift from medical noncompliance to patient engagement also affords an opportunity to consider how some recommendations create obstacles for others and to find positive ways to embrace conflicting needs, tensions, and reasons for refusal in order to promote collective goals.

Motivation and emotion predict medical students' attention to computer-based feedback.

Science.gov (United States)

Naismith, Laura M; Lajoie, Susanne P

2017-12-14

Students cannot learn from feedback unless they pay attention to it. This study investigated relationships between the personal factors of achievement goal orientations, achievement emotions, and attention to feedback in BioWorld, a computer environment for learning clinical reasoning. Novice medical students (N = 28) completed questionnaires to measure their achievement goal orientations and then thought aloud while solving three endocrinology patient cases and reviewing corresponding expert solutions. Questionnaires administered after each case measured participants' experiences of five feedback emotions: pride, relief, joy, shame, and anger. Attention to individual text segments of the expert solutions was modelled using logistic regression and the method of generalized estimating equations. Participants did not attend to all of the feedback that was available to them. Performance-avoidance goals and shame positively predicted attention to feedback, and performance-approach goals and relief negatively predicted attention to feedback. Aspects of how the feedback was displayed also influenced participants' attention. Findings are discussed in terms of their implications for educational theory as well as the design and use of computer learning environments in medical education.

Early Seizure Frequency and Aetiology Predict Long-Term Medical Outcome in Childhood-Onset Epilepsy

Science.gov (United States)

Sillanpaa, Matti; Schmidt, Dieter

2009-01-01

In clinical practice, it is important to predict as soon as possible after diagnosis and starting treatment, which children are destined to develop medically intractable seizures and be at risk of increased mortality. In this study, we determined factors predictive of long-term seizure and mortality outcome in a population-based cohort of 102…

Cyclotron-produced radioisotopes and their clinical use at the Austin PET Centre

Energy Technology Data Exchange (ETDEWEB)

Tochon-Danguy, H.J. [Centre for PET, Melbourne, VIC (Australia). Austin and Repatriation Medical Centre

1997-12-31

A Centre for Positron Emission Tomography (PET) has been established within the Department of Nuclear Medicine at the Austin and Repatriation Medical Centre in Melbourne. PET is a non-invasive technique based on the use of biologically relevant compounds labelled with short-lived positron-emitting radionuclides such as carbon-11, nitrogen-13, oxygen-15 and fluorine-18. The basic equipment consists of a medical cyclotron (10 MeV proton and 5 MeV deuteron), six lead-shielded hot cells with associated radiochemistry facilities and a whole body PET scanner. During its first five years of operation, the Melbourne PET Centre, has pursued a strong radiolabelling development program, leading to an ambitious clinical program in neurology, oncology and cardiology. This presentation will describe the basic principles of the PET technique and review the cyclotron-produced radioisotopes and radiopharmaceuticals. Radiolabelling development programs and clinical applications are also addressed. 30 refs., 1 tab., 1 fig.

Predicting complex acute wound healing in patients from a wound expertise centre registry: a prognostic study.

Science.gov (United States)

Ubbink, Dirk T; Lindeboom, Robert; Eskes, Anne M; Brull, Huub; Legemate, Dink A; Vermeulen, Hester

2015-10-01

It is important for caregivers and patients to know which wounds are at risk of prolonged wound healing to enable timely communication and treatment. Available prognostic models predict wound healing in chronic ulcers, but not in acute wounds, that is, originating after trauma or surgery. We developed a model to detect which factors can predict (prolonged) healing of complex acute wounds in patients treated in a large wound expertise centre (WEC). Using Cox and linear regression analyses, we determined which patient- and wound-related characteristics best predict time to complete wound healing and derived a prediction formula to estimate how long this may take. We selected 563 patients with acute wounds, documented in the WEC registry between 2007 and 2012. Wounds had existed for a median of 19 days (range 6-46 days). The majority of these were located on the leg (52%). Five significant independent predictors of prolonged wound healing were identified: wound location on the trunk [hazard ratio (HR) 0·565, 95% confidence interval (CI) 0·405-0·788; P = 0·001], wound infection (HR 0·728, 95% CI 0·534-0·991; P = 0·044), wound size (HR 0·993, 95% CI 0·988-0·997; P = 0·001), wound duration (HR 0·998, 95% CI 0·996-0·999; P = 0·005) and patient's age (HR 1·009, 95% CI 1·001-1·018; P = 0·020), but not diabetes. Awareness of the five factors predicting the healing of complex acute wounds, particularly wound infection and location on the trunk, may help caregivers to predict wound healing time and to detect, refer and focus on patients who need additional attention. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Implementation of an electronic medical record system in previously computer-naïve primary care centres: a pilot study from Cyprus.

Science.gov (United States)

Samoutis, George; Soteriades, Elpidoforos S; Kounalakis, Dimitris K; Zachariadou, Theodora; Philalithis, Anastasios; Lionis, Christos

2007-01-01

The computer-based electronic medical record (EMR) is an essential new technology in health care, contributing to high-quality patient care and efficient patient management. The majority of southern European countries, however, have not yet implemented universal EMR systems and many efforts are still ongoing. We describe the development of an EMR system and its pilot implementation and evaluation in two previously computer-naïve public primary care centres in Cyprus. One urban and one rural primary care centre along with their personnel (physicians and nurses) were selected to participate. Both qualitative and quantitative evaluation tools were used during the implementation phase. Qualitative data analysis was based on the framework approach, whereas quantitative assessment was based on a nine-item questionnaire and EMR usage parameters. Two public primary care centres participated, and a total often health professionals served as EMR system evaluators. Physicians and nurses rated EMR relatively highly, while patients were the most enthusiastic supporters for the new information system. Major implementation impediments were the physicians' perceptions that EMR usage negatively affected their workflow, physicians' legal concerns, lack of incentives, system breakdowns, software design problems, transition difficulties and lack of familiarity with electronic equipment. The importance of combining qualitative and quantitative evaluation tools is highlighted. More efforts are needed for the universal adoption and routine use of EMR in the primary care system of Cyprus as several barriers to adoption exist; however, none is insurmountable. Computerised systems could improve efficiency and quality of care in Cyprus, benefiting the entire population.

Production, administration and disposal of cyclotron produced shortlived radioactive gases for positron emission tomography studies at the Austin Repatriation Medical Centre, Melbourne

Energy Technology Data Exchange (ETDEWEB)

Egan, G.F.; O`Keefe, G. [Austin Hospital, Heidelberg, VIC (Australia); Tochon-Danguy, H.J.; Midgley, S.; Phana, K.S.; Sachinidis, J.; Chan, J.G. [Melbourne Univ., Parkville, VIC (Australia). School of Physics

1995-01-01

Positron Emission Tomography (PET) Centre is operational at the Austin Repatriation Medical Centre, Melbourne. The major equipment consists of a 10 MeV cyclotron and a whole body PET scanner. Radioactive gases produced and used directly in clinical studies include [{sup 15}O]O{sub 2}, [{sup 15}O]CO, and [{sup 15}O]CO{sub 2}, whilst [{sup 11}C]CO{sub 2} is also produced for use in radiochemistry syntheses. Radioactivity delivery rates of 3.7, 3.3, and 1.6 GBq/min to the scanner suite have been achieved for [{sup 15}O]O{sub 2}, [{sup 15}O]CO{sub 2}, and [{sup 15}O]CO respectively, and batch productions of 36.3 GBq of [{sup 11}C]CO{sub 2} have been produced. The production. patient administration and disposal of the short-lived radioactive gases has been achieved in compliance with radiation protection principles. Radioactive gas doses of 1.7 GBq are administered to patients with less than 0.02 MBq/m{sup 3} leakage into the scanner suite. Less than 13 MBq of [ {sup 15}O]-labelled gases are released into the environment per patient study at a concentration of 0.018 MBq/m{sup 3}. Annually less than 2 GBq is expected to be released into the environment. The centre design and first four months` experience of radioactive gas production, administration and disposal is presented. 5 refs., 4 tab., 1 fig.

Ant colony optimization algorithm for interpretable Bayesian classifiers combination: application to medical predictions.

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Salah Bouktif

Full Text Available Prediction and classification techniques have been well studied by machine learning researchers and developed for several real-word problems. However, the level of acceptance and success of prediction models are still below expectation due to some difficulties such as the low performance of prediction models when they are applied in different environments. Such a problem has been addressed by many researchers, mainly from the machine learning community. A second problem, principally raised by model users in different communities, such as managers, economists, engineers, biologists, and medical practitioners, etc., is the prediction models' interpretability. The latter is the ability of a model to explain its predictions and exhibit the causality relationships between the inputs and the outputs. In the case of classification, a successful way to alleviate the low performance is to use ensemble classiers. It is an intuitive strategy to activate collaboration between different classifiers towards a better performance than individual classier. Unfortunately, ensemble classifiers method do not take into account the interpretability of the final classification outcome. It even worsens the original interpretability of the individual classifiers. In this paper we propose a novel implementation of classifiers combination approach that does not only promote the overall performance but also preserves the interpretability of the resulting model. We propose a solution based on Ant Colony Optimization and tailored for the case of Bayesian classifiers. We validate our proposed solution with case studies from medical domain namely, heart disease and Cardiotography-based predictions, problems where interpretability is critical to make appropriate clinical decisions.The datasets, Prediction Models and software tool together with supplementary materials are available at http://faculty.uaeu.ac.ae/salahb/ACO4BC.htm.

"Giving us hope": Parent and neonatal staff views and expectations of a planned family-centred discharge process (Train-to-Home).

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Ingram, Jenny; Redshaw, Maggie; Manns, Sarah; Beasant, Lucy; Johnson, Debbie; Fleming, Peter; Pontin, David

2017-08-01

Preparing families and preterm infants for discharge is relatively unstructured in many UK neonatal units (NNUs). Family-centred neonatal care and discharge planning are recommended but variable. Qualitative interviews with 37 parents of infants in NNUs, and 18 nursing staff and 5 neonatal consultants explored their views of discharge planning and perceptions of a planned family-centred discharge process (Train-to-Home). Train-to-Home facilitates communication between staff and parents throughout the neonatal stay, using a laminated train and parent booklets. Parents were overwhelmingly positive about Train-to-Home. They described being given hope, feeling in control and having something visual to show their baby's progress. They reported positive involvement of fathers and families, how predicted discharge dates helped them prepare for home and ways staff engaged with Train-to-Home when communicating with them. Nursing staff reactions were mixed-some were uncertain about when to use it, but found the visual images powerful. Medical staff in all NNUs were positive about the intervention recognizing that it helped in communicating better with parents. Using a parent-centred approach to communication and informing parents about the needs and progress of their preterm infant in hospital is welcomed by parents and many staff. This approach meets the recommended prioritization of family-centred care for such families. Predicted discharge dates helped parents prepare for home, and the ways staff engaged with Train-to-Home when communicating with them helped them feel more confident as well as having something visual to show their baby's progress. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Evaluating the Predictive Validity of Suicidal Intent and Medical Lethality in Youth

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Sapyta, Jeffrey; Goldston, David B.; Erkanli, Alaattin; Daniel, Stephanie S.; Heilbron, Nicole; Mayfield, Andrew; Treadway, S. Lyn

2012-01-01

Objectives: To examine whether suicidal intent and medical lethality of past suicide attempts are predictive of future attempts, the association between intent and lethality, and the consistency of these characteristics across repeated attempts among youth. Method: Suicide attempts in a 15-year prospective study of 180 formerly psychiatrically…

How learning analytics can early predict under-achieving students in a blended medical education course.

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Saqr, Mohammed; Fors, Uno; Tedre, Matti

2017-07-01

Learning analytics (LA) is an emerging discipline that aims at analyzing students' online data in order to improve the learning process and optimize learning environments. It has yet un-explored potential in the field of medical education, which can be particularly helpful in the early prediction and identification of under-achieving students. The aim of this study was to identify quantitative markers collected from students' online activities that may correlate with students' final performance and to investigate the possibility of predicting the potential risk of a student failing or dropping out of a course. This study included 133 students enrolled in a blended medical course where they were free to use the learning management system at their will. We extracted their online activity data using database queries and Moodle plugins. Data included logins, views, forums, time, formative assessment, and communications at different points of time. Five engagement indicators were also calculated which would reflect self-regulation and engagement. Students who scored below 5% over the passing mark were considered to be potentially at risk of under-achieving. At the end of the course, we were able to predict the final grade with 63.5% accuracy, and identify 53.9% of at-risk students. Using a binary logistic model improved prediction to 80.8%. Using data recorded until the mid-course, prediction accuracy was 42.3%. The most important predictors were factors reflecting engagement of the students and the consistency of using the online resources. The analysis of students' online activities in a blended medical education course by means of LA techniques can help early predict underachieving students, and can be used as an early warning sign for timely intervention.

Do personality traits assessed on medical school admission predict exit performance? A UK-wide longitudinal cohort study.

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MacKenzie, R K; Dowell, J; Ayansina, D; Cleland, J A

2017-05-01

Traditional methods of assessing personality traits in medical school selection have been heavily criticised. To address this at the point of selection, "non-cognitive" tests were included in the UK Clinical Aptitude Test, the most widely-used aptitude test in UK medical education (UKCAT: http://www.ukcat.ac.uk/ ). We examined the predictive validity of these non-cognitive traits with performance during and on exit from medical school. We sampled all students graduating in 2013 from the 30 UKCAT consortium medical schools. Analysis included: candidate demographics, UKCAT non-cognitive scores, medical school performance data-the Educational Performance Measure (EPM) and national exit situational judgement test (SJT) outcomes. We examined the relationships between these variables and SJT and EPM scores. Multilevel modelling was used to assess the relationships adjusting for confounders. The 3343 students who had taken the UKCAT non-cognitive tests and had both EPM and SJT data were entered into the analysis. There were four types of non-cognitive test: (1) libertariancommunitarian, (2) NACE-narcissism, aloofness, confidence and empathy, (3) MEARS-self-esteem, optimism, control, self-discipline, emotional-nondefensiveness (END) and faking, (4) an abridged version of 1 and 2 combined. Multilevel regression showed that, after correcting for demographic factors, END predicted SJT and EPM decile. Aloofness and empathy in NACE were predictive of SJT score. This is the first large-scale study examining the relationship between performance on non-cognitive selection tests and medical school exit assessments. The predictive validity of these tests was limited, and the relationships revealed do not fit neatly with theoretical expectations. This study does not support their use in selection.

A user-centred approach to requirements elicitation in medical device development: a case study from an industry perspective.

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Martin, Jennifer L; Clark, Daniel J; Morgan, Stephen P; Crowe, John A; Murphy, Elizabeth

2012-01-01

The healthcare industry is dependent upon the provision of well designed medical devices. To achieve this it is recommended that user-centred design should begin early, and continue throughout device development. This is a challenge, particularly for smaller companies who may lack the necessary expertise and knowledge. The aim of this study was to conduct a rigorous yet focused investigation into the user requirements for a new medical imaging device. Open-ended semi-structured interviews were conducted with potential clinical users of the device to investigate the clinical need for the device and the potential benefits for patients and clinical users. The study identified a number of new and significant clinical needs that suggested that the concept of the device should be fundamentally changed. The clinical and organisational priorities of the clinical users were identified, as well as a number of factors that would act as barriers to the safe and effective adoption of the device. The developers reported that this focused approach to early requirements elicitation would result in an improved product, reduce the time to market, and save the time and cost of producing and evaluating an inappropriate prototype. Copyright © 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Predictors of surgical site infections among patients undergoing major surgery at Bugando Medical Centre in Northwestern Tanzania

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Imirzalioglu Can

2011-08-01

Full Text Available Abstract Background Surgical site infection (SSI continues to be a major source of morbidity and mortality in developing countries despite recent advances in aseptic techniques. There is no baseline information regarding SSI in our setting therefore it was necessary to conduct this study to establish the prevalence, pattern and predictors of surgical site infection at Bugando Medical Centre Mwanza (BMC, Tanzania. Methods This was a cross-sectional prospective study involving all patients who underwent major surgery in surgical wards between July 2009 and March 2010. After informed written consent for the study and HIV testing, all patients who met inclusion criteria were consecutively enrolled into the study. Pre-operative, intra-operative and post operative data were collected using standardized data collection form. Wound specimens were collected and processed as per standard operative procedures; and susceptibility testing was done using disc diffusion technique. Data were analyzed using SPSS software version 15 and STATA. Results Surgical site infection (SSI was detected in 65 (26.0% patients, of whom 56 (86.2% and 9 (13.8% had superficial and deep SSI respectively. Among 65 patients with clinical SSI, 56(86.2% had positive aerobic culture. Staphylococcus aureus was the predominant organism 16/56 (28.6%; of which 3/16 (18.8% were MRSA. This was followed by Escherichia coli 14/56 (25% and Klebsiella pneumoniae 10/56 (17.9%. Among the Escherichia coli and Klebsiella pneumoniae isolates 9(64.3% and 8(80% were ESBL producers respectively. A total of 37/250 (14.8% patients were HIV positive with a mean CD4 count of 296 cells/ml. Using multivariate logistic regression analysis, presence of pre-morbid illness (OR = 6.1, use of drain (OR = 15.3, use of iodine alone in skin preparation (OR = 17.6, duration of operation ≥ 3 hours (OR = 3.2 and cigarette smoking (OR = 9.6 significantly predicted surgical site infection (SSI Conclusion SSI is common

Predictive validity of the comprehensive basic science examination mean score for assessment of medical students' performance

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Firouz Behboudi

2002-04-01

Full Text Available Background Medical education curriculum improvements can be achieved bye valuating students performance. Medical students have to pass two undergraduate comprehensive examinations, basic science and preinternship, in Iran. Purpose To measure validity of the students' mean score in comprehensive basic science exam (CBSE for predicting their performance in later curriculum phases. Methods This descriptive cross-sectional study was conducted on 95 (38 women and 55 men Guilan medical university students. Their admission to the university was 81% by regional quota and 12% by shaheed and other organizations' share. They first enrolled in 1994 and were able to pass CBS£ at first try. Data on gender, regional quota, and average grades of CBS£, PC, and CPIE were collected by a questionnaire. The calculations were done by SPSS package. Results The correlation coefficient between CBS£ and CPIE mean scores (0.65 was higher than correlation coefficient between CBS£ and PC mean scores (0.49. The predictive validity of CBS£ average grade was significant for students' performance in CPIE; however, the predictive validity of CBSE mean scores for students I pe1jormance in PC was lower. Conclusion he students' mean score in CBSE can be a good denominator for their further admission. We recommend further research to assess the predictive validity for each one of the basic courses. Keywords predictive validity, comprehensive basic exam

Enhanced risk prediction model for emergency department use and hospitalizations in patients in a primary care medical home.

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Takahashi, Paul Y; Heien, Herbert C; Sangaralingham, Lindsey R; Shah, Nilay D; Naessens, James M

2016-07-01

With the advent of healthcare payment reform, identifying high-risk populations has become more important to providers. Existing risk-prediction models often focus on chronic conditions. This study sought to better understand other factors to improve identification of the highest risk population. A retrospective cohort study of a paneled primary care population utilizing 2010 data to calibrate a risk prediction model of hospital and emergency department (ED) use in 2011. Data were randomly split into development and validation data sets. We compared the enhanced model containing the additional risk predictors with the Minnesota medical tiering model. The study was conducted in the primary care practice of an integrated delivery system at an academic medical center in Rochester, Minnesota. The study focus was primary care medical home patients in 2010 and 2011 (n = 84,752), with the primary outcome of subsequent hospitalization or ED visit. A total of 42,384 individuals derived the enhanced risk-prediction model and 42,368 individuals validated the model. Predictors included Adjusted Clinical Groups-based Minnesota medical tiering, patient demographics, insurance status, and prior year healthcare utilization. Additional variables included specific mental and medical conditions, use of high-risk medications, and body mass index. The area under the curve in the enhanced model was 0.705 (95% CI, 0.698-0.712) compared with 0.662 (95% CI, 0.656-0.669) in the Minnesota medical tiering-only model. New high-risk patients in the enhanced model were more likely to have lack of health insurance, presence of Medicaid, diagnosed depression, and prior ED utilization. An enhanced model including additional healthcare-related factors improved the prediction of risk of hospitalization or ED visit.

Splenic injuries at Bugando Medical Centre in northwestern Tanzania: a tertiary hospital experience

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2012-01-01

Background Splenic injuries constitute a continuing diagnostic and therapeutic challenge to the trauma or general surgeons practicing in developing countries where sophisticated imaging facilities are either not available or exorbitantly expensive. The purpose of this review was to describe our own experience in the management of the splenic injuries outlining the aetiological spectrum, injury characteristics and treatment outcome of splenic injuries in our local environment and to identify predictors of outcome among these patients. Methods A prospective descriptive study of splenic injury patients was carried out at Bugando Medical Centre in Northwestern Tanzania between March 2009 and February 2011. Statistical data analysis was done using SPSS software version 17.0. Results A total of 118 patients were studied. The male to female ratio was 6.4:1. Their ages ranged from 8 to 74 years with a median age of 22 years. The modal age group was 21-30 years. The majority of patients (89.8%) had blunt trauma and road traffic accidents (63.6%) were the most frequent cause of injuries. Most patients sustained grade III (39.0%) and IV (38.1%) splenic injuries. Majority of patients (86.4%) were treated operatively with splenectomy (97.1%) being the most frequently performed procedure. Postoperative complications were recorded in 30.5% of cases. The overall length of hospital stay (LOS) ranged from 1 day to 120 days with a median of 18 days. Mortality rate was 19.5%. Patients who had severe trauma (Kampala Trauma Score II ≤ 6) and those with associated injuries stayed longer in the hospital (P trauma scores (KTS II), grade of splenic injuries, admission systolic blood pressure ≤ 90 mmHg, estimated blood loss > 2000 mls, HIV infection with CD4 ≤ 200 cells/μl and presence of postoperative complications were significantly associated with mortality (P Trauma resulting from road traffic accidents (RTAs) remains the most common cause of splenic injuries in our setting. Most

Personalized mortality prediction driven by electronic medical data and a patient similarity metric.

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Lee, Joon; Maslove, David M; Dubin, Joel A

2015-01-01

Clinical outcome prediction normally employs static, one-size-fits-all models that perform well for the average patient but are sub-optimal for individual patients with unique characteristics. In the era of digital healthcare, it is feasible to dynamically personalize decision support by identifying and analyzing similar past patients, in a way that is analogous to personalized product recommendation in e-commerce. Our objectives were: 1) to prove that analyzing only similar patients leads to better outcome prediction performance than analyzing all available patients, and 2) to characterize the trade-off between training data size and the degree of similarity between the training data and the index patient for whom prediction is to be made. We deployed a cosine-similarity-based patient similarity metric (PSM) to an intensive care unit (ICU) database to identify patients that are most similar to each patient and subsequently to custom-build 30-day mortality prediction models. Rich clinical and administrative data from the first day in the ICU from 17,152 adult ICU admissions were analyzed. The results confirmed that using data from only a small subset of most similar patients for training improves predictive performance in comparison with using data from all available patients. The results also showed that when too few similar patients are used for training, predictive performance degrades due to the effects of small sample sizes. Our PSM-based approach outperformed well-known ICU severity of illness scores. Although the improved prediction performance is achieved at the cost of increased computational burden, Big Data technologies can help realize personalized data-driven decision support at the point of care. The present study provides crucial empirical evidence for the promising potential of personalized data-driven decision support systems. With the increasing adoption of electronic medical record (EMR) systems, our novel medical data analytics contributes to

Personalized mortality prediction driven by electronic medical data and a patient similarity metric.

Directory of Open Access Journals (Sweden)

Joon Lee

Full Text Available Clinical outcome prediction normally employs static, one-size-fits-all models that perform well for the average patient but are sub-optimal for individual patients with unique characteristics. In the era of digital healthcare, it is feasible to dynamically personalize decision support by identifying and analyzing similar past patients, in a way that is analogous to personalized product recommendation in e-commerce. Our objectives were: 1 to prove that analyzing only similar patients leads to better outcome prediction performance than analyzing all available patients, and 2 to characterize the trade-off between training data size and the degree of similarity between the training data and the index patient for whom prediction is to be made.We deployed a cosine-similarity-based patient similarity metric (PSM to an intensive care unit (ICU database to identify patients that are most similar to each patient and subsequently to custom-build 30-day mortality prediction models. Rich clinical and administrative data from the first day in the ICU from 17,152 adult ICU admissions were analyzed. The results confirmed that using data from only a small subset of most similar patients for training improves predictive performance in comparison with using data from all available patients. The results also showed that when too few similar patients are used for training, predictive performance degrades due to the effects of small sample sizes. Our PSM-based approach outperformed well-known ICU severity of illness scores. Although the improved prediction performance is achieved at the cost of increased computational burden, Big Data technologies can help realize personalized data-driven decision support at the point of care.The present study provides crucial empirical evidence for the promising potential of personalized data-driven decision support systems. With the increasing adoption of electronic medical record (EMR systems, our novel medical data analytics

'Smashed by the National Health'? A Closer Look at the Demise of the Pioneer Health Centre, Peckham.

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Conford, Philip

2016-04-01

The Pioneer Health Centre, based in South London before and after the Second World War, remains a source of interest for advocates of a positive approach to health promotion in contrast with the treatment of those already ill. Its closure in 1950 for lack of funds has been blamed on the then recently established National Health Service, but this article argues that such an explanation is over-simplified and ignores a number of other factors. The Centre had struggled financially during the 1930s and tried to gain support from the Medical Research Council. The Council appeared interested in the Centre before the war, but was less sympathetic in the 1940s. Around the time of its closure and afterwards, the Centre was also involved in negotiations with London County Council; these failed because the Centre's directors would not accept the changes which the Council would have needed to make. Unpublished documents reveal that the Centre's directors were uncompromising and that their approach to the situation antagonised their colleagues. Changes in medical science also worked against the Centre. The success of sulphonamide drugs appeared to render preventive medicine less significant, while the development of statistical techniques cast doubt on the Centre's experimental methods. The Centre was at the heart of the nascent organic farming movement, which opposed the rapid growth of chemical cultivation. But what might be termed 'chemical triumphalism' was on the march in both medicine and agriculture, and the Centre was out of tune with the mood of the times.

Using benchmarking to identify inter-centre differences in persistent ductus arteriosus treatment: can we improve outcome?

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Jansen, Esther J S; Dijkman, Koen P; van Lingen, Richard A; de Vries, Willem B; Vijlbrief, Daniel C; de Boode, Willem P; Andriessen, Peter

2017-10-01

The aim of this study was to identify inter-centre differences in persistent ductus arteriosus treatment and their related outcomes. Materials and methods We carried out a retrospective, multicentre study including infants between 24+0 and 27+6 weeks of gestation in the period between 2010 and 2011. In all centres, echocardiography was used as the standard procedure to diagnose a patent ductus arteriosus and to document ductal closure. In total, 367 preterm infants were included. All four participating neonatal ICU had a comparable number of preterm infants; however, differences were observed in the incidence of treatment (33-63%), choice and dosing of medication (ibuprofen or indomethacin), number of pharmacological courses (1-4), and the need for surgical ligation after failure of pharmacological treatment (8-52%). Despite the differences in treatment, we found no difference in short-term morbidity between the centres. Adjusted mortality showed independent risk contribution of gestational age, birth weight, ductal ligation, and perinatal centre. Using benchmarking as a tool identified inter-centre differences. In these four perinatal centres, the factors that explained the differences in patent ductus arteriosus treatment are quite complex. Timing, choice of medication, and dosing are probably important determinants for successful patent ductus arteriosus closure.

WaLIDD score, a new tool to diagnose dysmenorrhea and predict medical leave in university students

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Teherán, Aníbal A; Piñeros, Luis Gabriel; Pulido, Fabián; Mejía Guatibonza, María Camila

2018-01-01

Background Dysmenorrhea is a frequent and misdiagnosed symptom affecting the quality of life in young women. A working ability, location, intensity, days of pain, dysmenorrhea (WaLIDD) score was designed to diagnose dysmenorrhea and to predict medical leave. Methods This cross-sectional design included young medical students, who completed a self-administered questionnaire that contained the verbal rating score (VRS; pain and drug subscales) and WaLIDD scales. The correlation between scales was established through Spearman test. The area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, and likelihood ratio (LR +/−) were evaluated to diagnose students availing medical leave due to dysmenorrhea; moreover, to predict medical leave in students with dysmenorrhea, a binary logistic regression was performed. Results In all, 585 students, with a mean age of 21 years and menarche at 12 years, participated. Most of them had regular cycles, 5 days of menstrual blood flow and 1–2 days of lower abdominal pain. The WaLIDD scale presented an adequate internal consistency and strong correlation with VRS subscales. With a cutoff of >6 for WaLIDD and 2 for VRS subscales (drug subscale and pain subscale) to identify students with dysmenorrhea, these scales presented an area under the curve (AUC) ROC of 0.82, 0.62, and 0.67, respectively. To identify students taking medical leave due to dysmenorrhea, WaLIDD (cutoff >9) and VRS subscales (cutoff >2) presented an AUC ROC of 0.97, 0.68, and 0.81; moreover, the WaLIDD scale showed a good LR +14.2 (95% CI, 13.5–14.9), LR −0.00 (95% CI, undefined), and predictive risk (OR 5.38; 95% CI, 1.78–16.2). Conclusion This research allowed a comparison between two multidimensional scales regarding their capabilities, one previously validated and a new one, to discriminate among the general population of medical students, among those with dysmenorrhea or those availing medical leave secondary to dysmenorrhea

Children and adolescents admitted to a university-level trauma centre in Denmark 2002-2011

DEFF Research Database (Denmark)

Ekström, Danny Stefan; Hviid Larsen, Rasmus; Lauritsen, Jens Martin

2017-01-01

INTRODUCTION: The epidemiology of children or adolescents admitted to a Scandinavian trauma centre is largely unknown. The aim of this paper was to describe the epidemiology and severity of potentially severely injured children and adolescents admitted to a university hospital trauma centre....... METHODS: This was a descriptive study of all children and adolescents aged 0-17 admitted to the university level trauma centre at Odense University Hospital, Denmark in the 2002-2011 period. Data were extracted from the Southern Danish Trauma Register and from medical records. RESULTS: A total of 950...

On a turbulent wall model to predict hemolysis numerically in medical devices

Science.gov (United States)

Lee, Seunghun; Chang, Minwook; Kang, Seongwon; Hur, Nahmkeon; Kim, Wonjung

2017-11-01

Analyzing degradation of red blood cells is very important for medical devices with blood flows. The blood shear stress has been recognized as the most dominant factor for hemolysis in medical devices. Compared to laminar flows, turbulent flows have higher shear stress values in the regions near the wall. In case of predicting hemolysis numerically, this phenomenon can require a very fine mesh and large computational resources. In order to resolve this issue, the purpose of this study is to develop a turbulent wall model to predict the hemolysis more efficiently. In order to decrease the numerical error of hemolysis prediction in a coarse grid resolution, we divided the computational domain into two regions and applied different approaches to each region. In the near-wall region with a steep velocity gradient, an analytic approach using modeled velocity profile is applied to reduce a numerical error to allow a coarse grid resolution. We adopt the Van Driest law as a model for the mean velocity profile. In a region far from the wall, a regular numerical discretization is applied. The proposed turbulent wall model is evaluated for a few turbulent flows inside a cannula and centrifugal pumps. The results present that the proposed turbulent wall model for hemolysis improves the computational efficiency significantly for engineering applications. Corresponding author.

A student-centred electronic health record system for clinical education.

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Elliott, Kristine; Judd, Terry; McColl, Geoff

2011-01-01

Electronic Health Record (EHR) systems are an increasingly important feature of the national healthcare system [1]. However, little research has investigated the impact this will have on medical students' learning. As part of an innovative technology platform for a new masters level program in medicine, we are developing a student-centred EHR system for clinical education. A prototype was trialed with medical students over several weeks during 2010. This paper reports on the findings of the trial, which had the overall aim of assisting our understanding of how trainee doctors might use an EHR system for learning and communication in a clinical setting. In primary care and hospital settings, EHR systems offer potential benefits to medical students' learning: Longitudinal tracking of clinical progress towards established learning objectives [2]; Capacity to search across a substantial body of records [3]; Integration with online medical databases [3]; Development of expertise in creating, accessing and managing high quality EHRs [4]. While concerns have been raised that EHR systems may alter the interaction between teachers and students [3], and may negatively influence physician-patient communication [6], there is general consensus that the EHR is changing the current practice environment and teaching practice needs to respond. Final year medical students on clinical placement at a large university teaching hospital were recruited for the trial. Following a four-week period of use, semi-structured interviews were conducted with 10 participants. Audio-recorded interviews were transcribed and data analysed for emerging themes. Study participants were also surveyed about the importance of EHR systems in general, their familiarity with them, and general perceptions of sharing patient records. Medical students in this pilot study identified a number of educational, practical and administrative advantages that the student-centred EHR system offered over their existing ad

Shaken but prepared: Analysis of disaster response at an academic medical centre following the Boston Marathon bombings.

Science.gov (United States)

Osgood, Robert; Scanlon, Courtney; Jotwani, Rohan; Rodkey, Daniel; Arshanskiy, Maria; Salem, Deeb

Over the last decade, there has been a rise in the number of mass casualty incidences (MCIs) and their subsequent effect on hospital systems. While there has been much discussion over improving procedures to treat victims of MCIs, there has not been a thorough, systems-based analysis concerning the costs incurred by hospitals during such events. Here the authors examine the history of the Hospital Incident Command Center and how its evolution at Tufts Medical Center helped mitigate the damage following the Boston Marathon Bombings. Tufts' unique variations to the Hospital Incident Command Center include strategic communication hierarchies and a 'zero cost centre' financial system which both provided for a quick and adaptive response. Operating in collaboration with the Conference of Boston Teaching Hospitals encouraged coordination and preparation during emergency situations such as mass casualty events. The direct and indirect effects on Tufts Medical Center stemming from the Boston Marathon Bombings were analysed. Tufts MC treated 36 victims immediately following the MCI. The estimated total cost during the week of April 15 to April 19, 2013 was $776,051. The cost was primarily comprised of lost revenue from cancelled outpatient and inpatient hospital services, as well as expenses incurred due to overtime pay, salary expenses, PPE kits and hospitality services. Finally, the authors examine ways to reduce the future costs during emergency situations through increasing communication with employees, understanding the source of all direct expenses, and mitigating excess risk by developing partnerships with other hospital systems.

The Defence Medical Library Service and military medicine.

Science.gov (United States)

Walker, S B

2005-01-01

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

Experiences with the implementation of a national teaching qualification in university medical centres and veterinary medicine in the Netherlands.

Science.gov (United States)

Molenaar, Willemina M Ineke; Zanting, Anneke

2015-02-01

In 2008, a compulsory national basic teaching qualification was introduced for all university teachers in the Netherlands. At that time all eight University Medical Centres (UMCs) and the only Faculty of Veterinary Medicine had adopted or were setting up teacher development programmes. This study explores how these programmes relate to each other and to the basic teaching qualification. To gather information on teacher development programmes in the UMCs and the Veterinary Medicine Faculty an online survey was filled out by teacher development representatives from each of them. The programmes had main features in common (e.g. competency based and portfolio assessment), but differed somewhat in contents according to the local situation. Importantly, they had all been formally accepted as equivalent to the basic teaching qualification. We consider the freedom to tailor the qualifications to the medical context as well as to the local situation of the UMCs and the Veterinary Medicine Faculty one of the major success factors and the well-established collaboration between teacher development representatives of the UMCs and the Faculty of Veterinary Medicine as another. Challenges for the future include embedding the teacher development programmes in the institutional organizations and maintaining and further developing the programmes and the competencies of the qualified teachers, e.g. in a senior qualification.

Predicting United States Medical Licensure Examination Step 2 clinical knowledge scores from previous academic indicators

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Monteiro KA

2017-06-01

Full Text Available Kristina A Monteiro, Paul George, Richard Dollase, Luba Dumenco Office of Medical Education, The Warren Alpert Medical School of Brown University, Providence, RI, USA Abstract: The use of multiple academic indicators to identify students at risk of experiencing difficulty completing licensure requirements provides an opportunity to increase support services prior to high-stakes licensure examinations, including the United States Medical Licensure Examination (USMLE Step 2 clinical knowledge (CK. Step 2 CK is becoming increasingly important in decision-making by residency directors because of increasing undergraduate medical enrollment and limited available residency vacancies. We created and validated a regression equation to predict students’ Step 2 CK scores from previous academic indicators to identify students at risk, with sufficient time to intervene with additional support services as necessary. Data from three cohorts of students (N=218 with preclinical mean course exam score, National Board of Medical Examination subject examinations, and USMLE Step 1 and Step 2 CK between 2011 and 2013 were used in analyses. The authors created models capable of predicting Step 2 CK scores from academic indicators to identify at-risk students. In model 1, preclinical mean course exam score and Step 1 score accounted for 56% of the variance in Step 2 CK score. The second series of models included mean preclinical course exam score, Step 1 score, and scores on three NBME subject exams, and accounted for 67%–69% of the variance in Step 2 CK score. The authors validated the findings on the most recent cohort of graduating students (N=89 and predicted Step 2 CK score within a mean of four points (SD=8. The authors suggest using the first model as a needs assessment to gauge the level of future support required after completion of preclinical course requirements, and rescreening after three of six clerkships to identify students who might benefit from

Prediction of Mortality and Causes of Death in a Burn Centre: A Retrospective Clinical Study

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Celalettin Sever

2011-09-01

Full Text Available Aim: Mortality rates are important outcome parameters after burn. The causes of mortality have been reported differently in the literature. The aim of the study was to identify parameters that are predictive of major morbidity factors and risk of mortality in patients with burn injury. Material and Methods: This study was performed among the patients who admitted to the burn center period between December 2001 and June 2010. Within this period, demographic data, treatment, and outcomes of treatment were reviewed and analyzed. Results: The burn patients were analysed retrospectively during 9-years period between December 2001 and January 2010. Burns caused by scalding were the most frequent (69.7 % followed by flames (24.4 %. 4.30 % of the patients died because of multisystem organ failure, septicaemia and cardiac respiratory failure. Conclusions:The most common cause of mortality was multiorgan failure according to our study. The mortality rates and causes of burn centers should be investigated retrospectively between different burn centres to determine the most common cause of mortality in burn centers. 

Differential effects of two types of formative assessment in predicting performance of first-year medical students.

Science.gov (United States)

Krasne, Sally; Wimmers, Paul F; Relan, Anju; Drake, Thomas A

2006-05-01

Formative assessments are systematically designed instructional interventions to assess and provide feedback on students' strengths and weaknesses in the course of teaching and learning. Despite their known benefits to student attitudes and learning, medical school curricula have been slow to integrate such assessments into the curriculum. This study investigates how performance on two different modes of formative assessment relate to each other and to performance on summative assessments in an integrated, medical-school environment. Two types of formative assessment were administered to 146 first-year medical students each week over 8 weeks: a timed, closed-book component to assess factual recall and image recognition, and an un-timed, open-book component to assess higher order reasoning including the ability to identify and access appropriate resources and to integrate and apply knowledge. Analogous summative assessments were administered in the ninth week. Models relating formative and summative assessment performance were tested using Structural Equation Modeling. Two latent variables underlying achievement on formative and summative assessments could be identified; a "formative-assessment factor" and a "summative-assessment factor," with the former predicting the latter. A latent variable underlying achievement on open-book formative assessments was highly predictive of achievement on both open- and closed-book summative assessments, whereas a latent variable underlying closed-book assessments only predicted performance on the closed-book summative assessment. Formative assessments can be used as effective predictive tools of summative performance in medical school. Open-book, un-timed assessments of higher order processes appeared to be better predictors of overall summative performance than closed-book, timed assessments of factual recall and image recognition.

Phonons in face-centred cubic calcium and strontium

International Nuclear Information System (INIS)

Singh, S.P.; Rathore, R.P.S.

1984-01-01

The axially symmetric and unpaired forces are employed to analyse the phonon dispersion and elastic behaviour of face centred cubic calcium and strontium which have so far not been studied adequately. The model with three parameters predicts the results which agree marvellously with the recently measured data. (author)

Trauma treatment in a role 1 medical facility in Afghanistan

DEFF Research Database (Denmark)

Vedel, Pernille Nygaard; Helsø, I; Jørgensen, H L

2013-01-01

Most of the emergency care delivered in Afghanistan is currently provided by the military sector and non-governmental organisations. Main Operating Base (MOB) Price in Helmand Province has a small medical centre and due to its location provides critical care to civilians and military casualties a...... and this article describes the patterns in trauma patient care at the MOB Price medical centre regarding the types of patients and injuries....

Personalized Mortality Prediction Driven by Electronic Medical Data and a Patient Similarity Metric

Science.gov (United States)

Lee, Joon; Maslove, David M.; Dubin, Joel A.

2015-01-01

Background Clinical outcome prediction normally employs static, one-size-fits-all models that perform well for the average patient but are sub-optimal for individual patients with unique characteristics. In the era of digital healthcare, it is feasible to dynamically personalize decision support by identifying and analyzing similar past patients, in a way that is analogous to personalized product recommendation in e-commerce. Our objectives were: 1) to prove that analyzing only similar patients leads to better outcome prediction performance than analyzing all available patients, and 2) to characterize the trade-off between training data size and the degree of similarity between the training data and the index patient for whom prediction is to be made. Methods and Findings We deployed a cosine-similarity-based patient similarity metric (PSM) to an intensive care unit (ICU) database to identify patients that are most similar to each patient and subsequently to custom-build 30-day mortality prediction models. Rich clinical and administrative data from the first day in the ICU from 17,152 adult ICU admissions were analyzed. The results confirmed that using data from only a small subset of most similar patients for training improves predictive performance in comparison with using data from all available patients. The results also showed that when too few similar patients are used for training, predictive performance degrades due to the effects of small sample sizes. Our PSM-based approach outperformed well-known ICU severity of illness scores. Although the improved prediction performance is achieved at the cost of increased computational burden, Big Data technologies can help realize personalized data-driven decision support at the point of care. Conclusions The present study provides crucial empirical evidence for the promising potential of personalized data-driven decision support systems. With the increasing adoption of electronic medical record (EMR) systems, our

Centre of Excellence For Simulation Education and Innovation (CESEI).

Science.gov (United States)

Qayumi, A Karim

2010-01-01

Simulation is becoming an integral part of medical education. The American College of Surgeons (ACS) was the first organization to recognize the value of simulation-based learning, and to award accreditation for educational institutions that aim to provide simulation as part of the experiential learning opportunity. Centre of Excellence for Simulation Education and Innovation (CESEI) is a multidisciplinary and interprofessional educational facility that is based at the University of British Columbia (UBC) and Vancouver Costal Health Authority (VCH). Centre of Excellence for Simulation Education and Innovation's goal is to provide excellence in education, research, and healthcare delivery by providing a technologically advanced environment and learning opportunity using simulation for various groups of learners including undergraduate, postgraduate, nursing, and allied health professionals. This article is an attempt to describe the infrastructure, services, and uniqueness of the Centre of Excellence for Simulation Education and Innovation. Copyright 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Surveillance, Evaluation of Programmatic Management of Drug Resistant Tuberculosis (PMDT at DR-TB Centre, NITRD, New Delhi

Directory of Open Access Journals (Sweden)

Preeti Padda

2018-03-01

Full Text Available Background: PMDT was launched in 2007 in our country but drug resistant TB remains to be a public health problem. Effective surveillance is the backbone for success of any programme and true stands for PMDT. Aim & Objectives: To identify the strengths and constraints of the surveillance evaluation system. Material & Methods: A cross sectional study was conducted in January 2015 at DR-TB Centre of NITRD, New Delhi which caters to a population of 29 lacs. PMDT surveillance system was evaluated using attributes like simplicity, data quality, acceptability, positive predictive value, representativeness and timeliness defined by CDC, USA guidelines. Relevant information was collected using data abstraction form and interview with stakeholders. Data was analysed using EpiInfo 07 version. Results: Nodal officer and District TB officer are responsible for surveillance system activities of PMDT at DR-TB centre and district level, respectively. All the reports (100% were submitted on time and all the districts were reporting to DR-TB centre. 75% of TB-HIV coordinators found reporting formats to be simple but all the quarterly reports were found to be complete. Data quality was not found to be optimal. Conclusion: Private sector needs to be taken on board as they have no to minimal involvement in PMDT. For data quality improvement time to time training of medical officers and health workers should be organized.

Personality traits and types predict medical school stress: a six-year longitudinal and nationwide study.

Science.gov (United States)

Tyssen, Reidar; Dolatowski, Filip C; Røvik, Jan Ole; Thorkildsen, Ruth F; Ekeberg, Oivind; Hem, Erlend; Gude, Tore; Grønvold, Nina T; Vaglum, Per

2007-08-01

Personality types (combinations of traits) that take into account the interplay between traits give a more detailed picture of an individual's character than do single traits. This study examines whether both personality types and traits predict stress during medical school training. We surveyed Norwegian medical students (n = 421) 1 month after they began medical school (T1), at the mid-point of undergraduate Year 3 (T2), and at the end of undergraduate Year 6 (T3). A total of 236 medical students (56%) responded at all time-points. They were categorised according to Torgersen's personality typology by their combination of high and low scores on the 'Big Three' personality traits of extroversion, neuroticism and conscientiousness. We studied the effects of both personality types (spectator, insecure, sceptic, brooder, hedonist, impulsive, entrepreneur and complicated) and traits on stress during medical school. There was a higher level of stress among female students. The traits of neuroticism (P = 0.002) and conscientiousness (P = 0.03) were independent predictors of stress, whereas female gender was absorbed by neuroticism in the multivariate model. When controlled for age and gender, 'brooders' (low extroversion, high neuroticism, high conscientiousness) were at risk of experiencing more stress (P = 0.02), whereas 'hedonists' (high extroversion, low neuroticism, low conscientiousness) were more protected against stress (P = 0.001). This is the first study to show that a specific combination of personality traits can predict medical school stress. The combination of high neuroticism and high conscientiousness is considered to be particularly high risk.

Anonymising the Sparse Dataset: A New Privacy Preservation Approach while Predicting Diseases

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V. Shyamala Susan

2016-09-01

Full Text Available Data mining techniques analyze the medical dataset with the intention of enhancing patient’s health and privacy. Most of the existing techniques are properly suited for low dimensional medical dataset. The proposed methodology designs a model for the representation of sparse high dimensional medical dataset with the attitude of protecting the patient’s privacy from an adversary and additionally to predict the disease’s threat degree. In a sparse data set many non-zero values are randomly spread in the entire data space. Hence, the challenge is to cluster the correlated patient’s record to predict the risk degree of the disease earlier than they occur in patients and to keep privacy. The first phase converts the sparse dataset right into a band matrix through the Genetic algorithm along with Cuckoo Search (GCS.This groups the correlated patient’s record together and arranges them close to the diagonal. The next segment dissociates the patient’s disease, which is a sensitive value (SA with the parameters that determine the disease normally Quasi Identifier (QI.Finally, density based clustering technique is used over the underlying data to  create anonymized groups to maintain privacy and to predict the risk level of disease. Empirical assessments on actual health care data corresponding to V.A.Medical Centre heart disease dataset reveal the efficiency of this model pertaining to information loss, utility and privacy.

A survey of probiotic use practices among patients at a tertiary medical centre.

Science.gov (United States)

Draper, K; Ley, C; Parsonnet, J

2017-05-30

Probiotic use has skyrocketed in recent years. Little is known, however, about patient knowledge and practices regarding probiotic use, especially in the context of antibiotic use. An invitation to complete a short, anonymous, electronic survey was sent by email to 965 patients at a tertiary medical centre in California who had agreed to be contacted for participation in research studies. Questions were asked about both probiotic and antibiotic use in the prior three months. Of 333 survey respondents, 55% had recently used probiotics, including food products and/or supplements (90 and 60% of probiotic users, respectively). Women were more likely than men to have used probiotics (odds ratio (OR): 1.99; 95% confidence interval (CI): 1.2-3.4). Health care providers (HCP) had prescribed antibiotics to 79 (24%) respondents in the preceding three months. Among antibiotic users, 33% had initiated or changed probiotics at the time of antibiotic use, usually without a recommendation from their prescribing HCP (72%). Only 12% of those who took probiotics with antibiotics had received a specific recommendation from their HCP. Most patients chose to take probiotic mixtures (56%), with few selecting evidence-based strains, such as Lactobacillus rhamnosus GG (11%). Regular probiotic use among patients is common. Typically, these probiotics are not recommended by a HCP, even in conjunction with antibiotic prescriptions. While a growing body of evidence supports specific probiotic strains for the prevention of antibiotic-associated diarrhoea, patients are often not receiving a specific recommendation from their HCP and appear to be taking strains without guidance from supporting evidence.

Staff eye doses in a large medical centre in Saudi Arabia: are they meeting the new ICRP recommendations?

International Nuclear Information System (INIS)

Al-Haj, Abdalla N.; Al-Gain, Ibrahim; Lobriguito, Aida M.

2015-01-01

A 5-y retrospective analysis of the cardiology staff eye doses was performed on 34 staff from different categories (cardiologists, nurses and technologists) at King Faisal Specialist Hospital and Research Centre (KFSHRC) in Riyadh, Saudi Arabia. KFSHRC is a tertiary medical centre with 800-bed capacity having more than 5000 cardiac catheterisation procedures performed annually. The aim of the study is to derive staff doses to the lens of the eyes using the personal dose equivalent Hp(0.07) values from the annual TLD dose report for the years 2008-2012 and determine the category of staff with high estimated eye doses. The study also aims to investigate the causes for high doses and recommend dose-reduction techniques. The dose to the lens of the eye was estimated by using the ratio Hp(0.07) slab /H lens of 1.1 where Hp(0.07) values are the reported doses read from TLD badge worn at the collar level. The average annual eye dose of each category for the 5-y monitoring period was determined. Cardiologists tend to receive higher doses than the nurses by a factor of 2-4 and can exceed 5 mSv y -1 . No correlation exists between the eye doses of nurses and the cardiologists. There is a need to use a conversion coefficient in terms of eye lens dose per dose-area product for faster estimation of eye lens doses. However, there is a limitation on the use of the conversion coefficient because it will depend on the clinical procedure and the X-ray tube angulation. Further investigation on this limitation is needed. (authors)

Standard procedures for adults in accredited sleep medicine centres in Europe

DEFF Research Database (Denmark)

Fischer, Jürgen; Dogas, Zoran; Bassetti, Claudio L

2012-01-01

The present paper describes standardized procedures within clinical sleep medicine. As such, it is a continuation of the previously published European guidelines for the accreditation of sleep medicine centres and European guidelines for the certification of professionals in sleep medicine, aimed...... at creating standards of practice in European sleep medicine. It is also part of a broader action plan of the European Sleep Research Society, including the process of accreditation of sleep medicine centres and certification of sleep medicine experts, as well as publishing the Catalogue of Knowledge...... and Skills for sleep medicine experts (physicians, non-medical health care providers, nurses and technologists), which will be a basis for the development of relevant educational curricula. In the current paper, the standard operational procedures sleep medicine centres regarding the diagnostic...

Length of stay in asylum centres and mental health in asylum seekers

DEFF Research Database (Denmark)

Hallas, Peter; Hansen, Anne R; Staehr, Mia A

2007-01-01

BACKGROUND: The length of stay in asylum centres is generally mentioned as a possible health risk to asylum seekers. Medical staff working with asylum seekers has claimed that long lengths of stay in asylum centres might cause or aggravate mental disorders. We used records from a large, multiethnic...... specialists. If an asylum seeker needed more than three specialist consultations for mental illness or five consultations for physical illness the referrals had to be approved by The Danish Immigration Service. Between July 2001 - December 2002 the Red Cross prospectively registered health related data on all......: Length of stay in asylum centres was associated with an increase in referrals for mental disorders in a large, multiethnic group of asylum seekers. The present study supports the view that prolonged length of stay in an asylum centre is a risk factor for mental health. The risk of psychiatric illness...

Integrating gender into a basic medical curriculum.

NARCIS (Netherlands)

Verdonk, P.; Mans, L.J.L.; Lagro-Janssen, A.L.M.

2005-01-01

INTRODUCTION: In 1998, gaps were found to exist in the basic medical curriculum of the Radboud University Nijmegen Medical Centre regarding health-related gender differences in terms of biological, psychological and social factors. After screening the curriculum for language, content and context,

MEDICAL SERVICE - URGENT CALLS

CERN Multimedia

Service Médical

2000-01-01

IN URGENT NEED OF A DOCTOR GENEVA: EMERGENCY SERVICES GENEVA AND VAUD 144 FIRE BRIGADE 118 POLICE 117 CERN FIREMEN 767-44-44 ANTI-POISONS CENTRE Open 24h/24h 01-251-51-51 Patient not fit to be moved, call family doctor, or: GP AT HOME: Open 24h/24h 748-49-50 AMG- Association Of Geneva Doctors: Emergency Doctors at home 07h-23h 322 20 20 Patient fit to be moved: HOPITAL CANTONAL CENTRAL 24 Micheli-du-Crest 372-33-11 ou 382-33-11 EMERGENCIES 382-33-11 ou 372-33-11 CHILDREN'S HOSPITAL 6 rue Willy-Donzé 372-33-11 MATERNITY 32 bvd.de la Cluse 382-68-16 ou 382-33-11 OPHTHALMOLOGY 22 Alcide Jentzer 382-33-11 ou 372-33-11 MEDICAL CENTRE CORNAVIN 1-3 rue du Jura 345 45 50 HOPITAL DE LA TOUR Meyrin 719-61-11 EMERGENCIES 719-61-11 CHILDREN'S EMERGENCIES 719-61-00 LA TOUR MEDICAL CENTRE 719-74-00 European Emergency Call 112   FRANCE: EMERGENCY SERVICES 15 FIRE BRIGADE 18 POLICE 17 CERN FIREMEN AT HOME 00-41-22-767-44-44 ...

Predictive validity of the personal qualities assessment for selection of medical students in Scotland.

Science.gov (United States)

Dowell, Jon; Lumsden, Mary Ann; Powis, David; Munro, Don; Bore, Miles; Makubate, Boikanyo; Kumwenda, Ben

2011-01-01

The Personal Qualities Assessment (PQA) was developed to enhance medical student selection by measuring a range of non-cognitive attributes in the applicants to medical school. Applicants to the five Scottish medical schools were invited to pilot the test in 2001 and 2002. To evaluate the predictive validity of PQA for selecting medical students. A longitudinal cohort study was conducted in which PQA scores were compared with senior year medical school performance. Consent to access performance markers was obtained from 626 students (61.6% of 1017 entrants in 2002-2003). Linkable Foundation Year (4th) rankings were available for 411 (66%) students and objective structured clinical examination (OSCE) rankings for 335 (54%) of those consenting. Both samples were representative of the original cohort. No significant correlations were detected between separate elements of the PQA assessment and student performance. However, using the algorithm advocated by Powis et al. those defined as 'non-extreme' (libertarian-communitarian moral orientation scales were ranked higher in OSCEs (average of 7.5% or 25 out of 335, p = 0.049). This study was limited by high attrition and basic outcome markers which are insensitive to relevant non-cognitive characteristics. However, it is the largest currently available study of predictive validity for the PQA assessment. There was one finding of significance: that those students who were identified by PQA as 'not extreme' on the two personal characteristics scales performed better in an OSCE measure of professionalism. Futures studies are required since psychometric testing for both cognitive and non-cognitive attributes are increasingly used in admission process and these should include more and better measures of professionalism against which to correlate non-cognitive traits.

Money for nothing? The net costs of medical training.

Science.gov (United States)

Barros, Pedro P; Machado, Sara R

2010-09-01

One of the stages of medical training is the residency programme. Hosting institutions often claim compensation for the training provided. How much should this compensation be? According to our results, given the benefits arising from having residents among the house staff, no transfer (either tuition fee or subsidy) should be set to compensate the hosting institution for providing medical training. This paper quantifies the net costs of medical training, defined as the training costs over and above the wage paid. We jointly consider two effects. On the one hand, residents take extra time and resources from both the hosting institution and the supervisor. On the other hand, residents can be regarded as a less expensive substitute to nurses and/or graduate physicians, in the production of health care, both in primary care centres and hospitals. The net effect can be either positive or negative. We use the fact that residents, in Portugal, are centrally allocated to National Health Service hospitals to treat them as a fixed exogenous production factor. The data used comes from Portuguese hospitals and primary care centres. Cost function estimates point to a small negative marginal impact of residents on hospitals' (-0.02%) and primary care centres' (-0.9%) costs. Nonetheless, there is a positive relation between size and cost to the very large hospitals and primary care centres. Our approach to estimation of residents' costs controls for other teaching activities hospitals might have (namely undergraduate Medical Schools). Overall, the net costs of medical training appear to be quite small.

Medical physics education and training activities in India

International Nuclear Information System (INIS)

Kumar, Munish; Gomathi, K.; Sharma, S.D.; Chourasiya, G.; Mayya, Y.S.; Sahani, G.; Sharma Dash, P.K.; Agarwal, S.P.

2008-01-01

Since the discovery of x-rays and radioactivity, ionising radiations are finding extensive applications in human health care programmes worldwide. X-rays are being used in India for various applications since 1898. Further the establishment of Tata Memorial Hospital in 1941, as a centre for the treatment of cancer was the stepping-stone for medical physics in India with Dr. Ramaiah Naidu as the first medical physicist. Since then, the field of medical physics has made a tremendous progress. At cancer treatment centre, medical physicist cum RSO is required not only to ensure and maintain quality of radiation treatment by ensuring quality assurance, treatment planning and resonance with radiation oncologist but also acts as a bridge between the cancer treatment centre and regulatory authority (AERB) and also ensures radiation safety. Currently there are around 399 teletherapy units (280 telecobalt and 119 medical linear accelerator) in our country and the number is further likely to increase in future due to i) More awareness about cancer and prevalence of around 1 million new cancer cases per year and ii) The indigenous production of telecobalt and linear accelerator units has brought down the cost. In fact in India, there is a need of more than 1000 teletherapy units. In view of above, well-trained and qualified medical physicists are required. In this paper, various educational and training activities in India are described. The paper also casts light on growing demands for starting M.Phil and Ph.D. degrees in medical physics in India

Medical procedures in the event of nuclear power plant accidents. Guidelines for: Medical consultants for emergency response commander; physicians in emergency care centres; physicians in outpatient and inpatient care

International Nuclear Information System (INIS)

Genkel, Simone

2008-01-01

The author of the contribution under consideration reports on medical procedures in the event of nuclear power plant accidents. This contribution consists of the following sections: protective measures, tasks of radiation protection physicians, emergency care centres. It has been pointed out that differentiation of the hospitals is acquired which accept radiation accident patients. However, only a small number of hospitals will be able to professionally treat patients with suspected gastrointestinal or pronounced (muco)cutaneous type of hospitals with haemotological-oncological departments. Thus they should be able to treat patients who have been exposed to radiation doses between 1 and 6 Gy without any difficulties. Even larger is the number of hospitals which can accept patients who were exposed to a radiation dose of less than 1 Gy, but suffer from other complicating diseases (injuries, general diseases)

Early experience with open heart surgery in a pioneer private hospital in West Africa: the Biket medical centre experience.

Science.gov (United States)

Onakpoya, Uvie Ufuoma; Adenle, Adebisi David; Adenekan, Anthony Taiwo

2017-01-01

More than forty years after the first open heart surgery in Nigeria, all open heart surgeries were carried out in government-owned hospitals before the introduction of such surgeries in 2013 at Biket Medical Centre, a privately owned hospital in Osogbo, South-western Nigeria. The aim of this paper is to review our initial experience with open heart surgery in this private hospital. All patients who underwent open heart surgery between August 2013 and January 2014 were included in this prospective study. The medical records of the patients were examined and data on age, sex, diagnosis, type of surgery, cardiopulmonary bypass details, complications and length of hospital stay were extracted and the data was analysed using SPSS version 16. Eighteen patients comprising of 12 males and 6 females with ages ranging between 8 months and 52 years (mean= of 15.7 +/- 15 years) were studied. Pericardial patch closure of isolated ventricular septal defect was done in 7 patients (38.9%) while total correction of isolated tetralogy of Fallot was carried out in 5 patients (27.8%). Two patients had mitral valve repair for rheumatic mitral regurgitation. Sixty day mortality was 0%. Safe conduct of open heart surgery in the private hospital setting is feasible in Nigeria. It may be our only guarantee of hitch free and sustainable cardiac surgery.

Egyptian Journal of Medical Laboratory Sciences

African Journals Online (AJOL)

The main objective of this journal is to cover all aspects of medical laboratory science. Contributions are received from staff members of academic, basic and laboratory science departments of the different medical schools and research centres all over Egypt and it fulfils a real need amongst Egyptian doctors working in the ...

[Approaches to development and implementation of the medical information system for military-medical commission of the multidisciplinary military-medical organisation].

Science.gov (United States)

Kuvshinov, K E; Klipak, V M; Chaplyuk, A L; Moskovko, V M; Belyshev, D V; Zherebko, O A

2015-06-01

The current task of the implementation of medical information systems in the military and medical organizations is an automation of the military-medical expertise as one of the most important activities. In this regard, noteworthy experience of the 9th Medical Diagnostic Centre (9th MDC), where on the basis of medical information system "Interi PROMIS" for the first time was implemented the automation of the work of military medical commission. The given paper presents an algorithm for constructing of the information system for the military-medical examination; detailed description of its elements is given. According to military servicemen the implementation of the Military Medical Commission (MMC) subsystem of the medical information system implemented into the 9th MDC has reduced the time required for the MMC and paperwork, greatly facilitate the work of physicians and medical specialists on military servicemen examination. This software can be widely applied in ambulatory and hospital practice, especially in case of mass military-medical examinations.

Length of stay in asylum centres and mental health in asylum seekers: a retrospective study from Denmark

OpenAIRE

Hallas, Peter; Hansen, Anne R; St?hr, Mia A; Munk-Andersen, Ebbe; Jorgensen, Henrik L

2007-01-01

Abstract Background The length of stay in asylum centres is generally mentioned as a possible health risk to asylum seekers. Medical staff working with asylum seekers has claimed that long lengths of stay in asylum centres might cause or aggravate mental disorders. We used records from a large, multiethnic group of asylum seekers to study if the incidence of mental disorders increased with length of stay. Methods The study population was asylum seekers in Danish asylum centres run by the Dani...

Possibilities for Hospital Treatment of Industrial Accident Victims in Military Medical Academy

International Nuclear Information System (INIS)

Todorovic, V.; Jevtic, M.; Jovanovic, D.; Jovic-Stosic, J.

2007-01-01

Possibility of mass injuries in traffic, industrial accidents or terrorist attack is every day reality. Management of victims may need complex measures including activities on the site, transportation, and hospital care. Preparedness for hospital treatment of mass trauma or poisoning is among the main duties of Military Medical Academy (MMA). It is medical institution of tertiary level with the capacity of 1214 beds in 13 surgical clinics, 12 internal medicine clinics, 2 neuropsychiatry clinics, poison control centre and organ transplantation centre. National Poison Control Centre is the only specialized institution for treatment of adult's acute poisonings in the country. Centre includes: 1. Clinic of Toxicology and Clinical Pharmacology with Intensive Care Unit and Toxicology Information Department; 2. Institute of Experimental Toxicology and Pharmacology; 3. Mobile Toxicological - Chemical Squad. Being a part of MMA, Centre benefits from all advantages of central type hospital, including possibilities for contemporary diagnostic and therapeutic procedures of different specialities, and other necessary medical and logistic support. Except hospital organization and preparedness for admission of mass injuries victims, one of strategic goals of MMA is functional integration in civilian health care system including more detailed planning for collaboration in case of chemical accidents.(author)

Data analysis in medical education research : a multilevel perspective

NARCIS (Netherlands)

Leppink, Jimmie

A substantial part of medical education research focuses on learning in teams (e.g., departments, problem-based learning groups) or centres (e.g., clinics, institutions) that are followed over time. Individual students or employees sharing the same team or centre tend to be more similar in learning

Unhappiness and dissatisfaction in doctors cannot be predicted by selectors from medical school application forms: A prospective, longitudinal study

Directory of Open Access Journals (Sweden)

Ferguson E

2005-12-01

Full Text Available Abstract Background Personal statements and referees' reports are widely used on medical school application forms, particularly in the UK, to assess the suitability of candidates for a career in medicine. However there are few studies which assess the validity of such information for predicting unhappiness or dissatisfaction with a career in medicine. Here we combine data from a long-term prospective study of medical student selection and training, with an experimental approach in which a large number of assessors used a paired comparison technique to predict outcome. Methods Data from a large-scale prospective study of students applying to UK medical schools in 1990 were used to identify 40 pairs of doctors, matched by sex, for whom personal statements and referees' reports were available, and who in a 2002/3 follow-up study, one pair member was very satisfied and the other very dissatisfied with medicine as a career. In 2005, 96 assessors, who were experienced medical school selectors, doctors, medical students or psychology students, used information from the doctors' original applications to judge which member of each pair of doctors was the happier, more satisfied doctor. Results None of the groups of assessors were significantly different from chance expectations in using applicants' personal statements and the referees' reports to predict actual future satisfaction or dissatisfaction, the distribution being similar to binomial expectations. However judgements of pairs of application forms from pairs of doctors showed a non-binomial distribution, indicating consensus among assessors as to which doctor would be the happy doctor (although the consensus was wrong in half the cases. Assessors taking longer to do the task concurred more. Consensus judgements seem mainly to be based on referees' predictions of academic achievement (even though academic achievement is not actually a valid predictor of happiness or satisfaction. Conclusion

Headache associated disability in medical students at the Kenyatta ...

African Journals Online (AJOL)

Objective: To study headache associated disability in a group of medical students at the Kenyatta National Hospital. Study design: Cross sectional survey. Results: Between October 1994 and January 1995 we conducted a survey on headache characteristics on medical students at both the Kenya Medical Training Centre ...

Evaluation of telemedicine centres in Madhya Pradesh, Central India.

Science.gov (United States)

Bali, Surya; Gupta, Arti; Khan, Asif; Pakhare, Abhijit

2016-04-01

In a developing country such as India, there is substantial inequality in health care distribution. Telemedicine facilities were established in Madhya Pradesh in 2007-2008. The purpose of this study was to evaluate the infrastructure, equipment, manpower, and functional status of Indian Space and Research Organisation (ISRO) telemedicine nodes in Madhya Pradesh. All district hospitals and medical colleges with nodes were visited by a team of three members. The study was conducted from December 2013-January 2014. The team recorded the structural facility situation and physical conditions on a predesigned pro forma. The team also conducted interviews with the nodal officers, data entry operator and other relevant people at these centres. Of the six specialist nodes, four were functional and two were non-functional. Of 10 patient nodes, two nodes were functional, four were semi-functional and four were non-functional. Most of the centres were not working due to a problem with their satellite modem. The overall condition of ISRO run telemedicine centres in Madhya Pradesh was found to be poor. Most of these centres failed to provide telemedicine consultations. We recommend replacing this system with another cost effective system available in the state wide area network (SWAN). We suggest the concept of the virtual out-patient department. © The Author(s) 2015.

Characteristics predicting laparoscopic skill in medical students: nine years' experience in a single center.

Science.gov (United States)

Nomura, Tsutomu; Matsutani, Takeshi; Hagiwara, Nobutoshi; Fujita, Itsuo; Nakamura, Yoshiharu; Kanazawa, Yoshikazu; Makino, Hiroshi; Mamada, Yasuhiro; Fujikura, Terumichi; Miyashita, Masao; Uchida, Eiji

2018-01-01

We introduced laparoscopic simulator training for medical students in 2007. This study was designed to identify factors that predict the laparoscopic skill of medical students, to identify intergenerational differences in abilities, and to estimate the variability of results in each training group. Our ultimate goal was to determine the optimal educational program for teaching laparoscopic surgery to medical students. Between 2007 and 2015, a total of 270 fifth-year medical students were enrolled in this observational study. Before training, the participants were asked questions about their interest in laparoscopic surgery, experience with playing video games, confidence about driving, and manual dexterity. After the training, aspects of their competence (execution time, instrument path length, and economy of instrument movement) were assessed. Multiple regression analysis identified significant effects of manual dexterity, gender, and confidence about driving on the results of the training. The training results have significantly improved over recent years. The variability among the results in each training group was relatively small. We identified the characteristics of medical students with excellent laparoscopic skills. We observed educational benefits from interactions between medical students within each training group. Our study suggests that selection and grouping are important to the success of modern programs designed to train medical students in laparoscopic surgery.

East African Medical Journal - Vol 78, No 3 (2001)

African Journals Online (AJOL)

HIV infection in elderly medical patients · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT ... Dental caries and periodontal conditions among primary school children in ... Epidemiology of injury patients at Bugando Medical centre, Tanzania ...

Evaluation of risk factors in acute myocardial infarction patients admitted to the coronary care unit, Tripoli Medical Centre, Libya.

Science.gov (United States)

Abduelkarem, A R; El-Shareif, H J; Sharif, S I

2012-04-01

The aim of this study was to provide an overview of the risk factors for acute myocardial infarction in patients attending Tripoli Medical Centre, Libya. Records were reviewed for 622 patients with a mean age of 58.3 (SD 12.9) years. Diabetes mellitus (48.2%), hypertension (35.7%) and smoking (50.6%) were among the risk factors reported. There were 110 patients (17.7%) who died during hospitalization, mainly suffering cardiogenic shock (48.0%). The rate of use of thrombolytic therapy was low in patients who were female (40.4% versus 58.4% for males), older age (31.6% for those > 85 years versus 63.3% for patients < 55 years), diabetics (45.3% versus 62.0% for non-diabetic patients) and hypertensives (47.3% versus 57.8% for non-hypertensive patients). Prevention strategies should be implemented in order to improve the long-term prognosis and decrease overall morbidity and mortality from coronary artery disease in Libyan patients.

Learning patient-centred communication: The journey and the territory.

Science.gov (United States)

Cushing, Annie M

2015-10-01

The student entering medical school is about to undergo a socialisation process that profoundly shapes their development as a professional. A central feature is the formal and informal curriculum on the doctor-patient relationship and patient-centred communication. In this paper I will chart some of the features of the student journey which might impact on learning and practice. The medical undergraduate's role is largely that of observer and learner, rather than a provider of care, so much of the formal teaching on patient-centred communication is within simulated practice. Clinical practice environments are the most powerful influences on learning about professional behaviour. Challenges for educational practitioners include how to support authenticity in learners, respond to their agendas, and foster insight to enable flexibility about communication in different contexts. Parallels between the doctor-patient relationship and the student-tutor relationship are explored for their relevance. A number of educational theories can inform curriculum design and educational practice, notably Vygotsky's Zone of Proximal Development. Application of this and other social learning theories, together with students' reflections can enrich our planning of educational interventions and understanding of their impact. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Risk factors for prostate cancer in Universiti Kebangsaan Malaysia Medical Centre: a case-control study.

Science.gov (United States)

Subahir, Mohd Nizam; Shah, Shamsul Azhar; Zainuddin, Zulkifli Md

2009-01-01

In Malaysia, prostate cancer is ranked 6th among male cancer and expected to increase in the future. Several factors have shown to be related to prostate cancer such as sociodemographic, lifestyle, diet, occupational exposure, medical and health status. This is the first time a similar study was conducted in Malaysia to recognize the risk factors for prostate cancer patients who came for treatment at University Kebangsaan Malaysia Medical Centre (UKMMC). Prostate cancer cases diagnosed between 2003 and 2008 which met with the inclusion criteria were included in the study. One hundred and twelfth (112) pairs of cases and controls matched by age and ethnicity were analysed. McNemar Odds Ratios (OR(M)) were calculated using McNemar Calculator software for univariate analysis while conditional logistic regression was used for multivariate analysis, both using SPSS version 12.0. Most of the prostate cancer patients (68.8%) that came for treatment in UKMMC were above 70 years old. The majority were Chinese (50.0%) followed by Malay (46.4%) and Indian (3.6%). Multivariate analysis showed cases were more likely to have a first-degree relative with a history of cancer (OR= 3.77, 95% CI= 1.19-11.85), to have been exposed to pesticides (OR= 5.57, 95% CI= 1.75-17.78) and consumed more meat (OR= 12.23, 95% CI= 3.89-39.01). Significantly reduced risks of prostate cancer were noted among those consuming more vegetables (OR= 0.12, 95% CI= 0.02-0.84), more tomatoes (OR= 0.35, 95% CI= 0.13-0.93) and those who had frequent sexual intercourse (OR= 0.44, 95% CI= 0.19-0.96). Some lifestyle and occupation factors are strong predictors of the occurrence of prostate cancer among patients in UKMMC. More importantly, with the identification of the potentially modifiable risk factors, proper public health intervention can be improved.

Cognitive task load in a naval ship control centre : from identification to prediction

NARCIS (Netherlands)

Grootjen, M.; Neerincx, M.A.; Grootjen, M.; Veltman, J.

2006-01-01

Deployment of information and communication technology will lead to further automation of control centre tasks and an increasing amount of information to be processed. A method for establishing adequate levels of cognitive task load for the operators in such complex environments has been developed.

Establishment of a South African nuclear science exhibition centre

Energy Technology Data Exchange (ETDEWEB)

Lekwe, K.G.; Stander, G.; Faanhof, A. [South African Nuclear Energy Cooperation, P O Box 582, Pretoria (South Africa)

2008-07-01

After an initial survey undertaken by the South African Nuclear Energy Corporation (Necsa), one of the findings was that nuclear knowledge is virtually non-existent amongst the general public, including school children, throughout the country. The Department of Education (DoE) is currently in the process of introducing Nuclear as part of the school curriculum, which would require a collective effort between the schools and all the Nuclear Institutions in the country. Necsa as well as other nuclear industries have the responsibility to promote public awareness, appreciation and understanding of science and nuclear science in particular. Necsa is leading the national initiative to establish the nuclear science centre which would amongst others guide a person from the very basics of nuclear science to present and future applications thereof. The nuclear science centre will include information on the SAFARI-1 reactor, the Koeberg power reactor, the Pebble Bed Modular Reactor (PBMR), particle accelerators, food preservation, medical applications, etc. This paper will give the overview of the centre as well as its objectives thereof. (authors)

Establishment of a South African nuclear science exhibition centre

International Nuclear Information System (INIS)

Lekwe, K.G.; Stander, G.; Faanhof, A.

2008-01-01

After an initial survey undertaken by the South African Nuclear Energy Corporation (Necsa), one of the findings was that nuclear knowledge is virtually non-existent amongst the general public, including school children, throughout the country. The Department of Education (DoE) is currently in the process of introducing Nuclear as part of the school curriculum, which would require a collective effort between the schools and all the Nuclear Institutions in the country. Necsa as well as other nuclear industries have the responsibility to promote public awareness, appreciation and understanding of science and nuclear science in particular. Necsa is leading the national initiative to establish the nuclear science centre which would amongst others guide a person from the very basics of nuclear science to present and future applications thereof. The nuclear science centre will include information on the SAFARI-1 reactor, the Koeberg power reactor, the Pebble Bed Modular Reactor (PBMR), particle accelerators, food preservation, medical applications, etc. This paper will give the overview of the centre as well as its objectives thereof. (authors)

The epidemology of burn injuries of children and the importance of modern burn centre

Directory of Open Access Journals (Sweden)

Janez Mohar

2007-01-01

Full Text Available Background: Burns represent the major percentage of injuries to children. Their incidence level, injury mechanisms and treatment often differ from the burn injuries of adults.Methods: From the medical records of the Department for Plastic and Reconstructive Surgery of the Ljubljana Medical Centre we gathered, analyzed and compared the burn injuries of children up to the age of 15 who were admitted to hospital in the year 2003 to those who were treated as outpatients. Moreover, we compared the burn injuries of hospitalized children at the same department in the years 2003, 1993 and 1983 respectively. We compared their gender, age, the total body surface area of burns, the depth of burns, frequency of the mechanisms of injury, the affected parts of the body and the length and mode of treatment. Finally, we compared our results with the results of similar studies from other burn centres.Results: The number of children treated for burns at the department has declined. In all the years studied, the injured children were younger than 5 and the majority of them were boys. The number of children admitted with substantial total body surface areas of burns was also declining. However, there was an increase in the number of children admitted with burns less than 10 % of their total body surface area. The number of burns treated by surgery slightly increased over the years studied. There was a similar sex and age distribution among the hospitalized children and those treated as outpatients.Conclusions: The number of children hospitalized with burns is in decline. In the years 1983, 1993 and 2003, there was no significant difference in the percentage of children who were treated surgically and those who were treated conservatively (P = 0.247. The Burn Centre at the Department for Plastic and Reconstructive Surgery of the Ljubljana Medical Centre which together with the Burn Department of the Maribor General Hospital covers the population of two million

Inclusion of persons with mental illness in patient-centred medical homes: cross-sectional findings from Ontario, Canada.

Science.gov (United States)

Steele, Leah S; Durbin, Anna; Sibley, Lyn M; Glazier, Richard

2013-01-01

In Ontario, Canada, the patient-centred medical home is a model of primary care delivery that includes 3 model types of interest for this study: enhanced fee-for-service, blended capitation, and team-based blended capitation. All 3 models involve rostering of patients and have similar practice requirements but differ in method of physician reimbursement, with the blended capitation models incorporating adjustments for age and sex, but not case mix, of rostered patients. We evaluated the extent to which persons with mental illness were included in physicians' total practices (as rostered and non-rostered patients) and were included on physicians' rosters across types of medical homes in Ontario. Using population-based administrative data, we considered 3 groups of patients: those with psychotic or bipolar diagnoses, those with other mental health diagnoses, and those with no mental health diagnoses. We modelled the prevalence of mental health diagnoses and the proportion of patients with such diagnoses who were rostered across the 3 medical home model types, controlling for demographic characteristics and case mix. Compared with enhanced fee-for-service practices, and relative to patients without mental illness, the proportions of patients with psychosis or bipolar disorders were not different in blended capitation and team-based blended capitation practices (rate ratio [RR] 0.91, 95% confidence interval [CI] 0.82-1.01; RR 1.06, 95% CI 0.96-1.17, respectively). However, there were fewer patients with other mental illnesses (RR 0.94, 95% CI 0.90-0.99; RR 0.89, 95% CI 0.85-0.94, respectively). Compared with expected proportions, practices based on both capitation models were significantly less likely than enhanced fee-for-service practices to roster patients with psychosis or bipolar disorders (for blended capitation, RR 0.92, 95% CI 0.90-0.93; for team-based capitation, RR 0.92, 95% CI 0.88-0.93) and also patients with other mental illnesses (for blended capitation

Manche centre

International Nuclear Information System (INIS)

1997-05-01

After a general presentation of radioactivity and radioactive wastes and of the French national agency for the management of radioactive wastes (ANDRA), this brochure gives a general overview of the Manche low- and medium-level radioactive waste disposal centre: principles of storage safety, waste containers (first confinement barrier), storage facility and cover (second confinement barrier), the underground (third confinement barrier), the impact of the centre on its environment, and the control of radioactivity in the vicinity of the centre. (J.S.)

A profile of traumatic spinal cord injury and medical complications in Latvia

OpenAIRE

Nulle, Anda; Tjurina, Uljana; Erts, Renars; Vetra, Anita

2017-01-01

Study design A single centre retrospective study. Objectives To collect data and analyse the epidemiological profile of traumatic spinal cord injury and its medical complications during the subacute rehabilitation period. Setting Spinal Cord Injury Rehabilitation Programme of the National Rehabilitation Centre, ‘Vaivari’, Jurmala, Latvia. Methods Information was collected in 2015 from the medical records of 134 patients with a traumatic spinal cord injury admitted for primary rehabilitation b...

Supporting medical students with learning disabilities in Asian medical schools

Directory of Open Access Journals (Sweden)

Md. Anwarul Azim Majumder

2010-10-01

Full Text Available Md. Anwarul Azim Majumder1, Sayeeda Rahman2, Urban JA D’Souza3, Gad Elbeheri4, Khalid Bin Abdulrahman5, M Muzaherul Huq61,2Department of Clinical Sciences, School of Life Sciences, University of Bradford, West Yorkshire, Bradford, UK; 3School of Medicine, University Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia; 4Centre for Child Evaluation and Teaching, Kuwait; 5College of Medicine, Al-Imam University, Riyadh, Saudi Arabia; 6Centre for Medical Education (CME, Mohakhali, Dhaka, BangladeshAbstract: Learning disabilities (LDs represent the largest group of disabilities in higher education (HE institutes, including medical schools, and the numbers are continuing to rise. The worrying concern is that two-thirds to half of these students with LDs remain undiagnosed when they start their undergraduate education and may even graduate without having their disabilities diagnosed. These students struggle with their academic abilities, receive poor grades and, as a result, develop lower perceptions of their intellectual abilities than do those students without LDs. All these ultimately hamper their professional practice, employment, and career progression. Appropriate and adequate educational policies, provisions, and practices help students to progress satisfactorily. In Asian countries, public and professional awareness about LDs is low, supportive provisions are limited, legislations are inadequate, data are scarce, and equal-opportunity/widening-participation policies are not implemented effectively in the HE sector. This article discusses the issues related to LDs in medical education and draws policy, provision, and practice implications to identify, assess, and support students with LDs in medical schools, particularly in an Asian context.Keywords: medical education, learning disabilities, dyslexia, Asia

Implementation of the ALERT algorithm, a new dispatcher-assisted telephone cardiopulmonary resuscitation protocol, in non-Advanced Medical Priority Dispatch System (AMPDS) Emergency Medical Services centres.

Science.gov (United States)

Stipulante, Samuel; Tubes, Rebecca; El Fassi, Mehdi; Donneau, Anne-Francoise; Van Troyen, Barbara; Hartstein, Gary; D'Orio, Vincent; Ghuysen, Alexandre

2014-02-01

Early bystander cardiopulmonary resuscitation (CPR) is a key factor in improving survival from out-of-hospital cardiac arrest (OHCA). The ALERT (Algorithme Liégeois d'Encadrement à la Réanimation par Téléphone) algorithm has the potential to help bystanders initiate CPR. This study evaluates the effectiveness of the implementation of this protocol in a non-Advanced Medical Priority Dispatch System area. We designed a before and after study based on a 3-month retrospective assessment of victims of OHCA in 2009, before the implementation of the ALERT protocol in Liege emergency medical communication centre (EMCC), and the prospective evaluation of the same 3 months in 2011, immediately after the implementation. At the moment of the call, dispatchers were able to identify 233 OHCA in the first period and 235 in the second. Victims were predominantly male (59%, both periods), with mean ages of 64.1 and 63.9 years, respectively. In 2009, only 9.9% victims benefited from bystander CPR, this increased to 22.5% in 2011 (p<0.0002). The main reasons for protocol under-utilisation were: assistance not offered by the dispatcher (42.3%), caller physically remote from the victim (20.6%). Median time from call to first compression, defined here as no flow time, was 253s in 2009 and 168s in 2011 (NS). Ten victims were admitted to hospital after ROSC in 2009 and 13 in 2011 (p=0.09). From the beginning and despite its under-utilisation, the ALERT protocol significantly improved the number of patients in whom bystander CPR was attempted. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Evaluation of current care effectiveness: a survey of hypertension guideline implementation in Finnish health centres

DEFF Research Database (Denmark)

Alanen, Seija I; Johannala-Kemppainen, Riitta; Ijäs, Jarja J

2007-01-01

OBJECTIVE: To assess the extent and style of implementation of the Hypertension Guideline (HT Guideline) in Finnish primary health centres, and to identify a scale of contrasting implementation styles in the health centres (with the two ends of the scale being referred to as information...... implementers or disseminators respectively). DESIGN: A cross-sectional study. Development of a questionnaire and criteria for assessing the extent and style of implementation of the HT Guideline. SETTING: Primary healthcare. SUBJECTS: All head physicians and senior nursing officers in Finnish health centres (n...... =290). MAIN OUTCOME MEASURES: The extent of adoption of the HT Guideline in health centres and the characteristics associated with the implementation style. RESULTS: Responses were received from 410 senior medical staff (246 senior nursing officers and 164 head physicians) representing altogether 264...

Does non-medical prescribing make a difference to patients?

Science.gov (United States)

Carey, Nicola; Stenner, Karen

This article examines the literature on non-medical prescribing to establish its impact on UK healthcare. It discusses how better access to medication through non-medical prescribing can improve patient safety and patient-centred care, and how nurse prescribing can help ensure quality of care in the NHS during the current financial crisis.

[The use of medical journals by medical students. Which medical journals are read?].

Science.gov (United States)

Algra, Annemijn M; Dekker, Friedo W

2015-01-01

To investigate the role of scientific medical journals in Dutch medical curricula. Descriptive questionnaire study. In 2013, medical students (from year 3 onwards) at the Leiden University Medical Centre (LUMC), were invited to respond to an online questionnaire. They were presented with 28 multiple-choice questions and 11 statements about the use of scientific medical journals in the medical curriculum. We calculated the frequencies of the answers per question and analysed differences between medical students using two-by-two tables. The questionnaire was completed by 680 (53.0%) of 1277 invited medical students enrolled at the LUMC. Most of the respondents were those doing clinical rotations (56.6%) and 60.1% had research experience. More than half of the students read at least one scientific journal a few times per month; this percentage was 38.8% among third-year students, 49.3% among fourth-year students, 60.0% among those on clinical rotation, and was higher among students with research experience (63.3%) than among those without research experience (44.1%). Nearly 90% of students agreed with the statement that the development of academic and scientific education should take place in the bachelor's phase of medical school. Medical students start to read scientific medical journals at an early phase in the medical curriculum and this increases further when students start to undertake research projects or go on clinical rotation. Medical curricula should be constructed in such a way that medical students learn to select and interpret research findings adequately for themselves before they turn to articles from scientific medical journals.

Prediction of late failure after medical abortion from serial beta-hCG measurements and ultrasonography

DEFF Research Database (Denmark)

Rørbye, C; Nørgaard, M; Nilas, Lisbeth

2004-01-01

BACKGROUND: Surgical treatment of failed medical abortion may be performed several weeks after initiation of the abortion. There are no recognized methods for early identification of these late failures. We assessed the prognostic values of beta-hCG and ultrasonography in predicting late failure ...

The ideal Atomic Centre; Le Centre Atomique ideal

Energy Technology Data Exchange (ETDEWEB)

Mas, R [Commissariat a l' Energie Atomique, Saclay (France). Centre d' Etudes Nucleaires

1965-07-01

The author presents considerations which should prove to be of interest to all those who have to design, to construct and to operate a nuclear research centre. A large number of the ideas presented can also be applied to non-nuclear scientific research centres. In his report the author reviews: various problems with which the constructor is faced: ground-plan, infrastructure, buildings and the large units of scientific equipment in the centre, and those problems facing the director: maintenance, production, supplies, security. The author stresses the relationship which ought to exist between the research workers and the management. With this aim in view he proposes the creation of National School for Administration in Research which would train administrative executives for public or private organisations; they would be specialised in the fields of fundamental or applied research. (author) [French] L'auteur propose une base de reflexions a tous ceux qui doivent concevoir, realiser et faire vivre un Centre d'Etudes Nucleaires. Un grand nombre des idees exprimees peut d'ailleurs s'appliquer a un Centre d'Etudes Scientifiques non nucleaires. Dans son ouvrage, l'auteur passe en revue les differents problemes qui se posent au constructeur: plan, masse, infrastructure, batiments et grands appareils du Centre, et ceux qu'a a resoudre le directeur: entretien, fabrication, approvisionnements, securite. L'auteur insiste sur l'aspect des rapports qui doivent exister entre les chercheurs et ceux qui les administrent. Il propose a cette fin la creation d'une Ecole Nationale d'Administration de la Recherche qui formerait des cadres administratifs pour les organismes publics ou prives, specialises dans la Recherche fondamentale ou appliquee. (auteur)

Academic achievement, depression and anxiety during medical education predict the styles of success in a medical career: a 10-year longitudinal study.

Science.gov (United States)

Walkiewicz, Maciej; Tartas, Malgorzata; Majkowicz, Mikolaj; Budzinski, Waldemar

2012-01-01

Our study investigated the styles of success in the medical career in young physicians, in comparison with the same subjects examined 4-10 years earlier. The participants were first studied when they applied to the medical university (1999). Questionnaires were sent to all students each year (2000-2005). Fifty-four medical doctors participated in the first phase of the study completed a questionnaire four years after graduation. The current questionnaire included measures of burnout, satisfaction with medicine as a career, quality of life (QOL) and postgraduate examination results. Previous questionnaires had included measures of academic achievement, depression and anxiety. We can describe three different styles of success, which can be predicted during medical education. Physicians with the best professional competence have the lowest income. However, physicians with the lowest professional competence gain the highest income. Those with the highest QOL (general well-being and life satisfaction) have the lowest professional stress and vulnerability to burnout. Anxiety and academic achievement (during the second and fourth year of study) are the significant predictors of specific style belonging. Our results may be useful to medical school admissions and resident selection committees to identify candidates at risk for less satisfaction or less competence.

Fall prediction according to nurses' clinical judgment: differences between medical, surgical, and geriatric wards.

Science.gov (United States)

Milisen, Koen; Coussement, Joke; Flamaing, Johan; Vlaeyen, Ellen; Schwendimann, René; Dejaeger, Eddy; Surmont, Kurt; Boonen, Steven

2012-06-01

To assess the value of nurses' clinical judgment (NCJ) in predicting hospital inpatient falls. Prospective multicenter study. Six Belgian hospitals. Two thousand four hundred seventy participants (mean age 67.6 ± 18.3; female, 55.7%) on four surgical (n = 812, 32.9%), eight geriatric (n = 666, 27.0%), and four general medical wards (n = 992, 40.1%) were included upon admission. All participants were hospitalized for at least 48 hours. Within 24 hours after admission, nurses gave their judgment on the question "Do you think your patient is at high risk for falling?" Nurses were not trained in assessing fall risk. Falls were documented on a standardized incident report form. During hospitalization, 143 (5.8%) participants experienced one or more falls, accounting for 202 falls and corresponding to an overall rate of 7.9 falls per 1,000 patient days. NCJ of participant's risk of falling had high sensitivity (78-92%) with high negative predictive value (94-100%) but low positive predictive value (4-17%). Although false-negative rates were low (8-22%) for all departments and age groups, false-positive rates were high (55-74%), except on surgical and general medical wards and in participants younger than 75. This analysis, based on multicenter data and a large sample size, suggests that NCJ can be recommended on surgical and general medical wards and in individuals younger than 75, but on geriatric wards and in participants aged 75 and older, NCJ overestimates risk of falling and is thus not recommended because expensive comprehensive fall-prevention measures would be implemented in a large number of individuals who do not need it. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Patients' attitudes to medical and psychosocial aspects of care in fertility clinics: Findings from the Copenhagen Multi-centre Psychosocial Infertility (COMPI) Research Programme

DEFF Research Database (Denmark)

Schmidt, L; Holstein, B E; Boivin, J

2003-01-01

among infertile people. METHODS: We conducted an epidemiological study based on questionnaires among all new couples attending five fertility clinics with a response rate of 80.0% and a total of 2250 patients. RESULTS: The vast majority of both men and women considered a high level of medical......BACKGROUND: The aims were (i) to identify gender differences in motivations to seek assisted reproduction and gender differences in expectations about medical and psychosocial services and (ii) to examine factors that predict the perceived importance of, and intention to use, psychosocial services...... services for both men and women was high infertility-related stress in the marital, personal and social domain. CONCLUSIONS: A supportive attitude from medical staff and the provision of both medical and psychosocial information and support should be integral aspects of medical care in fertility clinics...

‘Smashed by the National Health’? A Closer Look at the Demise of the Pioneer Health Centre, Peckham

Science.gov (United States)

Conford, Philip

2016-01-01

The Pioneer Health Centre, based in South London before and after the Second World War, remains a source of interest for advocates of a positive approach to health promotion in contrast with the treatment of those already ill. Its closure in 1950 for lack of funds has been blamed on the then recently established National Health Service, but this article argues that such an explanation is over-simplified and ignores a number of other factors. The Centre had struggled financially during the 1930s and tried to gain support from the Medical Research Council. The Council appeared interested in the Centre before the war, but was less sympathetic in the 1940s. Around the time of its closure and afterwards, the Centre was also involved in negotiations with London County Council; these failed because the Centre’s directors would not accept the changes which the Council would have needed to make. Unpublished documents reveal that the Centre’s directors were uncompromising and that their approach to the situation antagonised their colleagues. Changes in medical science also worked against the Centre. The success of sulphonamide drugs appeared to render preventive medicine less significant, while the development of statistical techniques cast doubt on the Centre’s experimental methods. The Centre was at the heart of the nascent organic farming movement, which opposed the rapid growth of chemical cultivation. But what might be termed ‘chemical triumphalism’ was on the march in both medicine and agriculture, and the Centre was out of tune with the mood of the times. PMID:26971599

Joint hierarchical Gaussian process model with application to personalized prediction in medical monitoring.

Science.gov (United States)

Duan, Leo L; Wang, Xia; Clancy, John P; Szczesniak, Rhonda D

2018-01-01

A two-level Gaussian process (GP) joint model is proposed to improve personalized prediction of medical monitoring data. The proposed model is applied to jointly analyze multiple longitudinal biomedical outcomes, including continuous measurements and binary outcomes, to achieve better prediction in disease progression. At the population level of the hierarchy, two independent GPs are used to capture the nonlinear trends in both the continuous biomedical marker and the binary outcome, respectively; at the individual level, a third GP, which is shared by the longitudinal measurement model and the longitudinal binary model, induces the correlation between these two model components and strengthens information borrowing across individuals. The proposed model is particularly advantageous in personalized prediction. It is applied to the motivating clinical data on cystic fibrosis disease progression, for which lung function measurements and onset of acute respiratory events are monitored jointly throughout each patient's clinical course. The results from both the simulation studies and the cystic fibrosis data application suggest that the inclusion of the shared individual-level GPs under the joint model framework leads to important improvements in personalized disease progression prediction.

Dosimetry practices at the Radiation Technology Centre (Ghana)

International Nuclear Information System (INIS)

Emi-Reynolds, G.; Banini, G.K.; Ennison, I.

1997-01-01

Dosimetry practices undertaken to support research and pilot scale gamma irradiation activities at the Radiation Technology Centre of the Ghana Atomic Energy Commission are presented. The Fricke dosemeter was used for calibrating the gamma field of the gammacell-220. The Fricke system and the gammacell-220 were then used to calibrate the ethanol chlorobenzene (ECB) dosemeter. The Fricke and ECB dosemeter systems have become routine dosemeters at the centre. Dosimetry work has covered a wide range of research specimens and pilot scale products to establish the relevant irradiation protocol and parameters for routine treatment. These include yams, pineapple explants, blood for feeding tsetseflies, cocoa bud wood and cassava sticks. Pilot scale dosimetry studies on maize, medical devices like intravenous infusion sets and surgical gauze have also been completed. The results and observations made on some of these products are reported. (author). 4 refs., 5 figs

A single-item self-report medication adherence question predicts hospitalisation and death in patients with heart failure.

Science.gov (United States)

Wu, Jia-Rong; DeWalt, Darren A; Baker, David W; Schillinger, Dean; Ruo, Bernice; Bibbins-Domingo, Kristen; Macabasco-O'Connell, Aurelia; Holmes, George M; Broucksou, Kimberly A; Erman, Brian; Hawk, Victoria; Cene, Crystal W; Jones, Christine DeLong; Pignone, Michael

2014-09-01

To determine whether a single-item self-report medication adherence question predicts hospitalisation and death in patients with heart failure. Poor medication adherence is associated with increased morbidity and mortality. Having a simple means of identifying suboptimal medication adherence could help identify at-risk patients for interventions. We performed a prospective cohort study in 592 participants with heart failure within a four-site randomised trial. Self-report medication adherence was assessed at baseline using a single-item question: 'Over the past seven days, how many times did you miss a dose of any of your heart medication?' Participants who reported no missing doses were defined as fully adherent, and those missing more than one dose were considered less than fully adherent. The primary outcome was combined all-cause hospitalisation or death over one year and the secondary endpoint was heart failure hospitalisation. Outcomes were assessed with blinded chart reviews, and heart failure outcomes were determined by a blinded adjudication committee. We used negative binomial regression to examine the relationship between medication adherence and outcomes. Fifty-two percent of participants were 52% male, mean age was 61 years, and 31% were of New York Heart Association class III/IV at enrolment; 72% of participants reported full adherence to their heart medicine at baseline. Participants with full medication adherence had a lower rate of all-cause hospitalisation and death (0·71 events/year) compared with those with any nonadherence (0·86 events/year): adjusted-for-site incidence rate ratio was 0·83, fully adjusted incidence rate ratio 0·68. Incidence rate ratios were similar for heart failure hospitalisations. A single medication adherence question at baseline predicts hospitalisation and death over one year in heart failure patients. Medication adherence is associated with all-cause and heart failure-related hospitalisation and death in heart

Canadian Irradiation Centre

International Nuclear Information System (INIS)

1987-05-01

The Canadian Irradiation Centre is a non-profit cooperative project between Atomic Energy of Canada Limited, Radiochemical Company and Universite du Quebec, Institut Armand-Frappier, Centre for Applied Research in Food Science. The Centre's objectives are to develop, demonstrate and promote Canada's radiation processing technology and its applications by conducting applied research; training technical, professional and scientific personnel; educating industry and government; demonstrating operational and scientific procedures; developing processing procedures and standards, and performing product and market acceptance trials. This pamphlet outlines the history of radoation technology and the services offered by the Canadian Irradiation Centre

Trends and Weekly Cycles in a Large Swiss Emergency Centre: A 10 Year Period at the University Hospital of Bern

Directory of Open Access Journals (Sweden)

Christian T. Braun

2017-10-01

Full Text Available Popular demand for high quality care has increased in recent years. This is also the case for medical services and support at all times of the day and night is nowadays required. During the last ten years, there has been a marked increase in the demands on hospital emergency hospitals, particularly in the Western industrialized countries. The present retrospective study investigates how the demands on a large Swiss university centre have changed over a period of 10 years. Patient numbers are differentiated by age, gender, nationality, weekday and mode of referral. A retrospective analysis was performed of the data of the patients admitted to the Emergency Centre of Bern University Medical Hospital (Inselspital during the ten-year period from 2004 up to and including 2013 and who were treated as emergencies. A total of 264,272 patients were included in the study. It was shown that there was an uninterrupted annual increase from 23,555 patients in 2004 to 34,918 patients in 2013 (+48%. Most patients came to the Emergency Centre on Mondays, followed by Fridays. Because of the marked increase in life expectancy and the resulting demographic changes, there has been a marked increase in the number of older patients coming to the Emergency Centre for acute medical care. It was found that there were disproportionately high numbers of patients aged 20 to 49 years who were not Swiss citizens. In contrast, most patients over 60 were Swiss. In the coming years, emergency centres will have to adapt to the continued increase in patient numbers. This trend will continue, so that it is essential to consider the sociodemographic structure of a region when planning the availability of emergency medical care.

Regional coordination in medical emergencies and major incidents; plan, execute and teach

Directory of Open Access Journals (Sweden)

Hedelin Annika

2009-07-01

Full Text Available Abstract Background Although disasters and major incidents are difficult to predict, the results can be mitigated through planning, training and coordinated management of available resources. Following a fire in a disco in Gothenburg, causing 63 deaths and over 200 casualties, a medical disaster response centre was created. The center was given the task to coordinate risk assessments, disaster planning and training of staff within the region and on an executive level, to be the point of contact (POC with authority to act as "gold control," i.e. to take immediate strategic command over all medical resources within the region if needed. The aim of this study was to find out if the centre had achieved its tasks by analyzing its activities. Methods All details concerning alerts of the regional POC was entered a web-based log by the duty officer. The data registered in this database was analyzed during a 3-year period. Results There was an increase in number of alerts between 2006 and 2008, which resulted in 6293 activities including risk assessments and 4473 contacts with major institutions or key persons to coordinate or initiate actions. Eighty five percent of the missions were completed within 24 h. Twenty eight exercises were performed of which 4 lasted more than 24 h. The centre also offered 145 courses in disaster and emergency medicine and crisis communication. Conclusion The data presented in this study indicates that the center had achieved its primary tasks. Such regional organization with executive, planning, teaching and training responsibilities offers possibilities for planning, teaching and training disaster medicine by giving immediate feed-back based on real incidents.

Psychological capital, job demands and organisational commitment of employees in a call centre in Durban, South Africa

Directory of Open Access Journals (Sweden)

Kreshona Pillay

2014-12-01

Research purpose: This study investigated the relationship between psychological capital, job demands and organisational commitment and intended to determine whether psychological capital and job demands predict call centre employees’ organisational commitment. Motivation for the study: The study aimed to explore potential links between psychological capital, job demands and organisational commitment of call centre employees. It is premised on previous research that call centre job demands may be related to commitment to the organisation. Research approach, design and method: This cross-sectional study sampled 117 call centre employees from Durban, South Africa, and used a biographical questionnaire, psychological capital questionnaire, the job-demands-resources scale and the organisational commitment questionnaire to collect data. Main findings: Findings indicated a statistically significant relationship between psychological capital and work overload, as well as a practically and statistically significant relationship (medium effect between psychological capital and continuance organisational commitment. The results showed that psychological capital has predictive value for continuance organisational commitment. Practical/managerial implications: Psychological capital has predictive value for continuance organisational commitment. Organisations can develop initiatives to enhance positive psychological states and address this relationship. Contribution: The findings could be beneficial to management and employees in considering ways to boost psychological capital in order to improve organisational commitment.

Can dimensions of national culture predict cross-national differences in medical communication?

Science.gov (United States)

Meeuwesen, Ludwien; van den Brink-Muinen, Atie; Hofstede, Geert

2009-04-01

This study investigated at a country level how cross-national differences in medical communication can be understood from the first four of Hofstede's cultural dimensions, i.e. power distance, uncertainty avoidance, individualism/collectivism and masculinity/femininity, together with national wealth. A total of 307 general practitioners (GPs) and 5820 patients from Belgium, Estonia, Germany, Great Britain, the Netherlands, Poland, Romania, Spain, Sweden and Switzerland participated in the study. Medical communication was videotaped and assessed using Roter's interaction analysis system (RIAS). Additional context information of physicians (gender, job satisfaction, risk-taking and belief of psychological influence on diseases) and patients (gender, health condition, diagnosis and medical encounter expectations) was gathered by using questionnaires. Countries differ considerably form each other in terms of culture dimensions. The larger a nation's power distance, the less room there is for unexpected information exchange and the shorter the consultations are. Roles are clearly described and fixed. The higher the level of uncertainty avoidance, the less attention is given to rapport building, e.g. less eye contact. In 'masculine' countries there is less instrumental communication in the medical interaction, which was contrary to expectations. In wealthy countries, more attention is given to psychosocial communication. The four culture dimensions, together with countries' wealth, contribute importantly to the understanding of differences in European countries' styles of medical communication. Their predictive power reaches much further than explanations along the north/south or east/west division of Europe. The understanding of these cross-national differences is a precondition for the prevention of intercultural miscommunication. Improved understanding may occur at microlevel in the medical encounter, as well as on macrolevel in pursuing more effective cooperation and

CMS Centre at CERN

CERN Multimedia

2007-01-01

A new "CMS Centre" is being established on the CERN Meyrin site by the CMS collaboration. It will be a focal point for communications, where physicists will work together on data quality monitoring, detector calibration, offline analysis of physics events, and CMS computing operations. Construction of the CMS Centre begins in the historic Proton Synchrotron (PS) control room. The historic Proton Synchrotron (PS) control room, Opened by Niels Bohr in 1960, will be reused by CMS to built its control centre. TThe LHC@FNAL Centre, in operation at Fermilab in the US, will work very closely with the CMS Centre, as well as the CERN Control Centre. (Photo Fermilab)The historic Proton Synchrotron (PS) control room is about to start a new life. Opened by Niels Bohr in 1960, the room will be reused by CMS to built its control centre. When finished, it will resemble the CERN Contro...

Specific Disgust Sensitivities Differentially Predict Interest in Careers of Varying Procedural-Intensity among Medical Students

Science.gov (United States)

Consedine, Nathan S.; Windsor, John A.

2014-01-01

Mismatches between the needs of public health systems and student interests have led to renewed study on the factors predicting career specializations among medical students. While most work examines career and lifestyle values, emotional proclivities may be important; disgust sensitivity may help explain preferences for careers with greater and…

Human-centred Governance

DEFF Research Database (Denmark)

Bason, Christian

2017-01-01

Design approaches are now being applied all over the world as a powerful approach to innovating public policies and services. Christian Bason, author of Leading public design: Discovering human-centred governance, argues that by bringing design methods into play, public managers can lead change...... with citizens at the centre, and discover a new model for steering public organisations: human-centred governance....

Sense of coherence, career adaptability and burnout of early-career Black staff in the call centre environment

Directory of Open Access Journals (Sweden)

Nisha Harry

2013-11-01

Research purpose: This study explored whether call centre agents’ sense of coherence significantly influences their career adaptability and whether their burnout levels significantly moderate the sense of coherence–career adaptability relationship. The research also investigated whether age, gender and years of service (as control variables, along with sense of coherence, predicted career adaptability. Motivation for the study: The positive psychological construct of career adaptability and its association with call centre agents’ sense of coherence, burnout, age, gender and years of service have not yet been investigated in the call centre environment. Research design, approach and method: A cross-sectional quantitative survey design was used. The Orientation to Life, Career Adapt-Abilities Scale and Maslach Burnout Inventory General Scale were administered to a non-probability purposive sample of 409 early-career Black staff employed in three of the largest outsourced financial call centres in Africa. Main findings: Multiple regression analyses revealed that age, gender and meaningfulness significantly predicted call centre agents’ career adaptability, but that their burnout levels do not significantly moderate the sense of coherence–career adaptability relationship. Practical/managerial implications: Enhancing call centre agents’ sense of meaningfulness will increase their levels of career adaptability and career wellbeing. Contribution/value-add: This research is the first to investigate the construct of career adaptability in the call centre environment and adds new knowledge and insights to the existing wellness and positive psychology literature.

Treatment of prolonged convulsive seizures in children; a single centre, retrospective, observational study

NARCIS (Netherlands)

Vlaskamp, Danique R. M.; Brouwer, Oebele F.; Callenbach, Petra M. C.

2014-01-01

Objectives: To evaluate treatment of children with Prolonged Convulsive Seizures (PCS) at the University Medical Centre Groningen (UMCG). Material and methods: PCS were identified from an UMCG database of children with epilepsy aged = 10 mm and occurred between January 2000 and October 2012 in

Closing the gender leadership gap: a multi-centre cross-country comparison of women in management and leadership in academic health centres in the European Union.

Science.gov (United States)

Kuhlmann, Ellen; Ovseiko, Pavel V; Kurmeyer, Christine; Gutiérrez-Lobos, Karin; Steinböck, Sandra; von Knorring, Mia; Buchan, Alastair M; Brommels, Mats

2017-01-06

Women's participation in medicine and the need for gender equality in healthcare are increasingly recognised, yet little attention is paid to leadership and management positions in large publicly funded academic health centres. This study illustrates such a need, taking the case of four large European centres: Charité - Universitätsmedizin Berlin (Germany), Karolinska Institutet (Sweden), Medizinische Universität Wien (Austria), and Oxford Academic Health Science Centre (United Kingdom). The percentage of female medical students and doctors in all four countries is now well within the 40-60% gender balance zone. Women are less well represented among specialists and remain significantly under-represented among senior doctors and full professors. All four centres have made progress in closing the gender leadership gap on boards and other top-level decision-making bodies, but a gender leadership gap remains relevant. The level of achieved gender balance varies significantly between the centres and largely mirrors country-specific welfare state models, with more equal gender relations in Sweden than in the other countries. Notably, there are also similar trends across countries and centres: gender inequality is stronger within academic enterprises than within hospital enterprises and stronger in middle management than at the top level. These novel findings reveal fissures in the 'glass ceiling' effects at top-level management, while the barriers for women shift to middle-level management and remain strong in academic positions. The uneven shifts in the leadership gap are highly relevant and have policy implications. Setting gender balance objectives exclusively for top-level decision-making bodies may not effectively promote a wider goal of gender equality. Academic health centres should pay greater attention to gender equality as an issue of organisational performance and good leadership at all levels of management, with particular attention to academic enterprises

Report on Greece. Establishment of an atomic centre

Energy Technology Data Exchange (ETDEWEB)

NONE

1959-07-15

the IAEA to provide them with four experts. One of these experts - a specialist in health physics - will assist the Greek AEC in organizing a health physics department and a central radiation safety service and in preparing a health hazards report for the Greek research reactor. Another expert will be concerned with the medical applications of radioisotopes, particularly in the clinical research field. Routine diagnostic and therapeutic radioisotope services have already been established at the Alexandra Hospital, and the time has come for extending the work to include clinical research on diseases which are common in Greece. The advice of a third expert will be available mainly in connexion with the research programme of the Greek reactor. The fourth expert will advise the Greek AEC on the setting up of the biological laboratory of the Greek Nuclear Centre; he will also assist in developing a work programme and take part in actual research work. The IAEA Board also approved a Greek request for the supply of a small amount of equipment, essential for the work of the experts. Besides, the first medical research contract to be given by IAEA was placed with the Department of Clinical Therapeutics of Athens University for work on the diagnosis of certain diseases with the aid of radioisotopes

Report on Greece. Establishment of an atomic centre

International Nuclear Information System (INIS)

1959-01-01

the IAEA to provide them with four experts. One of these experts - a specialist in health physics - will assist the Greek AEC in organizing a health physics department and a central radiation safety service and in preparing a health hazards report for the Greek research reactor. Another expert will be concerned with the medical applications of radioisotopes, particularly in the clinical research field. Routine diagnostic and therapeutic radioisotope services have already been established at the Alexandra Hospital, and the time has come for extending the work to include clinical research on diseases which are common in Greece. The advice of a third expert will be available mainly in connexion with the research programme of the Greek reactor. The fourth expert will advise the Greek AEC on the setting up of the biological laboratory of the Greek Nuclear Centre; he will also assist in developing a work programme and take part in actual research work. The IAEA Board also approved a Greek request for the supply of a small amount of equipment, essential for the work of the experts. Besides, the first medical research contract to be given by IAEA was placed with the Department of Clinical Therapeutics of Athens University for work on the diagnosis of certain diseases with the aid of radioisotopes

Educating medical students for work in culturally diverse societies.

Science.gov (United States)

Loudon, R F; Anderson, P M; Gill, P S; Greenfield, S M

1999-09-01

Recent attention has focused on whether government health service institutions, particularly in the United Kingdom, reflect cultural sensitivity and competence and whether medical students receive proper guidance in this area. To systematically identify educational programs for medical students on cultural diversity, in particular, racial and ethnic diversity. The following databases were searched: MEDLINE (1963-August 1998); Bath International Data Service (BIDS) Institute for Scientific Information science and social science citation indexes (1981-August 1998); BIDS International Bibliography for the Social Sciences (1981-August 1998); and the Educational Resources Information Centre (1981-August 1998). In addition, the following online data sets were searched: Kings Fund; Centre for Ethnic Relations, University of Warwick; Health Education Authority; European Research Centre on Migration and Ethnic Relations, University of Utrecht; International Centre for Intercultural Studies, University of London; the Refugee Studies Programme, University of Oxford. Medical education and academic medicine journals (1994-1998) were searched manually and experts in medical education were contacted. Studies included in the analysis were articles published in English before August 1998 that described specific programs for medical students on racial and ethnic diversity. Of 1456 studies identified by the literature search, 17 met the criteria. Two of the authors performed the study selection independently. The following data were extracted: publication year, program setting, student year, whether a program was required or optional, the teaching staff and involvement of minority racial and ethnic communities, program length, content and teaching methods, student assessment, and nature of program evaluation. Of the 17 selected programs, 13 were conducted in North America. Eleven programs were exclusively for students in years 1 or 2. Fewer than half (n = 7) the programs were part of

Probabilistic predictive modelling of carbon nanocomposites for medical implants design.

Science.gov (United States)

Chua, Matthew; Chui, Chee-Kong

2015-04-01

Modelling of the mechanical properties of carbon nanocomposites based on input variables like percentage weight of Carbon Nanotubes (CNT) inclusions is important for the design of medical implants and other structural scaffolds. Current constitutive models for the mechanical properties of nanocomposites may not predict well due to differences in conditions, fabrication techniques and inconsistencies in reagents properties used across industries and laboratories. Furthermore, the mechanical properties of the designed products are not deterministic, but exist as a probabilistic range. A predictive model based on a modified probabilistic surface response algorithm is proposed in this paper to address this issue. Tensile testing of three groups of different CNT weight fractions of carbon nanocomposite samples displays scattered stress-strain curves, with the instantaneous stresses assumed to vary according to a normal distribution at a specific strain. From the probabilistic density function of the experimental data, a two factors Central Composite Design (CCD) experimental matrix based on strain and CNT weight fraction input with their corresponding stress distribution was established. Monte Carlo simulation was carried out on this design matrix to generate a predictive probabilistic polynomial equation. The equation and method was subsequently validated with more tensile experiments and Finite Element (FE) studies. The method was subsequently demonstrated in the design of an artificial tracheal implant. Our algorithm provides an effective way to accurately model the mechanical properties in implants of various compositions based on experimental data of samples. Copyright © 2015 Elsevier Ltd. All rights reserved.

The South African National Accelerator Centre and its research programme

Energy Technology Data Exchange (ETDEWEB)

Watanabe, Y. [Kyushu Univ., Fukuoka (Japan)

1997-03-01

An overview of the South African National Accelerator Centre and its research activities is given with emphasis on medium energy nuclear physics and nuclear data measurements for medical use. Also presented is a preliminary result of {sup 40}Ca(p,p`x) spectrum measurement for 392 MeV which has been carried out at RCNP, Osaka University, under the South Africa-Japan collaborative programme. (author)

Developments in the instruction of biostatistics at the Kuwait University Health Science Centre in a decade.

Science.gov (United States)

Moussa, Mohamed A A

2002-01-01

Kuwait has witnessed many changes that influenced, among other things, the structure of medical education including biostatistics. This article describes the developments in biostatistics instruction and curriculum in the Health Science Centre, University of Kuwait, during the past 10 years. Instead of teaching biostatistics as an independent component, the university has developed an integrated course (35 hr of lectures and 12 hr of tutorial sessions) of biostatistics, epidemiology, and demography that is taught to undergraduate medical and dentistry students to ensure interdisciplinary interaction, to remove redundancies, and to standardize terminology across the three disciplines. The core curriculum of the biostatistics course is compatible with the recommendations of the American Statistical Association. Separate biostatistics courses are also offered to pharmacy and allied health students to address their diverse interests. In addition, new biostatistics and computer applications instruction courses were developed and are taught to the students of the Master of Science (MSc), Master of Public Health (MPH), and PhD programs. For continuing medical education, a workshop on biostatistics and computer applications is organized annually for the medical profession as a collaboration between the Health Science Centre and the Kuwait Institute for Medical Specialization. The instructor and curriculum content of the biostatistics courses are confidentially evaluated and independently analyzed by the office of the Vice Dean for Academic Affairs. Overall, students evaluate the biostatistics instructors highly and are pleased with the content of the biostatistics curriculum. During the last decade, biostatistics instruction in the Kuwait Health Science Centre had many new developments. An integrated course on biostatistics, epidemiology, and demography was developed with emphasis on problem solving and small group learning. Another biostatistics course is offered to the

BrisSynBio: a BBSRC/EPSRC-funded Synthetic Biology Research Centre.

Science.gov (United States)

Sedgley, Kathleen R; Race, Paul R; Woolfson, Derek N

2016-06-15

BrisSynBio is the Bristol-based Biotechnology and Biological Sciences Research Council (BBSRC)/Engineering and Physical Sciences Research Council (EPSRC)-funded Synthetic Biology Research Centre. It is one of six such Centres in the U.K. BrisSynBio's emphasis is on rational and predictive bimolecular modelling, design and engineering in the context of synthetic biology. It trains the next generation of synthetic biologists in these approaches, to facilitate translation of fundamental synthetic biology research to industry and the clinic, and to do this within an innovative and responsible research framework. © 2016 The Author(s).

Physician-staffed emergency helicopter reduces transportation time from alarm call to highly specialized centre

DEFF Research Database (Denmark)

Fjaeldstad, A.

2013-01-01

INTRODUCTION: Since 2007, the number of Danish emergency departments has decreased from 44 to 21. Longer distances to specialized treatment have increased the demand for advanced prehospital treatment. A Danish 24/7 Helicopter Emergency Medical System (HEMS) project in western Denmark was initiated......-to-centre) for patients with ST-elevation myocardial infarction (STEMI) or severe injury (Injury Severity Score > 15). MATERIAL AND METHODS: In this prospective study with a matched historical control group, the time-to-doctor and the time-to-centre for patients with STEMI or severe injury transported by HEMS were...

Authorship issues in multi-centre clinical trials: the importance of making an authorship contract.

Science.gov (United States)

Rosenberg, Jacob; Burcharth, Jakob; Pommergaard, Hans-Christian; Vinther, Siri

2015-02-01

Discussions about authorship often arise in multi-centre clinical trials. Such trials may involve up to hundreds of contributors of whom some will eventually co-author the final publication. It is, however, often impossible to involve all contributors in the manuscript process sufficiently for them to qualify for authorship as defined by the International Committee of Medical Journal Editors. Therefore, rules for authorship in multi-centre trials are strongly recommended. We propose two contracts to prevent conflicts regarding authorship; both are freely available for use without pay but with reference to the original source.

Under-utilisation of preventive medication in patients with cardiovascular disease is greatest in younger age groups (PREDICT-CVD 15).

Science.gov (United States)

Mehta, Suneela; Wells, Sue; Riddell, Tania; Kerr, Andrew; Pylypchuk, Romana; Marshall, Roger; Ameratunga, Shanthi; Chan, Wing Cheuk; Thornley, Simon; Crengle, Sue; Harrison, Jeff; Drury, Paul; Elley, C Raina; Bell, Fionna; Jackson, Rod

2011-06-01

Blood pressure-lowering (BPL) and lipid-lowering (LL) medications together reduce estimated absolute five-year cardiovascular disease (CVD) risk by >40%. International studies indicate that the proportion of people with CVD receiving pharmacotherapy increases with advancing age. To compare BPL and LL medications, by sociodemographic characteristics, for patients with known CVD in primary care settings. The study population included patients aged 35-74 with known CVD assessed in primary care from July 2006 to October 2009 using a web-based computerised decision support system (PREDICT) for risk assessment and management. Clinical data linked anonymously to national sociodemographic and pharmaceutical dispensing databases. Differences in dispensing BPL and LL medications in six months before first PREDICT assessment was analysed according to age, sex, ethnicity and deprivation. Of 7622 people with CVD, 1625 <55 years old, 2862 were women and 4609 lived in deprived areas (NZDep quintiles 4/5). The study population included 4249 European, 1556 Maori, 1151 Pacific and 329 Indian peoples. BPL medications were dispensed to 81%, LL medications to 73%, both BPL and LL medications to 67%, and 87% received either class of medication. Compared with people aged 65-75, people aged 35-44 were 30-40% less likely and those aged 45-54 were 10-15% less likely to be dispensed BPL, LL medications or both. There were minimal differences in likelihood of dispensing according to sex, ethnicity or deprivation. BPL and LL medications are under-utilised in patients with known CVD in New Zealand. Only two-thirds of patients in this cohort are on both. Younger patients are considerably less likely to be on recommended medications.

Medical complications and outcomes at an onsite rehabilitation unit for older people.

LENUS (Irish Health Repository)

Mulroy, M

2013-09-01

The rehabilitation of older patients in Ireland after an acute medical event occurs at dedicated onsite hospital units or at offsite centres. Information on medical complications and outcomes is inadequate.

Determination of medical education environment in Punjab private and public medical colleges affiliated with University of Health Sciences, Lahore-Pakistan.

Science.gov (United States)

Khan, Junaid Sarfraz; Tabasum, Saima; Yousafzai, Usman Khalil

2009-01-01

The main purpose of this study was to identify differences, if any, in the Medical Education Climate between the Private and Public Medical Colleges in the Province of Punjab affiliated with the University of Health Sciences, Lahore and to gather recommendations from students on measures that need to be taken to improve the environment. This Mixed Quantitative and Qualitative Prospective Study was conducted in 2008. The population of the study consisted of 1612 MBBS Final Year Medical Students of both Private and Public Medical Colleges. Stratified Random Sampling was done to ensure representation of both Sectors. Dundee Ready Education Environment Measure (DREEM) was used to assimilate Quantitative Data and a Questionnaire consisting of 10 items was used to accumulate Qualitative Data. To analyse Quantitative Data, t-test and Chi-square tests were used. Common themes were identified in the Qualitative Data. All the SIX Research Hypotheses were rejected and Null Hypotheses were upheld. Analysis of Qualitative Data indicated a number of Examination, Curriculum, Teaching Methodology, Teacher and Peer related Stressors without discrimination in students of both Private and Public Sectors. Solutions by students focused on improving co-ordination between Institutions and University of Health Sciences as well as developing and delivering Clinically-Centred, Community-Oriented and Problem-Based Education through development of appropriate Teaching Methodologies. Even though there is no difference in the Medical Education Climate between the Private and Public Medical Education Sectors, the Environment is less than Ideal. However, this can be improved through shifting the onus of Education from Teacher-Centred Didactic Approach to a more Student-Centred Self-Learning Strategy. In this paradigm shift the UHS, Lahore needs to play a pivotal role in order to effectively train the Trainers and standardise this change throughout Punjab.

Assessing communication skills of clinical call handlers working at an out-of-hours centre: development of the RICE rating scale.

Science.gov (United States)

Derkx, Hay P; Rethans, Jan-Joost E; Knottnerus, J André; Ram, Paul M

2007-05-01

Out-of-hours centres provide telephone support to patients with medical problems. In most of these centres specially-trained nurses handle incoming telephone calls. They assess patients' needs, the degree of urgency, and determine the level of care required. Assessment of the medical problem and the quality of 'care-by-phone' depend on the medical and communication skills of the call handlers. To develop a valid, reliable, and practical rating scale to evaluate the communication skills of call handlers working at an out-of-hours centre and to improve quality of communication. Qualitative study with focus groups followed by validation of the rating scale and measurement of reliability (internal consistency). Out-of-hours centres in the Netherlands. A focus group developed the rating scale. Experts with experience in training and evaluating communication skills of medical students and GPs commented on the scale to ensure content validity. The reliability of the rating scale was tested in a pilot in which ten specially-trained assessors scored six telephone calls each. The scale, known as the RICE rating scale, has 17 items divided over four different phases of the telephone consultation: Reason for calling; Information gathering; Conclusion; and Evaluation (RICE). Content validity of the scale was assessed by two experts. Reliability of the scale tested in the pilot was 0.73 (Cronbach's alpha). Establishing a rating scale to assess the communication skills of call handlers which meets common scientific demands, such as content validity and reliability, proved successful. This instrument can be used to give feedback to call handlers.

Spinal injuries admitted at the Federal Medical Centre, Umuahia ...

African Journals Online (AJOL)

The treatment was mostly conservative . The most frequent complication were bowel dysfunction, urinary bladder dysfunction , urinary tract infection and pressure ulcers. Ten (20.4%) walked without support, 9(18.4%) discharged against medical advice and 4(8.2%) were discharged on wheel chair. Twenty-two (44.9%) were ...

Validation of core medical knowledge by postgraduates and specialists.

NARCIS (Netherlands)

Koens, F.; Rademakers, J.J.; Cate, O.T.J. ten

2005-01-01

BACKGROUND: Curriculum constructors and teachers must decide on the content and level of objectives and materials included in the medical curriculum. At University Medical Centre Utrecht it was decided to test relatively detailed knowledge at a regular level in study blocks and to design a progress

A Study on the Socio demographic Profile of the Attendees at the Integrated Counseling and Testing Centre of Institute of Medical Sciences BHU, Varanasi, Uttar Pradesh

Directory of Open Access Journals (Sweden)

Rashmi Kumari

2016-03-01

Full Text Available Introduction: Human Immunodeficiency Virus (HIV counseling and testing services are a key entry point to the prevention of HIV infection and to the treatment and care of the people who are infected with HIV. The Integrated Counseling and Testing Centre (ICTC services are a cost effective intervention in the prevention of HIV/AIDS.Aims: To study the socio demographic characteristics of the attendees at the ICTC centre.Material and Methods: Setting – ICTC of Institutes of Medical Sciences BHU, Varanasi, Study Design: A cross-sectional, record based study, Study duration: The study population included 41159 clients who attended the ICTC centres from January 2009 to December 2011.Results: An overall 12.85% of the ICTC attendees were HIV Seropositive subjects. During 2009 to 2011. i.e. during past 3 years total males tested for HIV at the ICTC were 23326, out of which 3202 were HIV+ve showing positivity rate of 13.7%, while total females tested were 16671 out of which 2063 were HIV+ve showing positivity rate of about 12.4%. Consecutively in the last three years maximum load of patients was from the age groups 35-49 years (19.13% followed by 25-34 years (15.4%.Conclusion: People’s attitudes towards HIV are changing after the introduction of the ICTC, which plays a major role in the primary and secondary prevention of HIV. There is a more urgent need for the introduction of interventional measures like sex education and preventive education among the general population

Experience with a bone bank operation and allograft bone infection in recipients at a medical centre in southern Taiwan.

Science.gov (United States)

Liu, J W; Chao, L H; Su, L H; Wang, J W; Wang, C J

2002-04-01

To assess the contamination rate of allograft bones at retrieval and the infection rate of the implanted allograft bone, we audited a bone bank retrospectively and reviewed the medical charts of allograft bone recipients between June 1999 and June 2000 at a medical centre in southern Taiwan. The bone bank did its utmost to minimize allograft contamination with hospital-acquired pathogens by adopting purposefully designed criteria for selection of donors. This protocol included sterilization with soaking of the retrieved allograft in a solution of a first-generation cephalosporin before storage and prophylaxis in recipients with first-generation cephalosporin. The contamination rates at allograft retrieval from living and cadaveric donors were 2.7% and 12.4%, respectively (P<0.001). Culture of 262 specimens taken at allograft implant revealed 12 (4.6%) positive for culture. Of the 12 patients implanted with allograft bones positive for culture, nine (75.0%) had allograft bone infection, while three (25.0%) did not. Among the 250 recipients with sterile allograft bones, four (1.6%) were found to have allograft infection. None of the cases of infection required removal of the allograft bones, and all cases were successfully treated with tailored antimicrobial therapy based on susceptibility tests on isolated bacteria. The overall infection rate was 5.0%, which compared favourably with those in other series. A prospective cohort study is needed to determine which of the varied sterilization methodologies gives the best and/or most cost-effective outcome. Copyright 2002 The Hospital Infection Society.

Complete quantum control of exciton qubits bound to isoelectronic centres.

Science.gov (United States)

Éthier-Majcher, G; St-Jean, P; Boso, G; Tosi, A; Klem, J F; Francoeur, S

2014-05-30

In recent years, impressive demonstrations related to quantum information processing have been realized. The scalability of quantum interactions between arbitrary qubits within an array remains however a significant hurdle to the practical realization of a quantum computer. Among the proposed ideas to achieve fully scalable quantum processing, the use of photons is appealing because they can mediate long-range quantum interactions and could serve as buses to build quantum networks. Quantum dots or nitrogen-vacancy centres in diamond can be coupled to light, but the former system lacks optical homogeneity while the latter suffers from a low dipole moment, rendering their large-scale interconnection challenging. Here, through the complete quantum control of exciton qubits, we demonstrate that nitrogen isoelectronic centres in GaAs combine both the uniformity and predictability of atomic defects and the dipole moment of semiconductor quantum dots. This establishes isoelectronic centres as a promising platform for quantum information processing.

Japanese scoring systems to predict resistance to intravenous immunoglobulin in Kawasaki disease were unreliable for Caucasian Israeli children.

Science.gov (United States)

Arane, Karen; Mendelsohn, Kerry; Mimouni, Michael; Mimouni, Francis; Koren, Yael; Simon, Dafna Brik; Bahat, Hilla; Helou, Mona Hanna; Mendelson, Amir; Hezkelo, Nofar; Glatstein, Miguel; Berkun, Yackov; Eisenstein, Eli; Aviel, Yonatan Butbul; Brik, Riva; Hashkes, Philip J; Uziel, Yosef; Harel, Liora; Amarilyo, Gil

2018-05-24

This study assessed the validity of using established Japanese risk scoring methods to predict intravenous immunoglobulin (IVIG) resistance to Kawasaki disease in Israeli children. We reviewed the medical records of 282 patients (70% male) with Kawasaki disease from six Israeli medical centres between 2004-2013. Their mean age was 2.5 years. The risk scores were calculated using the Kobayashi, Sano and Egami scoring methods and analysed to determine if a higher risk score predicted IVIG resistance in this population. Factors that predicted a lack of response to the initial IVIG dose were identified. We found that 18% did not respond to the first IVIG dose. The three scoring methods were unable to reliably predict IVIG resistance, with sensitivities of 23-32% and specificities of 67-87%. Calculating a predictive score that was specific for this population was also unsuccessful. The factors that predicted a lacked of response to the first IVIG dose included low albumin, elevated total bilirubin and ethnicity. The established risk scoring methods created for Japanese populations with Kawasaki disease were not suitable for predicting IVIG resistance in Caucasian Israeli children and we were unable to create a specific scoring method that was able to do this. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Socio-demography and medical history as predictors of health-related quality of life of breast cancer survivors.

Science.gov (United States)

Ramadas, Amutha; Qureshi, Ahmad Munir; Dominic, Nisha Angela; Botross, Nevein Philip; Riad, Amgad; Thirunavuk Arasoo, Valliammai Jayanthi; Elangovan, Soman

2015-01-01

Even after completion of conventional treatment, breast cancer survivors continue to exhibit a variety of psychological and physical symptoms, affecting their quality of life. The study aimed to investigate the relationship between socio-demography, medical characteristics and health-related quality of life (HR-QOL) of a sample of breast cancer survivors in Malaysia. This pilot cross-sectional survey was conducted among breast cancer survivors (n=40) who were members of Breast Cancer Support Group Centre Johor Bahru. A validated self-administered questionnaire was used to identify the relationships between socio-demography, medical characteristics and HR-QOL of the participants. Living with family and completion of treatment were significant predictive factors of self-rated QOL, while living with family and ever giving birth significantly predicted satisfaction with health and physical health. Psychological health had moderate correlations with number of children and early cancer stage. Survivors' higher personal income (>MYR4,500) was the only significant predictor of social relationship, while age, income more than MYR4,500 and giving birth significantly predicted environment domain score. The findings suggested the survivors coped better in all four HR-QOL domains if they were married, lived with family, had children and were employed.

[Negative and positive predictive relationships between coping strategies and the three dimensions of burnout among Hungarian medical students].

Science.gov (United States)

Ádám, Szilvia; Nistor, Anikó; Nistor, Katalin; Hazag, Anikó

2014-08-10

Effective management and prevention of widespread burnout among medical students in Hungary require thorough understanding of its relations to coping strategies, which lacks sufficient data. To explore the prevalence of burnout and its relations to coping strategies among medical students. Cross-sectional study with 292 participants. Burnout was assessed by the Maslach Burnout Inventory-Student Survey. Coping strategies were evaluated by the Folkman-Lazarus Ways of Coping Questionnaire and questions about health-maintenance behaviours. Associations between burnout and coping strategies were explored with linear regression analyses. The prevalence of high-level burnout was 25-56%. Both problem-focused coping and support-seeking were protective factors of exhaustion and cynicism, however, they predicted reduced personal accomplishment. Emotion-focused coping predicted exhaustion and cynicism and correlated negatively with reduced personal accomplishment. Health-maintenance behaviours were protective factors for exhaustion and predicted reduced personal accomplishment. Deployment of coping strategies that target the most prevalent burnout dimension may improve effective management of burnout.

RTEMS Centre - Support and Maintenance Centre to RTEMS Operating System

Science.gov (United States)

Silva, H.; Constantino, A.; Freitas, D.; Coutinho, M.; Faustino, S.; Mota, M.; Colaço, P.; Sousa, J.; Dias, L.; Damjanovic, B.; Zulianello, M.; Rufino, J.

2009-05-01

RTEMS CENTRE - Support and Maintenance Centre to RTEMS Operating System is a joint ESA/Portuguese Task Force initiative to develop a support and maintenance centre to the Real-Time Executive for Multiprocessor Systems (RTEMS). This paper gives a high level visibility of the progress, the results obtained and the future work in the RTEMS CENTRE [6] and in the RTEMS Improvement [7] projects. RTEMS CENTRE started officially in November 2006, with the RTEMS 4.6.99.2 version. A full analysis of RTEMS operating system was produced. The architecture was analysed in terms of conceptual, organizational and operational concepts. The original objectives [1] of the centre were primarily to create and maintain technical expertise and competences in this RTOS, to develop a website to provide the European Space Community an entry point for obtaining support (http://rtemscentre.edisoft.pt), to design, develop, maintain and integrate some RTEMS support tools (Timeline Tool, Configuration and Management Tools), to maintain flight libraries and Board Support Packages, to develop a strong relationship with the World RTEMS Community and finally to produce some considerations in ARINC-653, DO-178B and ECSS E-40 standards. RTEMS Improvement is the continuation of the RTEMS CENTRE. Currently the RTEMS, version 4.8.0, is being facilitated for a future qualification. In this work, the validation material is being produced following the Galileo Software Standards Development Assurance Level B [5]. RTEMS is being completely tested, errors analysed, dead and deactivated code removed and tests produced to achieve 100% statement and decision coverage of source code [2]. The SW to exploit the LEON Memory Management Unit (MMU) hardware will be also added. A brief description of the expected implementations will be given.

Medical, psychological and social features in a large cohort of adults with Prader-Willi syndrome: experience from a dedicated centre in France.

Science.gov (United States)

Laurier, V; Lapeyrade, A; Copet, P; Demeer, G; Silvie, M; Bieth, E; Coupaye, M; Poitou, C; Lorenzini, F; Labrousse, F; Molinas, C; Tauber, M; Thuilleaux, D; Jauregi, J

2015-05-01

Prader-Willi syndrome (PWS) is a developmental genetic disorder characterised by a variable expression of medical, cognitive and behavioural symptoms. In adulthood, the prevalence and severity of these symptoms determine the quality of life of the affected persons. Because of their rare disease condition, data on health and social problems in adults with PWS are scarce. In this research, we present medical, psychological and social features of a large cohort of adults admitted to a specialised PWS centre in France and analyse the differences according to genotype, gender and age. Data from 154 patients (68 men/86 women), with a median age of 27 years (range 16-54), were collected during their stay in our centre. Clinical histories were completed using information from parents or main caregivers, and the same medical team performed the diagnosis of different clinical conditions. Statistical analyses were performed to determine the influence of factors such as genotype, age or gender. Paternal deletion genotype was the most frequent (65%) at all ages. Most patients had mild or moderate intellectual disability (87%). Only 30% had studied beyond primary school and 70% were in some special educational or working programme. Most of them lived in the family home (57%). The most prevalent somatic comorbidities were scoliosis (78%), respiratory problems (75%), dermatological lesions (50%), hyperlipidaemia (35%), hypothyroidism (26%), Type 2 diabetes mellitus (25%) and lymph oedema (22%). Some form of psychotropic treatment was prescribed in 58% of subjects, and sex hormones in 43%. Patients with deletion had a higher body mass index (44 vs. 38.9 kg/m(2)) and displayed higher frequency of sleep apnoeas. Non-deletion patients received insulin treatment (19% vs. 4%) and antipsychotic treatment (54.8% vs. 32.7%) more frequently. No difference was observed in the prevalence of Type 2 diabetes between the two genotype groups. Patients >27 years of age had a higher rate of

Medical radiation physics in Bulgaria

International Nuclear Information System (INIS)

Todorov, V.; Vasileva, G.

1999-01-01

In Bulgaria medical radiation physics in not yet on a world level. The number of medical physicists working in diagnostic and therapeutic centres is low. Comparatively good is the situation of medical physics in the areas of therapy and radiation protection. But the role of physics in medicine is underestimated as a whole, because of subjective reasons. At the other hand the education in this area is good and very professional. Since 1992 there has been established a specialty 'medical physics' in University of Shoumen and since 1997 the same specialty exists in Sofia University. The situation is expected to be approved with reorganization of the Health System in Bulgaria with compliance with the European standards

Sudan Journal of Medical Sciences

African Journals Online (AJOL)

Sudan JMS is a joint project of continuous medical education program at Faculty of Medicine - Omdurman Islamic University, The National Centre for Gastroenterology and Liver Diseases, Ibn Sina Hospital and Omdurman teaching Hospital (Sudan). Sudan JMS is published every three months. High-quality papers written ...

Colour centres induced in LiF by low-energy electrons

CERN Document Server

Baldacchini, G; Montereali, R M; Scacco, A

1998-01-01

A detailed study has been carried out on the optical properties of intrinsic colour centres, created in LiF crystals under irradiation with low-penetration 3 keV electrons. The kinetics of the production of F and M centres, determined from optical absorption measurements, exhibits a typical three-stage structure and an evident saturation at high doses. The quantitative evaluation of the kinetic parameters is in excellent agreement with the predictions of the most comprehensive theoretical model. A comparison of the effects of irradiation at different temperatures, determined from absorption and photoluminescence spectra, allows one to deduce the conditions for preferential formation of F sub 2 or F sub 3 sup + defects in LiF crystals. (author)

Nuclear research centres in the 21st century: An AECL perspective

International Nuclear Information System (INIS)

Fehrenbach, P.J.

2001-01-01

The nuclear energy programme of Canada started at Chalk River Laboratories with the setting up of Zero Energy Experimental Site in 1945. One of the early research reactors of Canada, the National Research Universal (NRU) continues to provide 70% of the world requirement of isotopes for medical and industrial applications. A CANDU prototype (208 MW(e)) came on line in 1967 and based on this concept, Canada has a large nuclear power programme. The role of nuclear research centres has evolved with time starting with strategic research in the initial phases through to implementation of technology, building and supporting industry, and carrying out advanced technology development. Most of these centres have important assets in terms of licensed sites, trained personnel, research reactors, shielded facilities and expertise for handling large quantities of radioactivity and high tech laboratories for advanced R and D. These centres would, therefore, continue to play an important role in emission free and economic energy generation, nuclear medicine, food irradiation and industrial applications. Nuclear research centres in different countries are at various stages of development and have many unique features. However, there are generic issues and much will be gained by developing a shared vision for the future and implementing programmes in a collaborative manner. (author)

Perceptions of patient-centred care at public hospitals in Nelson Mandela Bay

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Sihaam Jardien-Baboo

2016-10-01

Full Text Available In South Africa, the quality of health care is directly related to the concept of patient-centred care and the enactment of the Batho Pele Principles and the Patients' Rights Charter. Reports in the media indicate that public hospitals in the Eastern Cape Province are on the brink of collapse, with many patients being treated in condemned hospitals which lacked piped water, electricity and essential medical equipment. Receiving quality care, and principally patient-centred care, in the face of such challenges is unlikely and consequently leads to the following question: “Are patients receiving patient-centred care in public hospitals?” A qualitative, explorative, descriptive and contextual study was conducted to explore and describe the perceptions of professional nurses regarding patient-centred care in public hospitals in Nelson Mandela Bay. Semi-structured interviews were conducted with a total of 40 purposively selected professional nurses working in public hospitals in Nelson Mandela Bay, Eastern Cape Province. Interviews were analysed according to the method described by Tesch in Creswell (2009:192. Professional nurses perceive patient-centred care as an awareness of the importance of the patient's culture, involving the patient's family, incorporating values of love and respect, optimal communication in all facets of patient care and accountability to the patient. Factors which enable patient-centred care were a positive work environment for staff, nursing manager's demonstrating exemplary professional leadership, continuous in service education for staff and collaborative teamwork within the interdisciplinary team. Barriers to patient-centred care were a lack of adequate resources, increased administrative work due to fear of litigation and unprofessional behaviour of nursing staff.

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

Science.gov (United States)

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.

Medical management and planning for radiation emergencies

International Nuclear Information System (INIS)

Bongirwar, P.R.

2001-01-01

Radiation Emergencies which result as a consequence of nuclear or radiological accidents can produce a spectrum of different types of radiation injuries which could include cases of whole body irradiation causing Acute Radiation Syndrome, partial body irradiation, radiation burns (localized irradiation), radioactive contamination and combined injuries having component of conventional injuries. General principles of managing these cases entail doing triage, offering immediate emergency care and instituting definitive treatment. Infra-structural facilities which are required to facilitate their management include first aid post at plant site, personnel decontamination centre, site clinic and specialized hospital which can offer comprehensive investigational and treatment modalities. Training of medical and paramedical personnel is crucial as part of emergency preparedness programme and if needed, help can be sought from WHO's Radiation Emergency Medical Preparedness and Assistance Network Centres. (author)

Lossless medical image compression using geometry-adaptive partitioning and least square-based prediction.

Science.gov (United States)

Song, Xiaoying; Huang, Qijun; Chang, Sheng; He, Jin; Wang, Hao

2018-06-01

To improve the compression rates for lossless compression of medical images, an efficient algorithm, based on irregular segmentation and region-based prediction, is proposed in this paper. Considering that the first step of a region-based compression algorithm is segmentation, this paper proposes a hybrid method by combining geometry-adaptive partitioning and quadtree partitioning to achieve adaptive irregular segmentation for medical images. Then, least square (LS)-based predictors are adaptively designed for each region (regular subblock or irregular subregion). The proposed adaptive algorithm not only exploits spatial correlation between pixels but it utilizes local structure similarity, resulting in efficient compression performance. Experimental results show that the average compression performance of the proposed algorithm is 10.48, 4.86, 3.58, and 0.10% better than that of JPEG 2000, CALIC, EDP, and JPEG-LS, respectively. Graphical abstract ᅟ.

Psychological capital, work engagement and organisational commitment amongst call centre employees in South Africa

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Janet C. Simons

2013-11-01

Research purpose: The purpose of the research was to determine the relationship between psychological capital, work engagement and organisational commitment amongst call centre employees; and further, to determine whether psychological capital and work engagement hold predictive value for the organisational commitment of call centre employees. Motivation for the study: There is a gap in research in understanding and enabling positive resource capacities in highly stressful work contexts such as call centres. Research design, approach and method: A cross-sectional survey design was used. A sample of 106 call centre employees from a South African organisation participated in the research. The measuring instruments included a demographic questionnaire, the Psychological Capital Questionnaire (PCQ, the Utrecht Work Engagement Scale (UWES and the Organisational Commitment Questionnaire (OCQ. Main findings: Significant positive relationships were found between psychological capital, work engagement and organisational commitment. The results showed work engagement as being the only significant predictor of organisational commitment. Practical/managerial implications: Call centre employers need to develop and implement workplace interventions that would increase the psychological capital of call centre employees. Contribution/value-add: The research findings will benefit both call centre employees and management. The study highlighted the importance of the role of optimism as a subdimension of psychological capital in developing work engagement and organisational commitment amongst call centre employees.

Attitudes and perceptions of medical students about family medicine in Spain: protocol for a cross-sectional survey

Science.gov (United States)

Alonso-Coello, Pablo; Villa, Josep Jiménez; Hijar, Antonio Monreal; Tuduri, Xavier Mundet; Puime, Ángel Otero

2011-01-01

Background Despite the fact that family medicine (FM) has become established as a specialty in the past 25 years, this has not been reflected in the inclusion of the specialty in the majority of medical schools in Spain. Almost 40% of the students will work in primary care but, in spite of this, most universities do not have an assessed placement as such. There are only specific practice periods in health centres or some student-selected components with little weight in the overall curricula. Objectives To evaluate the attitudes and perceptions of medical students about FM in the health system and their perception about the need for specific training in FM at the undergraduate level. To explore change over time of these attitudes and perceptions and to examine potential predictive factors for change. Finally, we will review what teaching activity in FM is offered across the Spanish schools of medicine. Methods Descriptive cross-sectional survey. Each one of the different analyses will consist of two surveys: one for all the students in the first, third and fifth year of medical school in all the Spanish schools of medicine asking about their knowledge, perceptions and attitudes in relation to primary care and FM. There will be an additional survey for the coordinating faculty of the study in each university about the educational activities related to FM that are carried out in their centres. The repetition of the study every 2 years will allow for an analysis of the evolution of the cohort of students until they receive their degree and the potential predictive factors. Discussion This study will provide useful information for strategic planning decisions, content and educational methodology in medical schools in Spain and elsewhere. It will also help to evaluate the influence of the ongoing changes in FM, locally and at the European level, on the attitudes and perceptions of the students towards FM in Spain. PMID:22189348

The Search for Centre

Science.gov (United States)

Nunes, April

2006-01-01

This paper acknowledges the importance of a dancer's centre but likewise highlights the problematic nature of the communication of this concept from dance teacher to student. After a brief introduction of orthodox approaches in finding centre, this paper suggests a method of locating centre through the ancient somatic technique.

Patient monitoring in Polish assisted reproductive technology centres

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Anna Krawczak

2016-12-01

Full Text Available In 2014, the Polish non-governmental patient association ‘Our Stork’ (Nasz Bocian introduced the ‘Patient monitoring in ART centres’ research project to gather previously unrecorded information on the situation of infertile people and the provision of assisted reproductive treatment in Poland. When the research project began, assisted reproductive treatment centres were unregulated by the state, a situation that had existed for more than 28 years following the birth of the first Polish test-tube baby in 1987. Patients signed civil contracts, remaining unprotected in terms of safety of treatment and recognition of their rights, and their presumed social position was described by doctors as ‘disciplined patients’ – a reflection of what Michele Foucault described as biopolitics. The research project comprised patient questionnaires (responses from 722 patients provided the basis for the document ‘Patient Recommendations in Infertility Treatment’, analysis of civil contracts and their accuracy in the context of patients’ legal rights in Poland, and in-depth interviews with assisted reproductive treatment centres’ owners, doctors, midwives, and patients to explore patient care. The data reveal that there is a lack of patient-centred care among doctors and medical staff in Poland and that following the passing into law of the 2015 Infertility Act, which introduced state regulation of assisted reproductive treatment centres, the situation for patients worsened.

Pharmacokinetics in Drug Discovery: An Exposure-Centred Approach to Optimising and Predicting Drug Efficacy and Safety.

Science.gov (United States)

Reichel, Andreas; Lienau, Philip

2016-01-01

The role of pharmacokinetics (PK) in drug discovery is to support the optimisation of the absorption, distribution, metabolism and excretion (ADME) properties of lead compounds with the ultimate goal to attain a clinical candidate which achieves a concentration-time profile in the body that is adequate for the desired efficacy and safety profile. A thorough characterisation of the lead compounds aiming at the identification of the inherent PK liabilities also includes an early generation of PK/PD relationships linking in vitro potency and target exposure/engagement with expression of pharmacological activity (mode-of-action) and efficacy in animal studies. The chapter describes an exposure-centred approach to lead generation, lead optimisation and candidate selection and profiling that focuses on a stepwise generation of an understanding between PK/exposure and PD/efficacy relationships by capturing target exposure or surrogates thereof and cellular mode-of-action readouts in vivo. Once robust PK/PD relationship in animal PD models has been constructed, it is translated to anticipate the pharmacologically active plasma concentrations in patients and the human therapeutic dose and dosing schedule which is also based on the prediction of the PK behaviour in human as described herein. The chapter outlines how the level of confidence in the predictions increases with the level of understanding of both the PK and the PK/PD of the new chemical entities (NCE) in relation to the disease hypothesis and the ability to propose safe and efficacious doses and dosing schedules in responsive patient populations. A sound identification of potential drug metabolism and pharmacokinetics (DMPK)-related development risks allows proposing of an effective de-risking strategy for the progression of the project that is able to reduce uncertainties and to increase the probability of success during preclinical and clinical development.

Psychotropic Medication Refusal: Reasons and Patients′ Perception at a Secure Forensic Psychiatric Treatment Centre

Directory of Open Access Journals (Sweden)

Olajide O Adelugba

2016-01-01

Full Text Available Poor adherence to prescribed medication regimens can undermine the effectiveness of medications. This study was conducted to determine the demographic profile of forensic psychiatric inpatients refusing medications and to identify the reasons for refusal. Data were collected through interviews using a questionnaire including Drug Attitude Inventory-10. Medication refusal was more common among Aboriginals (68%, n = 34 than Caucasians (32%, n = 16 and was highest among the patients 21-30 years of age (44%, n = 22. Antisocial personality disorder and substance use disorder featured prominently among patients refusing medications. The main reasons for medication refusal were inconvenience (34%, n = 17 followed by side effects (22%, n = 11, ineffective medication (20%, n = 10, illness-related (16%, n = 8, and no reasons (8%, n = 6. Antipsychotic medications topped the list of the major classes of medications refused followed by Antidepressants and Mood Stabilizers.

Can learning style predict student satisfaction with different instruction methods and academic achievement in medical education?

Science.gov (United States)

Gurpinar, Erol; Alimoglu, Mustafa Kemal; Mamakli, Sumer; Aktekin, Mehmet

2010-12-01

The curriculum of our medical school has a hybrid structure including both traditional training (lectures) and problem-based learning (PBL) applications. The purpose of this study was to determine the learning styles of our medical students and investigate the relation of learning styles with each of satisfaction with different instruction methods and academic achievement in them. This study was carried out with the participation of 170 first-year medical students (the participation rate was 91.4%). The researchers prepared sociodemographic and satisfaction questionnaires to determine the characteristics of the participants and their satisfaction levels with traditional training and PBL. The Kolb learning styles inventory was used to explore the learning styles of the study group. The participants completed all forms at the end of the first year of medical education. Indicators of academic achievement were scores of five theoretical block exams and five PBL exams performed throughout the academic year of 2008-2009. The majority of the participants took part in the "diverging" (n = 84, 47.7%) and "assimilating" (n = 73, 41.5%) groups. Numbers of students in the "converging" and "accommodating" groups were 11 (6.3%) and 8 (4.5%), respectively. In all learning style groups, PBL satisfaction scores were significantly higher than those of traditional training. Exam scores for "PBL and traditional training" did not differ among the four learning styles. In logistic regression analysis, learning style (assimilating) predicted student satisfaction with traditional training and success in theoretical block exams. Nothing predicted PBL satisfaction and success. This is the first study conducted among medical students evaluating the relation of learning style with student satisfaction and academic achievement. More research with larger groups is needed to generalize our results. Some learning styles may relate to satisfaction with and achievement in some instruction methods.

A comparative study of medication use after stroke in four countries.

Science.gov (United States)

Desmaele, Sara; Putman, Koen; De Wit, Liesbet; Dejaeger, Eddy; Gantenbein, Andreas R; Schupp, Wilfried; Steurbaut, Stephane; Dupont, Alain G; De Paepe, Kristien

2016-09-01

The use of medication plays an important role in secondary stroke prevention and treatment of post-stroke comorbidities. The Collaborative Evaluation of Rehabilitation in Stroke across Europe (CERISE) was set up to investigate the inpatient stroke rehabilitation process in four centres, each in a different European country: Belgium, Germany, United Kingdom and Switzerland. Patients' medication use 5 years post-stroke was compared between countries. Focus was put on cerebrovascular secondary prevention, including (a) adequate antithrombotic treatment, (b) treatment of cardiovascular comorbidities and diabetes, and (c) the use of lipid-lowering drugs; as well as on the treatment of stroke-related disorders such as depression, anxiety and pain. Medication data were available for 247 patients. Data about depression and anxiety were available for 233. There were no significant differences between the four centres in antithrombotic treatment and in the treatment of cardiovascular comorbidities and diabetes. However, significantly more patients from the UK were treated with lipid-lowering drugs compared to Belgian patients. Significant differences were also observed between the centres in the prevalence and treatment of depression. More Belgian patients suffered from depression compared to German patients and significantly more Belgian patients took antidepressants than patients in Germany. This was in contrast to the prevalence and treatment of anxiety and pain, for which no significant differences between the centres were seen. Related to pain treatment, it was observed that almost 40% of all patients suffering from pain, used no specific medication. Copyright © 2016 Elsevier B.V. All rights reserved.

Effects of assessing the productivity of faculty in academic medical centres: a systematic review

Science.gov (United States)

Akl, Elie A.; Meerpohl, Joerg J.; Raad, Dany; Piaggio, Giulia; Mattioni, Manlio; Paggi, Marco G.; Gurtner, Aymone; Mattarocci, Stefano; Tahir, Rizwan; Muti, Paola; Schünemann, Holger J.

2012-01-01

Background: Many academic medical centres have introduced strategies to assess the productivity of faculty as part of compensation schemes. We conducted a systematic review of the effects of such strategies on faculty productivity. Methods: We searched the MEDLINE, Healthstar, Embase and PsycInfo databases from their date of inception up to October 2011. We included studies that assessed academic productivity in clinical, research, teaching and administrative activities, as well as compensation, promotion processes and satisfaction. Results: Of 531 full-text articles assessed for eligibility, we included 9 articles reporting on eight studies. The introduction of strategies for assessing academic productivity as part of compensation schemes resulted in increases in clinical productivity (in six of six studies) in terms of clinical revenue, the work component of relative-value units (these units are nonmonetary standard units of measure used to indicate the value of services provided), patient satisfaction and other departmentally used standards. Increases in research productivity were noted (in five of six studies) in terms of funding and publications. There was no change in teaching productivity (in two of five studies) in terms of educational output. Such strategies also resulted in increases in compensation at both individual and group levels (in three studies), with two studies reporting a change in distribution of compensation in favour of junior faculty. None of the studies assessed effects on administrative productivity or promotion processes. The overall quality of evidence was low. Interpretation: Strategies introduced to assess productivity as part of a compensation scheme appeared to improve productivity in research activities and possibly improved clinical productivity, but they had no effect in the area of teaching. Compensation increased at both group and individual levels, particularly among junior faculty. Higher quality evidence about the benefits

Effects of assessing the productivity of faculty in academic medical centres: a systematic review.

Science.gov (United States)

Akl, Elie A; Meerpohl, Joerg J; Raad, Dany; Piaggio, Giulia; Mattioni, Manlio; Paggi, Marco G; Gurtner, Aymone; Mattarocci, Stefano; Tahir, Rizwan; Muti, Paola; Schünemann, Holger J

2012-08-07

Many academic medical centres have introduced strategies to assess the productivity of faculty as part of compensation schemes. We conducted a systematic review of the effects of such strategies on faculty productivity. We searched the MEDLINE, Healthstar, Embase and PsycInfo databases from their date of inception up to October 2011. We included studies that assessed academic productivity in clinical, research, teaching and administrative activities, as well as compensation, promotion processes and satisfaction. Of 531 full-text articles assessed for eligibility, we included 9 articles reporting on eight studies. The introduction of strategies for assessing academic productivity as part of compensation schemes resulted in increases in clinical productivity (in six of six studies) in terms of clinical revenue, the work component of relative-value units (these units are nonmonetary standard units of measure used to indicate the value of services provided), patient satisfaction and other departmentally used standards. Increases in research productivity were noted (in five of six studies) in terms of funding and publications. There was no change in teaching productivity (in two of five studies) in terms of educational output. Such strategies also resulted in increases in compensation at both individual and group levels (in three studies), with two studies reporting a change in distribution of compensation in favour of junior faculty. None of the studies assessed effects on administrative productivity or promotion processes. The overall quality of evidence was low. Strategies introduced to assess productivity as part of a compensation scheme appeared to improve productivity in research activities and possibly improved clinical productivity, but they had no effect in the area of teaching. Compensation increased at both group and individual levels, particularly among junior faculty. Higher quality evidence about the benefits and harms of such assessment strategies is

Headache service quality: evaluation of quality indicators in 14 specialist-care centres.

Science.gov (United States)

Schramm, Sara; Uluduz, Derya; Gouveia, Raquel Gil; Jensen, Rigmor; Siva, Aksel; Uygunoglu, Ugur; Gvantsa, Giorgadze; Mania, Maka; Braschinsky, Mark; Filatova, Elena; Latysheva, Nina; Osipova, Vera; Skorobogatykh, Kirill; Azimova, Julia; Straube, Andreas; Eren, Ozan Emre; Martelletti, Paolo; De Angelis, Valerio; Negro, Andrea; Linde, Mattias; Hagen, Knut; Radojicic, Aleksandra; Zidverc-Trajkovic, Jasna; Podgorac, Ana; Paemeleire, Koen; De Pue, Annelien; Lampl, Christian; Steiner, Timothy J; Katsarava, Zaza

2016-12-01

The study was a collaboration between Lifting The Burden (LTB) and the European Headache Federation (EHF). Its aim was to evaluate the implementation of quality indicators for headache care Europe-wide in specialist headache centres (level-3 according to the EHF/LTB standard). Employing previously-developed instruments in 14 such centres, we made enquiries, in each, of health-care providers (doctors, nurses, psychologists, physiotherapists) and 50 patients, and analysed the medical records of 50 other patients. Enquiries were in 9 domains: diagnostic accuracy, individualized management, referral pathways, patient's education and reassurance, convenience and comfort, patient's satisfaction, equity and efficiency of the headache care, outcome assessment and safety. Our study showed that highly experienced headache centres treated their patients in general very well. The centres were content with their work and their patients were content with their treatment. Including disability and quality-of-life evaluations in clinical assessments, and protocols regarding safety, proved problematic: better standards for these are needed. Some centres had problems with follow-up: many specialised centres operated in one-touch systems, without possibility of controlling long-term management or the success of treatments dependent on this. This first Europe-wide quality study showed that the quality indicators were workable in specialist care. They demonstrated common trends, producing evidence of what is majority practice. They also uncovered deficits that might be remedied in order to improve quality. They offer the means of setting benchmarks against which service quality may be judged. The next step is to take the evaluation process into non-specialist care (EHF/LTB levels 1 and 2).

Pattern and outcome of chest injuries at Bugando Medical Centre in Northwestern Tanzania

Science.gov (United States)

2011-01-01

Background Chest injuries constitute a continuing challenge to the trauma or general surgeon practicing in developing countries. This study was conducted to outline the etiological spectrum, injury patterns and short term outcome of these injuries in our setting. Patients and methods This was a prospective study involving chest injury patients admitted to Bugando Medical Centre over a six-month period from November 2009 to April 2010 inclusive. Results A total of 150 chest injury patients were studied. Males outnumbered females by a ratio of 3.8:1. Their ages ranged from 1 to 80 years (mean = 32.17 years). The majority of patients (72.7%) sustained blunt injuries. Road traffic crush was the most common cause of injuries affecting 50.7% of patients. Chest wall wounds, hemothorax and rib fractures were the most common type of injuries accounting for 30.0%, 21.3% and 20.7% respectively. Associated injuries were noted in 56.0% of patients and head/neck (33.3%) and musculoskeletal regions (26.7%) were commonly affected. The majority of patients (55.3%) were treated successfully with non-operative approach. Underwater seal drainage was performed in 39 patients (19.3%). One patient (0.7%) underwent thoracotomy due to hemopericardium. Thirty nine patients (26.0%) had complications of which wound sepsis (14.7%) and complications of long bone fractures (12.0%) were the most common complications. The mean LOS was 13.17 days and mortality rate was 3.3%. Using multivariate logistic regression analysis, associated injuries, the type of injury, trauma scores (ISS, RTS and PTS) were found to be significant predictors of the LOS (P trauma scores (ISS, RTS and PTS), the need for ICU admission and the presence of complications (P Chest injuries resulting from RTCs remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTCs is necessary to reduce the incidence of chest injuries in this region. PMID:21244706

How does a shortage of physicians impact on the job satisfaction of health centre staff?

Science.gov (United States)

Saxén, Ulla; Jaatinen, Pekka T; Kivelä, Sirkka-Liisa

2008-01-01

The aim was to determine how a shortage of physicians at Finnish health centres has affected the job satisfaction of the entire staff. A questionnaire was posted to 2848 employees working with patients at health centres in the Finnish provinces of Satakunta and Varsinais-Suomi. The information concerning the shortage of physicians at health centres was taken from research undertaken by the Finnish Medical Association in October 2003. The health centres were divided into four groups according to the severity of the shortage. The questionnaire was returned by 1447 employees. The staff at health centres with the most severe shortage of physicians were less satisfied with the management of the organization. Employees at health centres with a minor shortage of physicians were more satisfied with the quality of services in their operational unit. The shortage of physicians had no impact on staff satisfaction regarding the operation of their work unit, the strain of dealing with issues within their work environment, feelings of stress, the strain of working under pressure that they experienced, or interest in finding a new job. The majority of healthcare employees are satisfied and motivated in their work. The shortage of physicians has only a slightly negative impact on their satisfaction.

The use of artificial neural networks and multiple linear regression to predict rate of medical waste generation

International Nuclear Information System (INIS)

Jahandideh, Sepideh; Jahandideh, Samad; Asadabadi, Ebrahim Barzegari; Askarian, Mehrdad; Movahedi, Mohammad Mehdi; Hosseini, Somayyeh; Jahandideh, Mina

2009-01-01

Prediction of the amount of hospital waste production will be helpful in the storage, transportation and disposal of hospital waste management. Based on this fact, two predictor models including artificial neural networks (ANNs) and multiple linear regression (MLR) were applied to predict the rate of medical waste generation totally and in different types of sharp, infectious and general. In this study, a 5-fold cross-validation procedure on a database containing total of 50 hospitals of Fars province (Iran) were used to verify the performance of the models. Three performance measures including MAR, RMSE and R 2 were used to evaluate performance of models. The MLR as a conventional model obtained poor prediction performance measure values. However, MLR distinguished hospital capacity and bed occupancy as more significant parameters. On the other hand, ANNs as a more powerful model, which has not been introduced in predicting rate of medical waste generation, showed high performance measure values, especially 0.99 value of R 2 confirming the good fit of the data. Such satisfactory results could be attributed to the non-linear nature of ANNs in problem solving which provides the opportunity for relating independent variables to dependent ones non-linearly. In conclusion, the obtained results showed that our ANN-based model approach is very promising and may play a useful role in developing a better cost-effective strategy for waste management in future.

The differences between medical trust and mistrust and their respective influences on medication beliefs and ART adherence among African-Americans living with HIV.

Science.gov (United States)

Pellowski, Jennifer A; Price, Devon M; Allen, Aerielle M; Eaton, Lisa A; Kalichman, Seth C

2017-09-01

The purpose of this study was to examine the relationships between medical mistrust and trust and to determine if these measures differentially predict antiretroviral therapy (ART) medication adherence for African-American adults living with HIV. A total of 458 HIV positive African-Americans completed a cross-sectional survey. Self-reported ART adherence was collected using the visual-analog scale. The Beliefs About Medicines Questionnaire was used to assess medication necessity and concern beliefs. All measures of medical mistrust and trust were significantly negatively correlated, ranging from r = -.339 to -.504. Race-based medical mistrust significantly predicted medication necessity and concern beliefs, whereas general medical mistrust only significantly predicted medication concerns. Both measures of trust significantly predicted medication necessity beliefs and medication concerns. Higher levels of race-based medical mistrust predicted lower medication adherence, whereas, neither trust in own physician nor trust in health care provider significantly predicted medication adherence. However, trust in own physician significantly predicted medication necessity beliefs, which predicted medication adherence. Trust and mistrust are not simply opposites of one another. These findings provide evidence for the complexity of understanding the relationship between health care trust, mistrust and patient-related health beliefs and behaviours.

Epidemiology of hemoglobinopathies and thalassemias in individuals referred to the haematology research centre, Shiraz University of Medical Sciences, Shiraz, Iran from 2006 to 2011.

Science.gov (United States)

Haghpanah, Sezaneh; Ramzi, Mani; Zakerinia, Maryam; Nourani Khojasteh, Habib; Haghshenas, Mansour; Rezaei, Narges; Moayed, Vida; Rezaei, Alireza; Karimi, Mehran

2014-01-01

Hemoglobinopathies and thalassemias are the most frequent genetic hereditary disorders with an increasing global health burden, especially in low- and middle-income countries. We aimed to determine the epidemiologic pattern of hemoglobinopathies and thalassemias in individuals referred to the Haematology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran, which is the most important referral center in Southern Iran during 2006 to 2011. The most frequent abnormality was β-thalassemia (β-thal) minor (24.0%), followed by α-thalassemia (α-thal) trait (10.0%), hemoglobin (Hb) S trait (4.0%) and Hb D-Punjab trait (4.0%). Because this center is a referral center, we detected a higher prevalence compared to the normal population; however, these data could help policymakers and health service providers to better programming for prevention of births affected with Hb disorders.

South Sudan Medical Journal: Editorial Policies

African Journals Online (AJOL)

Dr David Tibbutt. Past Adviser for Continuing Medical Education in Uganda, Editor of the "Uganda CME Newsletter" and Visiting Physician to Kitovu Hospital, Uganda and Kirambi Health Centre, Rwanda. Based in UK. EDITORIAL ADVISOR. Ann Burgess, BSc Nutrition, MPH. Nutritionist and editor working from Scotland.

Bubble propagation in Hele-Shaw channels with centred constrictions

Science.gov (United States)

Franco-Gómez, Andrés; Thompson, Alice B.; Hazel, Andrew L.; Juel, Anne

2018-04-01

We study the propagation of finite bubbles in a Hele-Shaw channel, where a centred occlusion (termed a rail) is introduced to provide a small axially uniform depth constriction. For bubbles wide enough to span the channel, the system’s behaviour is similar to that of semi-infinite fingers and a symmetric static solution is stable. Here, we focus on smaller bubbles, in which case the symmetric static solution is unstable and the static bubble is displaced towards one of the deeper regions of the channel on either side of the rail. Using a combination of experiments and numerical simulations of a depth-averaged model, we show that a bubble propagating axially due to a small imposed flow rate can be stabilised in a steady symmetric mode centred on the rail through a subtle interaction between stabilising viscous forces and destabilising surface tension forces. However, for sufficiently large capillary numbers Ca, the ratio of viscous to surface tension forces, viscous forces in turn become destabilising thus returning the bubble to an off-centred propagation regime. With decreasing bubble size, the range of Ca for which steady centred propagation is stable decreases, and eventually vanishes through the coalescence of two supercritical pitchfork bifurcations. The depth-averaged model is found to accurately predict all the steady modes of propagation observed experimentally, and provides a comprehensive picture of the underlying steady bifurcation structure. However, for sufficiently large imposed flow rates, we find that initially centred bubbles do not converge onto a steady mode of propagation. Instead they transiently explore weakly unstable steady modes, an evolution which results in their break-up and eventual settling into a steady propagating state of changed topology.

The Aube centre; Le Centre de l`Aube

Energy Technology Data Exchange (ETDEWEB)

NONE

1996-07-01

This educational booklet is devoted to a general presentation of the Aube radioactive wastes storage centre. After a short presentation of the Andra, the French national agency for the management of radioactive wastes, it gives some general information about radioactive wastes (origin, classification), containers (quality assurance and different types), wastes transportation (planning, safety), and about the Aube centre itself: description, treatment and conditioning of drums (compacting and injection), storage facilities, geological situation of the site, and environmental controls. (J.S.)

Patients' Non-Medical Characteristics Contribute to Collective Medical Decision-Making at Multidisciplinary Oncological Team Meetings.

Science.gov (United States)

Restivo, Léa; Apostolidis, Thémis; Bouhnik, Anne-Déborah; Garciaz, Sylvain; Aurran, Thérèse; Julian-Reynier, Claire

2016-01-01

The contribution of patients' non-medical characteristics to individual physicians' decision-making has attracted considerable attention, but little information is available on this topic in the context of collective decision-making. Medical decision-making at cancer centres is currently carried out using a collective approach, at MultiDisciplinary Team (MDT) meetings. The aim of this study was to determine how patients' non-medical characteristics are presented at MDT meetings and how this information may affect the team's final medical decisions. Observations were conducted at a French Cancer Centre during MDT meetings at which non-standard cases involving some uncertainty were discussed from March to May 2014. Physicians' verbal statements and predefined contextual parameters were collected with a non-participant observational approach. Non numerical data collected in the form of open notes were then coded for quantitative analysis. Univariate and multivariate statistical analyses were performed. In the final sample of patients' records included and discussed (N = 290), non-medical characteristics were mentioned in 32.8% (n = 95) of the cases. These characteristics corresponded to demographics in 22.8% (n = 66) of the cases, psychological data in 11.7% (n = 34), and relational data in 6.2% (n = 18). The patient's age and his/her "likeability" were the most frequently mentioned characteristics. In 17.9% of the cases discussed, the final decision was deferred: this outcome was positively associated with the patients' non-medical characteristics and with uncertainty about the outcome of the therapeutic options available. The design of the study made it difficult to draw definite cause-and-effect conclusions. The Social Representations approach suggests that patients' non-medical characteristics constitute a kind of tacit professional knowledge that may be frequently mobilised in physicians' everyday professional practice. The links observed between patients

Contextualisation of patient-centred care

DEFF Research Database (Denmark)

Dencker, Annemarie; Kristiansen, Maria; Andreassen Rix, Bo

2018-01-01

. In this qualitative comparative study, we explore the influence of medical contexts in three Danish hospital wards, haematology, oncological gynaecology and neuro-intensive care, on communication with patients about their children. In exploring the degree to which the inclusion of children in clinical encounters......Patients' family relations play an important part in the provision of patient-centred cancer care, not least when healthcare professionals encounter seriously ill patients with dependent children. Little is known about how children are perceived and dealt with in clinical encounters....... The thematic analysis was based on Bateson's conceptualisation of communication. We found that healthcare professionals' approach to children in clinical encounters and the ways in which children were positioned on each ward were influenced by aspects specific to the ward, including the diagnosis...

Client Centred Desing

DEFF Research Database (Denmark)

Ørngreen, Rikke; Nielsen, Janni; Levinsen, Karin

2008-01-01

In this paper we argue for the use of Client Centred preparation phases when designing complex systems. Through Client Centred Design human computer interaction can extend the focus on end-users to alse encompass the client's needs, context and resources....

Human-centred approaches in slipperiness measurement

Science.gov (United States)

Grönqvist, Raoul; Abeysekera, John; Gard, Gunvor; Hsiang, Simon M.; Leamon, Tom B.; Newman, Dava J.; Gielo-Perczak, Krystyna; Lockhart, Thurmon E.; Pai, Clive Y.-C.

2010-01-01

A number of human-centred methodologies—subjective, objective, and combined—are used for slipperiness measurement. They comprise a variety of approaches from biomechanically-oriented experiments to psychophysical tests and subjective evaluations. The objective of this paper is to review some of the research done in the field, including such topics as awareness and perception of slipperiness, postural and balance control, rating scales for balance, adaptation to slippery conditions, measurement of unexpected movements, kinematics of slipping, and protective movements during falling. The role of human factors in slips and falls will be discussed. Strengths and weaknesses of human-centred approaches in relation to mechanical slip test methodologies are considered. Current friction-based criteria and thresholds for walking without slipping are reviewed for a number of work tasks. These include activities such as walking on a level or an inclined surface, running, stopping and jumping, as well as stair ascent and descent, manual exertion (pushing and pulling, load carrying, lifting) and particular concerns of the elderly and mobility disabled persons. Some future directions for slipperiness measurement and research in the field of slips and falls are outlined. Human-centred approaches for slipperiness measurement do have many applications. First, they are utilized to develop research hypotheses and models to predict workplace risks caused by slipping. Second, they are important alternatives to apparatus-based friction measurements and are used to validate such methodologies. Third, they are used as practical tools for evaluating and monitoring slip resistance properties of foot wear, anti-skid devices and floor surfaces. PMID:11794763

A 6-YEAR EXPERIENCE OF HEART TRANSPLANTATION IN FEDERAL ALMAZOV NORTH-WEST MEDICAL RESEARCH CENTRE

Directory of Open Access Journals (Sweden)

E. V. Shlyakhto

2016-01-01

Full Text Available Aim. To estimate the results of 6-year experience of heart transplantation (HT in Federal Almazov North-West Medical Research Centre. Methods. From 2010 to 2015 we have performed 65 HT. Mean age was 44.3 ± 14 years old (from 10 to 64 years old. We used biventricular assist device (BIVAD, Berlin Heart Excor support in 7 heart transplant candidates before HT. 19 patients (29% received thymoglobulin, whereas 46 patients (71% had basiliximab to induce immunosuppression.Results. Extracorporeal membrane oxygenation machines were implanted in 5 patients (7.7% after HT due to acute right ventricular failure. Suture annuloplasty (the Batista procedure for tricuspid valve repair was carried out in 3 cases (4.6%. Venovenous hemodiafi ltration was used in 11 patients (16.9%. A total of 598 endomyocardial biopsies (EMB were performed after HT. Evidence of cellular rejection (R1 and R2 was presented in 286 biopsies (48%. The 30-day in-hospital mortality rate was 3.1%. The 6-month survival rate after HT was 92%, 1-year – 91% and overall survival for the 6-year period of observation – 89.2%. Maximum observation period was 71 months.Conclusions. The 6-year experience of HT in our Center has shown a high level of survival. BIVAD Excor support can be effectively used as a «bridge» to HT. Prevention of graft loss due to acute rejection in heart transplant recipients can be achieved only through regular EMB monitoring. The rate of viral infection increased in 2 months after HT.

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

OpenAIRE

Ismail, Salwani; Salam, Abdus; Alattraqchi, Ahmed G; Annamalai, Lakshmi; Chockalingam, Annamalai; Elena, Wan Putri; Rahman, Nor Iza A; Abubakar, Abdullahi Rabiu; Haque, Mainul

2015-01-01

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: Dida...

The electronic residency application service application can predict accreditation council for graduate medical education competency-based surgical resident performance.

Science.gov (United States)

Tolan, Amy M; Kaji, Amy H; Quach, Chi; Hines, O Joe; de Virgilio, Christian

2010-01-01

Program directors often struggle to determine which factors in the Electronic Residency Application Service (ERAS) application are important in the residency selection process. With the establishment of the Accreditation Council for Graduate Medical Education (ACGME) competencies, it would be important to know whether information available in the ERAS application can predict subsequent competency-based performance of general surgery residents. This study is a retrospective correlation of data points found in the ERAS application with core competency-based clinical rotation evaluations. ACGME competency-based evaluations as well as technical skills assessment from all rotations during residency were collected. The overall competency score was defined as an average of all 6 competencies and technical skills. A total of77 residents from two (one university and one community based university-affiliate) general surgery residency programs were included in the analysis. Receiving honors for many of the third year clerkships and AOA membership were associated with a number of the individual competencies. USMLE scores were predictive only of Medical Knowledge (p = 0.004). Factors associated with higher overall competency were female gender (p = 0.02), AOA (p = 0.06), overall number of honors received (p = 0.04), and honors in Ob/Gyn (p = 0.03) and Pediatrics (p = 0.05). Multivariable analysis showed honors in Ob/Gyn, female gender, older age, and total number of honors to be predictive of a number of individual core competencies. USMLE scores were only predictive of Medical Knowledge. The ERAS application is useful for predicting subsequent competency based performance in surgical residents. Receiving honors in the surgery clerkship, which has traditionally carried weight when evaluating a potential surgery resident, may not be as strong a predictor of future success. Copyright © 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights

Emergency medical assistance programs for nuclear power reactors

International Nuclear Information System (INIS)

Linnemann, R.E.; Mettler, F.A. Jr.

1977-01-01

This paper deals with a simple but practical medical support of geographically distributed nuclear reactors in isolated areas. A staff of experts at a centre devote their full attention to accident prevention and preparedness at reactor sites. They establish and maintain emergency medical programs at reactor sites and nearby support hospitals. The emphasis is on first aid and emergency treatment by medical attendants who are not and cannot be experts in radiation but do know how to treat patients. (author)

SAP Nuclear Competence Centre

International Nuclear Information System (INIS)

Andrlova, Z.

2009-01-01

In this issue we continue and introduce the SAP Nuclear Competence Centre and its head Mr. Igor Dzama. SAP Nuclear Competence Centrum is one of the fi rst competence centres outside ENEL headquarters. It should operate in Slovakia and should have competencies within the whole Enel group. We are currently dealing with the issues of organisation and funding. We are trying to balance the accountability to the NPP directors and to the management of the competence centres at Enel headquarters; we are looking at the relations between the competence centres within the group and defining the services that we will provide for the NPPs. author)

Investigation of techniques for energy-efficient new-build data centres

Energy Technology Data Exchange (ETDEWEB)

De Buck, A.; Afman, M.; Van Lieshout, M. [CE Delft, Delft (Netherlands); Harryvan, D. [Mansystems, Den Haag (Netherlands)

2013-05-15

Data centres are becoming an increasingly important sector of the Dutch economy, but are also substantial and rapidly growing energy consumers, currently responsible for approximately 1.5% of national electricity use. In recent years a range of technical options have been developed that permit major improvements in the energy efficiency of data centres. In this context CE Delft has investigated in-depth a number of options for new-build data centres. All these options limit energy use and are economically and technically feasible. The study was conducted for the Dutch government's NL Agency in close cooperation with the trade association Nederland ICT and individual data centres, as well as national and local government authorities. The study consists of an extensive literature study and entailed interviews with suppliers of energy-efficient techniques. Based on detailed data delivered by these suppliers, model calculations were performed to predict the energy performance at different loading degrees. The results were validated with data centre operators. The results show that a high degree of energy efficiency can be achieved. Various combinations of techniques available to this end can deliver EUEs below 1.2. This is a significant step beyond the EUE of 1.3 used as a reference. EUE, Energy Usage Efficiency, is a measure of how energy-efficient a data centre provides its services. A crucial factor in all technology combinations is substantial use of 'free cooling', i.e. utilising natural sources of cold. The efficient variants use technology geared to maximising such use. The type of power supply is another key factor, and in this respect modular construction is pivotal. Operational aspects are also important for achieving high efficiencies. The report is to serve as a basis for guidelines for local government in the framework of environmental permits.

Large-scale fuel cycle centres

International Nuclear Information System (INIS)

Smiley, S.H.; Black, K.M.

1977-01-01

The US Nuclear Regulatory Commission (NRC) has considered the nuclear energy centre concept for fuel cycle plants in the Nuclear Energy Centre Site Survey 1975 (NECSS-75) Rep. No. NUREG-0001, an important study mandated by the US Congress in the Energy Reorganization Act of 1974 which created the NRC. For this study, the NRC defined fuel cycle centres as consisting of fuel reprocessing and mixed-oxide fuel fabrication plants, and optional high-level waste and transuranic waste management facilities. A range of fuel cycle centre sizes corresponded to the fuel throughput of power plants with a total capacity of 50,000-300,000MW(e). The types of fuel cycle facilities located at the fuel cycle centre permit the assessment of the role of fuel cycle centres in enhancing the safeguard of strategic special nuclear materials - plutonium and mixed oxides. Siting fuel cycle centres presents a smaller problem than siting reactors. A single reprocessing plant of the scale projected for use in the USA (1500-2000t/a) can reprocess fuel from reactors producing 50,000-65,000MW(e). Only two or three fuel cycle centres of the upper limit size considered in the NECSS-75 would be required in the USA by the year 2000. The NECSS-75 fuel cycle centre evaluation showed that large-scale fuel cycle centres present no real technical siting difficulties from a radiological effluent and safety standpoint. Some construction economies may be achievable with fuel cycle centres, which offer opportunities to improve waste-management systems. Combined centres consisting of reactors and fuel reprocessing and mixed-oxide fuel fabrication plants were also studied in the NECSS. Such centres can eliminate shipment not only of Pu but also mixed-oxide fuel. Increased fuel cycle costs result from implementation of combined centres unless the fuel reprocessing plants are commercial-sized. Development of Pu-burning reactors could reduce any economic penalties of combined centres. The need for effective fissile

Organization of medical aid and treatment of individuals affected in radiation accidents

International Nuclear Information System (INIS)

Mikhajlov, M.G.; Andreev, E.A.; Bliznakov, V.

1979-01-01

The emergency programme of the medical service for radiation accidents constitutes part of the whole emergency programme of the establishment whose production process is derectly connected with the utilization of ionizing radiation sources. The chief of the establishment health centre also heads the operative radiation accident group. When a radiation accident occurs the medical personnel, according to a previously developed plan, reports at the Health centre. The medical aid is based on the principle of step treatment and evacuation of the affected persons, according to the prescriptions. The first step of the medical evacuation is the health centre; the second - the District hospital, where a team of specialists is formed, all of them previously well trained in the recognition and treatment of radiation sickness. The third step is the specialized clinic for radiation injuries. Persons, who have received irradiation dose of up to 100 rad, or are in a shock state, or have incorporated radioactive substances, are temporarily hospitalized at the health centre. The assistance rended to them consists of: control of shock, asphyxia and bleeding, primary surgical treatment of wounds in cases of complex injuries, deactivation under dosimetric control, attempt for accelerated removal of the radioactive substances, etc. At the District hospital and the specialized clinic the therapeutic measures are conformed to the pathogenetic mechanism and severity of clinical symptoms, and their dynamics. Their aim is first of all to block the earlier radiation effects, to prevent and to treat the haemorrhagic phenomena and infectious complications, to restore the activity of the blood organs, etc. (A.B.)

Clinical profile and factors associated with mortality in hospitalized patients with HIV/AIDS: a retrospective analysis from Tripoli Medical Centre, Libya, 2013.

Science.gov (United States)

Shalaka, N S; Garred, N A; Zeglam, H T; Awasi, S A; Abukathir, L A; Altagdi, M E; Rayes, A A

2015-10-02

In Libya, little is known about HIV-related hospitalizations and in-hospital mortality. This was a retrospective analysis of HIV-related hospitalizations at Tripoli Medical Centre in 2013. Of 227 cases analysed, 82.4% were males who were significantly older (40.0 versus 36.5 years), reported injection drug use (58.3% versus 0%) and were hepatitis C virus co-infected (65.8% versus 0%) compared with females. Severe immunosuppression was prevalent (median CD4 count = 42 cell/μL). Candidiasis was the most common diagnosis (26.0%); Pneumocystis pneumonia was the most common respiratory disease (8.8%), while cerebral toxoplasmosis was diagnosed in 8.4% of patients. Current HAART use was independently associated with low risk of in-hospital mortality (OR 0.33), while central nervous system symptoms (OR 4.12), sepsis (OR 6.98) and low total lymphocyte counts (OR 3.60) were associated with increased risk. In this study, late presentation with severe immunosuppression was common, and was associated with significant in-hospital mortality.

OrderRex: clinical order decision support and outcome predictions by data-mining electronic medical records.

Science.gov (United States)

Chen, Jonathan H; Podchiyska, Tanya; Altman, Russ B

2016-03-01

To answer a "grand challenge" in clinical decision support, the authors produced a recommender system that automatically data-mines inpatient decision support from electronic medical records (EMR), analogous to Netflix or Amazon.com's product recommender. EMR data were extracted from 1 year of hospitalizations (>18K patients with >5.4M structured items including clinical orders, lab results, and diagnosis codes). Association statistics were counted for the ∼1.5K most common items to drive an order recommender. The authors assessed the recommender's ability to predict hospital admission orders and outcomes based on initial encounter data from separate validation patients. Compared to a reference benchmark of using the overall most common orders, the recommender using temporal relationships improves precision at 10 recommendations from 33% to 38% (P < 10(-10)) for hospital admission orders. Relative risk-based association methods improve inverse frequency weighted recall from 4% to 16% (P < 10(-16)). The framework yields a prediction receiver operating characteristic area under curve (c-statistic) of 0.84 for 30 day mortality, 0.84 for 1 week need for ICU life support, 0.80 for 1 week hospital discharge, and 0.68 for 30-day readmission. Recommender results quantitatively improve on reference benchmarks and qualitatively appear clinically reasonable. The method assumes that aggregate decision making converges appropriately, but ongoing evaluation is necessary to discern common behaviors from "correct" ones. Collaborative filtering recommender algorithms generate clinical decision support that is predictive of real practice patterns and clinical outcomes. Incorporating temporal relationships improves accuracy. Different evaluation metrics satisfy different goals (predicting likely events vs. "interesting" suggestions). Published by Oxford University Press on behalf of the American Medical Informatics Association 2015. This work is written by US Government

Interprofessional collaborative patient-centred care: a critical exploration of two related discourses.

Science.gov (United States)

Fox, Ann; Reeves, Scott

2015-03-01

There has been sustained international interest from health care policy makers, practitioners, and researchers in developing interprofessional approaches to delivering patient-centred care. In this paper, we offer a critical exploration of a selection of professional discourses related to these practice paradigms, including interprofessional collaboration, patient-centred care, and the combination of the two. We argue that for some groups of patients, inequalities between different health and social care professions and between professionals and patients challenge the successful realization of the positive aims associated with these discourses. Specifically, we argue that interprofessional and professional-patient hierarchies raise a number of key questions about the nature of professions, their relationships with one another as well as their relationship with patients. We explore how the focus on interprofessional collaboration and patient-centred care have the potential to reinforce a patient compliance model by shifting responsibility to patients to do the "right thing" and by extending the reach of medical power across other groups of professionals. Our goal is to stimulate debate that leads to enhanced practice opportunities for health professionals and improved care for patients.

A designated centre for people with disabilities operated by St Aidan's Day Care Centre Ltd., Wexford

LENUS (Irish Health Repository)

Gibbons, C

2015-02-01

Ireland has seen a steady increase in paediatric sickle cell disease (SCD). In 2005, only 25% of children with SCD were referred to the haemoglobinopathy service in their first year. A non-funded screening programme was implemented. This review aimed to assess the impact screening has had. All children referred to the haemoglobinopathy service born in Ireland after 2005 were identified. Data was collected from the medical chart and laboratory system. Information was analysed using Microsoft Excel. 77 children with SCD were identified. The median age at antibiotic commencement in the screened group was 56 days compared with 447 days in the unscreened group, p = < 0.0003. 22 (28%) of infants were born in centre\\'s that do not screen and 17 (81%) were over 6 months old at referral, compared with 14 (21%) in the screened group. 6 (27%) of those in the unscreened group presented in acute crisis compared with 2 (3%) in the screened population. The point prevalence of SCD in Ireland is 0.2% in children under 15 yr of African and Asian descent. We identified delays in referral and treatment, which reflect the lack of government funded support and policy. We suggest all maternity units commence screening for newborns at risk of SCD. It is a cost effective intervention with a number needed to screen of just 4 to prevent a potentially fatal crisis.

Exploring the potential uses of value-added metrics in the context of postgraduate medical education.

Science.gov (United States)

Gregory, Simon; Patterson, Fiona; Baron, Helen; Knight, Alec; Walsh, Kieran; Irish, Bill; Thomas, Sally

2016-10-01

Increasing pressure is being placed on external accountability and cost efficiency in medical education and training internationally. We present an illustrative data analysis of the value-added of postgraduate medical education. We analysed historical selection (entry) and licensure (exit) examination results for trainees sitting the UK Membership of the Royal College of General Practitioners (MRCGP) licensing examination (N = 2291). Selection data comprised: a clinical problem solving test (CPST); a situational judgement test (SJT); and a selection centre (SC). Exit data was an applied knowledge test (AKT) from MRCGP. Ordinary least squares (OLS) regression analyses were used to model differences in attainment in the AKT based on performance at selection (the value-added score). Results were aggregated to the regional level for comparisons. We discovered significant differences in the value-added score between regional training providers. Whilst three training providers confer significant value-added, one training provider was significantly lower than would be predicted based on the attainment of trainees at selection. Value-added analysis in postgraduate medical education potentially offers useful information, although the methodology is complex, controversial, and has significant limitations. Developing models further could offer important insights to support continuous improvement in medical education in future.

The IOC Centres of Excellence bring prevention to sports medicine.

Science.gov (United States)

Engebretsen, Lars; Bahr, Roald; Cook, Jill L; Derman, Wayne; Emery, Carolyn A; Finch, Caroline F; Meeuwisse, Willem H; Schwellnus, Martin; Steffen, Kathrin

2014-09-01

The protection of an athlete's health and preventing injuries and illnesses in sport are top priorities for the IOC and its Medical Commission. The IOC therefore partners with selected research centres around the world and supports research in the field of sports medicine. This has enabled the IOC to develop an international network of expert scientists and clinicians in sports injury and disease prevention research. The IOC wants to promote injury and disease prevention and the improvement of physical health of the athlete by: (1) establishing long-term research programmes on injury and disease prevention (including studies on basic epidemiology, risk factors, injury mechanisms and intervention), (2) fostering collaborative relationships with individuals, institutions and organisations to improve athletes' health, (3) implementing and collaborating with applied, ongoing and novel research and development within the framework and long-term strategy of the IOC and (4) setting up knowledge translation mechanisms to share scientific research results with the field throughout the Olympic Movement and sports community and converting these results into concrete actions to protect the health of the athletes. In 2009, the IOC also identified four research centres that had an established track record in research, educational and clinical activities to achieve these ambitions: (1) the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Australia; (2) the Sport Injury Prevention Research Centre (SIPRC), Canada; (3) the Clinical Sport and Exercise Medicine Research (CSEM), South Africa and (4) the Oslo Sports Trauma Research Center (OSTRC), Norway. This paper highlights the work carried out by these four IOC Centres of Excellence over the past 6 years and their contribution to the world of sports medicine. 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.

Defining and describing birth centres in the Netherlands - a component study of the Dutch Birth Centre Study.

Science.gov (United States)

Hermus, M A A; Boesveld, I C; Hitzert, M; Franx, A; de Graaf, J P; Steegers, E A P; Wiegers, T A; van der Pal-de Bruin, K M

2017-07-03

During the last decade, a rapid increase of birth locations for low-risk births, other than conventional obstetric units, has been seen in the Netherlands. Internationally some of such locations are called birth centres. The varying international definitions for birth centres are not directly applicable for use within the Dutch obstetric system. A standard definition for a birth centre in the Netherlands is lacking. This study aimed to develop a definition of birth centres for use in the Netherlands, to identify these centres and to describe their characteristics. International definitions of birth centres were analysed to find common descriptions. In July 2013 the Dutch Birth Centre Questionnaire was sent to 46 selected Dutch birth locations that might qualify as birth centre. Questions included: location, reason for establishment, women served, philosophies, facilities that support physiological birth, hotel-facilities, management, environment and transfer procedures in case of referral. Birth centres were visited to confirm the findings from the Dutch Birth Centre Questionnaire and to measure distance and time in case of referral to obstetric care. From all 46 birth locations the questionnaires were received. Based on this information a Dutch definition of a birth centre was constructed. This definition reads: "Birth centres are midwifery-managed locations that offer care to low risk women during labour and birth. They have a homelike environment and provide facilities to support physiological birth. Community midwives take primary professional responsibility for care. In case of referral the obstetric caregiver takes over the professional responsibility of care." Of the 46 selected birth locations 23 fulfilled this definition. Three types of birth centres were distinguished based on their location in relation to the nearest obstetric unit: freestanding (n = 3), alongside (n = 14) and on-site (n = 6). Transfer in case of referral was necessary for all

Challenges in successfully developing three regional radiotherapy centres. The NCCI experience

International Nuclear Information System (INIS)

Greenham, Stuart

2011-01-01

Full text: This presentation will provide an overview of the processes, experience, challenges and success involved in the establishment of the North Coast Cancer Institute (NCCI). The NCCI is a network of three Integrated Oncology centres in Northern New South Wales offering integrated Medical, Radiation and Haematology outpatient services. NCCI was developed as part of the introduction of radiotherapy into a region previously without access to a local radiotherapy service and as a result with poor radiotherapy utilisation and referral rates. NCCI commenced radiotherapy services in Coffs Harbour in May 2007 followed by Port Macquarie in August of the same year and finally in Lismore in May 20 I O. Radiotherapy services commenced with Intensity Modulated Radiotherapy and Image guided radiotherapy as standard of care for some disease sites with remote access to planning systems and electronic workflow process supporting the treatment process. Forming a small team to simultaneously design, build and establish two new treatment centres to take advantage of the most contemporary treatment modalities while also planning for a third centre was a significant challenge. The challenges and successful outcomes will be discussed as part of this presentation.

Dimensionality and predictive validity of the HAM-Nat, a test of natural sciences for medical school admission.

Science.gov (United States)

Hissbach, Johanna C; Klusmann, Dietrich; Hampe, Wolfgang

2011-10-14

Knowledge in natural sciences generally predicts study performance in the first two years of the medical curriculum. In order to reduce delay and dropout in the preclinical years, Hamburg Medical School decided to develop a natural science test (HAM-Nat) for student selection. In the present study, two different approaches to scale construction are presented: a unidimensional scale and a scale composed of three subject specific dimensions. Their psychometric properties and relations to academic success are compared. 334 first year medical students of the 2006 cohort responded to 52 multiple choice items from biology, physics, and chemistry. For the construction of scales we generated two random subsamples, one for development and one for validation. In the development sample, unidimensional item sets were extracted from the item pool by means of weighted least squares (WLS) factor analysis, and subsequently fitted to the Rasch model. In the validation sample, the scales were subjected to confirmatory factor analysis and, again, Rasch modelling. The outcome measure was academic success after two years. Although the correlational structure within the item set is weak, a unidimensional scale could be fitted to the Rasch model. However, psychometric properties of this scale deteriorated in the validation sample. A model with three highly correlated subject specific factors performed better. All summary scales predicted academic success with an odds ratio of about 2.0. Prediction was independent of high school grades and there was a slight tendency for prediction to be better in females than in males. A model separating biology, physics, and chemistry into different Rasch scales seems to be more suitable for item bank development than a unidimensional model, even when these scales are highly correlated and enter into a global score. When such a combination scale is used to select the upper quartile of applicants, the proportion of successful completion of the curriculum

Dimensionality and predictive validity of the HAM-Nat, a test of natural sciences for medical school admission

Directory of Open Access Journals (Sweden)

Hissbach Johanna C

2011-10-01

Full Text Available Abstract Background Knowledge in natural sciences generally predicts study performance in the first two years of the medical curriculum. In order to reduce delay and dropout in the preclinical years, Hamburg Medical School decided to develop a natural science test (HAM-Nat for student selection. In the present study, two different approaches to scale construction are presented: a unidimensional scale and a scale composed of three subject specific dimensions. Their psychometric properties and relations to academic success are compared. Methods 334 first year medical students of the 2006 cohort responded to 52 multiple choice items from biology, physics, and chemistry. For the construction of scales we generated two random subsamples, one for development and one for validation. In the development sample, unidimensional item sets were extracted from the item pool by means of weighted least squares (WLS factor analysis, and subsequently fitted to the Rasch model. In the validation sample, the scales were subjected to confirmatory factor analysis and, again, Rasch modelling. The outcome measure was academic success after two years. Results Although the correlational structure within the item set is weak, a unidimensional scale could be fitted to the Rasch model. However, psychometric properties of this scale deteriorated in the validation sample. A model with three highly correlated subject specific factors performed better. All summary scales predicted academic success with an odds ratio of about 2.0. Prediction was independent of high school grades and there was a slight tendency for prediction to be better in females than in males. Conclusions A model separating biology, physics, and chemistry into different Rasch scales seems to be more suitable for item bank development than a unidimensional model, even when these scales are highly correlated and enter into a global score. When such a combination scale is used to select the upper quartile of

Molecular characteristic of alpha thalassaemia among patients diagnosed in UKM Medical Centre.

Science.gov (United States)

Azma, Raja Zahratul; Ainoon, Othman; Hafiza, Alauddin; Azlin, Ithnin; Noor Farisah, Abudul Razak; Nor Hidayati, Sardi; Noor Hamidah, Hussin

2014-04-01

Alpha (Α) thalassaemia is the most common inherited disorder in Malaysia. The clinical severity is dependant on the number of Α genes involved. Full blood count (FBC) and haemoglobin (Hb) analysis using either gel electrophoresis, high performance liquid chromatography (HPLC) or capillary zone electrophoresis (CE) are unable to detect definitively alpha thalassaemia carriers. Definitive diagnosis of Α-thalassaemias requires molecular analysis and methods of detecting both common deletional and non-deletional molecular abnormailities are easily performed in any laboratory involved in molecular diagnostics. We carried out a retrospective analysis of 1623 cases referred to our laboratory in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) for the diagnosis of Α-thalassaemia during the period October 2001 to December 2012. We examined the frequency of different types of alpha gene abnormalities and their haematologic features. Molecular diagnosis was made using a combination of multiplex polymerase reaction (PCR) and real time PCR to detect deletional and non-deletional alpha genes relevant to southeast Asian population. Genetic analysis confirmed the diagnosis of Α-thalassaemias in 736 cases. Majority of the cases were Chinese (53.1%) followed by Malays (44.2%), and Indians (2.7%). The most common gene abnormality was ΑΑ/--(SEA) (64.0%) followed by ΑΑ/-Α(3.7) (19.8%), -Α(3.7) /--(SEA) (6.9%), ΑΑ/ΑΑCS (3.0%), --(SEA)/--(SEA) (1.2%), -Α(3.7)/-Α(3.7) (1.1%), ΑΑ/-Α(4.2) (0.7%), -Α(4.2)/--(SEA (0.7%), -Α(3.7)/-Α(4.2) (0.5%), ΑΑ(CS)/-- SEA) (0.4%), ΑΑ(CS)/ΑΑ(Cd59) (0.4%), ΑΑ(CS)/ΑΑ(CS) (0.4%), -Α(3.7)/ΑΑ(Cd59) (0.3%), ΑΑ/ΑΑ(Cd59) (0.1%), ΑΑ(Cd59)/ ΑΑ(IVS I-1) (0.1%), -Α(3.7)/ΑΑ(CS) (0.1%) and --(SEA) /ΑΑ(Cd59) (0.1%). This data indicates that the molecular abnormalities of Α-thalassaemia in the Malaysian population is heterogenous. Although Α-gene deletion is the most common cause, non-deletional Α-gene abnormalities

Time-To-Complete Prediction for Data Transfers

CERN Document Server

Toler, Wesley

2016-01-01

Currently, there is no prediction provided to users for the amount of time a particular data transfer from one site in the Worldwide LHC Computing Grid to another will take to complete. To develop a time-to-complete prediction, network performance data and per-file information is gathered from two separate databases and fused, and the resulting cleaned data is fitted using random forest regression. Results are shown for two separate links: the link from CERN Data Centre to Brookhaven National Laboratory’s ATLAS data center, and the link from CERN Data Centre to SARA-MATRIX in Amsterdam. A total RMS error of 25.93 minutes between predicted and test data is found for the CERN-PROD -> BNL-ATLAS link, while the CERN-PROD -> SARA-MATRIX link yields a total RMS error of 3.00 minutes.

Logistic regression analysis to predict Medical Licensing Examination of Thailand (MLET) Step1 success or failure.

Science.gov (United States)

Wanvarie, Samkaew; Sathapatayavongs, Boonmee

2007-09-01

The aim of this paper was to assess factors that predict students' performance in the Medical Licensing Examination of Thailand (MLET) Step1 examination. The hypothesis was that demographic factors and academic records would predict the students' performance in the Step1 Licensing Examination. A logistic regression analysis of demographic factors (age, sex and residence) and academic records [high school grade point average (GPA), National University Entrance Examination Score and GPAs of the pre-clinical years] with the MLET Step1 outcome was accomplished using the data of 117 third-year Ramathibodi medical students. Twenty-three (19.7%) students failed the MLET Step1 examination. Stepwise logistic regression analysis showed that the significant predictors of MLET Step1 success/failure were residence background and GPAs of the second and third preclinical years. For students whose sophomore and third-year GPAs increased by an average of 1 point, the odds of passing the MLET Step1 examination increased by a factor of 16.3 and 12.8 respectively. The minimum GPAs for students from urban and rural backgrounds to pass the examination were estimated from the equation (2.35 vs 2.65 from 4.00 scale). Students from rural backgrounds and/or low-grade point averages in their second and third preclinical years of medical school are at risk of failing the MLET Step1 examination. They should be given intensive tutorials during the second and third pre-clinical years.

Contributions to HEVC Prediction for Medical Image Compression

OpenAIRE

Guarda, André Filipe Rodrigues

2016-01-01

Medical imaging technology and applications are continuously evolving, dealing with images of increasing spatial and temporal resolutions, which allow easier and more accurate medical diagnosis. However, this increase in resolution demands a growing amount of data to be stored and transmitted. Despite the high coding efficiency achieved by the most recent image and video coding standards in lossy compression, they are not well suited for quality-critical medical image compressi...

Medical records and radiation exposure cards

International Nuclear Information System (INIS)

Vigan, C.

1975-01-01

Some ideas concerning medical records at the Ispra Centre are exposed. The approved medical practitioner has two main tasks: he must gather enough relevant information to decide on the worker's suitability and also to determine his physical condition, normal or otherwise, and he must record it with enough detail to permit comparison with findings at later examinations. for the purposes of medical records, clinical examinations and complementary investigations, a large proportion of the measurements are of course made on the critical organs. The problems of the container or physical medium receiving the information to be recorded is considered. The possibilities offered by computer techniques are discussed

The cumulative risk of false-positive screening results across screening centres in the Norwegian Breast Cancer Screening Program

Energy Technology Data Exchange (ETDEWEB)

Roman, M., E-mail: Marta.Roman@kreftregisteret.no [Cancer Registry of Norway, Oslo (Norway); Department of Women and Children’s Health, Oslo University Hospital, Oslo (Norway); Skaane, P., E-mail: PERSK@ous-hf.no [Department of Radiology, Oslo University Hospital Ullevaal, University of Oslo, Oslo (Norway); Hofvind, S., E-mail: Solveig.Hofvind@kreftregisteret.no [Cancer Registry of Norway, Oslo (Norway); Oslo and Akershus University College of Applied Sciences, Faculty of Health Science, Oslo (Norway)

2014-09-15

Highlights: • We found variation in early performance measures across screening centres. • Radiologists’ performance may play a key role in the variability. • Potential to improve the effectiveness of breast cancer screening programs. • Continuous surveillance of screening centres and radiologists is essential. - Abstract: Background: Recall for assessment in mammographic screening entails an inevitable number of false-positive screening results. This study aimed to investigate the variation in the cumulative risk of a false positive screening result and the positive predictive value across the screening centres in the Norwegian Breast Cancer Screening Program. Methods: We studied 618,636 women aged 50–69 years who underwent 2,090,575 screening exams (1996–2010. Recall rate, positive predictive value, rate of screen-detected cancer, and the cumulative risk of a false positive screening result, without and with invasive procedures across the screening centres were calculated. Generalized linear models were used to estimate the probability of a false positive screening result and to compute the cumulative false-positive risk for up to ten biennial screening examinations. Results: The cumulative risk of a false-positive screening exam varied from 10.7% (95% CI: 9.4–12.0%) to 41.5% (95% CI: 34.1–48.9%) across screening centres, with a highest to lowest ratio of 3.9 (95% CI: 3.7–4.0). The highest to lowest ratio for the cumulative risk of undergoing an invasive procedure with a benign outcome was 4.3 (95% CI: 4.0–4.6). The positive predictive value of recall varied between 12.0% (95% CI: 11.0–12.9%) and 19.9% (95% CI: 18.3–21.5%), with a highest to lowest ratio of 1.7 (95% CI: 1.5–1.9). Conclusions: A substantial variation in the performance measures across the screening centres in the Norwegian Breast Cancer Screening Program was identified, despite of similar administration, procedures, and quality assurance requirements. Differences in the

The cumulative risk of false-positive screening results across screening centres in the Norwegian Breast Cancer Screening Program

International Nuclear Information System (INIS)

Roman, M.; Skaane, P.; Hofvind, S.

2014-01-01

Highlights: • We found variation in early performance measures across screening centres. • Radiologists’ performance may play a key role in the variability. • Potential to improve the effectiveness of breast cancer screening programs. • Continuous surveillance of screening centres and radiologists is essential. - Abstract: Background: Recall for assessment in mammographic screening entails an inevitable number of false-positive screening results. This study aimed to investigate the variation in the cumulative risk of a false positive screening result and the positive predictive value across the screening centres in the Norwegian Breast Cancer Screening Program. Methods: We studied 618,636 women aged 50–69 years who underwent 2,090,575 screening exams (1996–2010. Recall rate, positive predictive value, rate of screen-detected cancer, and the cumulative risk of a false positive screening result, without and with invasive procedures across the screening centres were calculated. Generalized linear models were used to estimate the probability of a false positive screening result and to compute the cumulative false-positive risk for up to ten biennial screening examinations. Results: The cumulative risk of a false-positive screening exam varied from 10.7% (95% CI: 9.4–12.0%) to 41.5% (95% CI: 34.1–48.9%) across screening centres, with a highest to lowest ratio of 3.9 (95% CI: 3.7–4.0). The highest to lowest ratio for the cumulative risk of undergoing an invasive procedure with a benign outcome was 4.3 (95% CI: 4.0–4.6). The positive predictive value of recall varied between 12.0% (95% CI: 11.0–12.9%) and 19.9% (95% CI: 18.3–21.5%), with a highest to lowest ratio of 1.7 (95% CI: 1.5–1.9). Conclusions: A substantial variation in the performance measures across the screening centres in the Norwegian Breast Cancer Screening Program was identified, despite of similar administration, procedures, and quality assurance requirements. Differences in the

Towards People-Centred Economic Reintegration? An Analysis of the Economic Reintegration Strategy of Demobilised Combatants in Colombia

Directory of Open Access Journals (Sweden)

Stefan Thorsell

2013-04-01

Full Text Available This paper investigates the suitability of the economic reintegration strategy for former Colombian combatants, taking into account the challenges facing this population. It argues that the international discourse primarily consists of a market-centred versus a people-centred perspective, each with a distinct approach to economic reintegration. The paper finds that in Colombia there was a lack of inclusion of key stakeholders in the initial design of the process. As a result, the economic reintegration strategy ended up merely accommodating certain neoliberal ideals and thereby leaned towards a market-centred approach. Lately, steps have been taken towards an increasingly people-centred approach. This is currently reflected in improved results of the process, which predict a brighter future for economic reintegration of former combatants in Colombia.

Perceived need to take medication is associated with medication non-adherence in patients with rheumatoid arthritis

Directory of Open Access Journals (Sweden)

Zwikker HE

2014-11-01

Full Text Available Hanneke E Zwikker,1,2 Sandra van Dulmen,3–5 Alfons A den Broeder,1,2 Bart J van den Bemt,1,2,6 Cornelia H van den Ende1,2 1Department of Rheumatology, 2Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands; 3Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands; 4NIVEL (Netherlands Institute for Health Services Research, Utrecht, the Netherlands; 5Department of Health Science, Buskerud and Vestfold University College, Drammen, Norway; 6Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands Background: This is the first cross-sectional study that aims to examine associations between beliefs about medication and non-adherence in patients with rheumatoid arthritis (RA using disease-modifying antirheumatic drugs, taking potential psychological confounders into account.Methods: Eligible patients (diagnosed with RA for ≥1 year or ≥18 years, using greater than or equal to one disease-modifying antirheumatic drug were included by their rheumatologist during regular outpatient visits between September 2009 and September 2010. Included patients received questionnaires. The Beliefs about Medicines Questionnaire was used to measure the perceived need to take medication (necessity beliefs, the concerns about taking medication (concern beliefs, general medication beliefs, and attitudes toward taking medication. Medication non-adherence (no/yes was measured using the Compliance Questionnaire Rheumatology (CQR. Associations between beliefs and non-adherence, and the influence of demographical, clinical, and psychological factors (symptoms of anxiety/depression, illness cognitions, self-efficacy were assessed using logistic regression.Results: A total of 580 of the 820 eligible patients willing to participate were included in the analyses (68% female, mean age 63 years, 30% non-adherent to their medication. Weaker necessity beliefs (OR [odds ratio]: 0.8, 95% CI

Multidisciplinary family-centred psychosocial care for patients with CHD: consensus recommendations from the AEPC Psychosocial Working Group.

Science.gov (United States)

Utens, Elisabeth M W J; Callus, Edward; Levert, Eveline M; Groote, Katya De; Casey, Frank

2018-02-01

Because of the enormous advances in the medical treatment of CHD, the long-term survival of patients suffering from this disease has increased significantly. Currently, about 90% of patients reach adulthood, which entails many new challenges both for patients and their families and for healthcare professionals. The main objective of family-centred psychosocial care is to strengthen the emotional resilience of chronically ill patients and their families by adopting a holistic approach. During the biannual meeting of the psychosocial working group in 2012, participants expressed the need for general European guidelines. The present recommendations were written to support medical staff and psychosocial healthcare professionals to provide the best care for children and adolescents with CHD as well as for their families. This article describes in detail how the integrated family-centred psychological care modules work, involving different healthcare specialists, including a paediatric/congenital cardiologist or a general paediatrician. The different clinical implications and specific needs have been taken into account and recommendations have been provided on the following: structured follow-up screening; identification of stressful periods related to cardiac surgery or invasive medical procedures; evidence-based, disease-specific, and family-oriented psychosocial interventions; and interactive media links to medical and psychosocial information.

The role of the emergency medical dispatch centre (EMDC) and prehospital emergency care safety: results from an incident report (IR) system.

Science.gov (United States)

Mortaro, Alberto; Pascu, Diana; Zerman, Tamara; Vallaperta, Enrico; Schönsberg, Alberto; Tardivo, Stefano; Pancheri, Serena; Romano, Gabriele; Moretti, Francesca

2015-07-01

The role of the emergency medical dispatch centre (EMDC) is essential to ensure coordinated and safe prehospital care. The aim of this study was to implement an incident report (IR) system in prehospital emergency care management with a view to detecting errors occurring in this setting and guiding the implementation of safety improvement initiatives. An ad hoc IR form for the prehospital setting was developed and implemented within the EMDC of Verona. The form included six phases (from the emergency call to hospital admission) with the relevant list of potential error modes (30 items). This descriptive observational study considered the results from 268 consecutive days between February and November 2010. During the study period, 161 error modes were detected. The majority of these errors occurred in the resource allocation and timing phase (34.2%) and in the dispatch phase (31.0%). Most of the errors were due to human factors (77.6%), and almost half of them were classified as either moderate (27.9%) or severe (19.9%). These results guided the implementation of specific corrective actions, such as the adoption of a more efficient Medical Priority Dispatch System and the development of educational initiatives targeted at both EMDC staff and the population. Despite the intrinsic limits of IR methodology, results suggest how the implementation of an IR system dedicated to the emergency prehospital setting can act as a major driver for the development of a "learning organization" and improve both efficacy and safety of first aid care.

International research centre launched

International Nuclear Information System (INIS)

1965-01-01

Full text: The first scientific research and educational institution to be set up on a completely international basis was officially inaugurated in Trieste on 5 October 1964 by the Director General of IAEA, Dr. Sigvard Eklund, when he opened the first seminar of the International Centre for Theoretical Physics. As evidence of the international nature of the institution he noted that the scientists who would work and teach there during the first year represented sixteen different countries. By the end of 1964, the Centre building was nearing completion and three of the five floors were occupied. A successful symposium had been held on the subject of plasma physics, and a score of professors and fellows were at work, from Bulgaria, Czechoslovakia, Greece, India, Japan, Jordan, the Netherlands, Norway, Pakistan, Poland, the United Kingdom, and the United States. A dozen scientific papers had been issued as preprints. The main purpose of the Centre is to foster the advancement of theoretical physics through training and research; at first the chief subject will be high-energy and elementary particle physics. Plasma physics, low energy physics and solid-state physics will also be dealt with. Special attention is paid to the needs of the developing countries. Of the 25 fellows selected for the academic year 1964-65, more than half are from South America, Africa and Asia. In conjunction with the Research Centre, there is an Advanced School for theoretical Physics to provide graduate training for fellows who need such preparation before they embark upon research. The Centre works under the guidance of a Scientific Council comprising the president, Prof. M. Sandoval-Vallarta (Nuclear Energy Commission of Mexico); Prof. A. Abragam (Saclay, France); Prof. R. Oppenheimer (Institute for Advanced Study, Princeton, USA); Dr. V. Soloviev (Dubna, USSR); Prof V.F. Weiskopf (Director General, CERN) ; Prof Abdus Salam (Imperial College, London) ; Prof. P. Budini (University of Trieste

A wearable sensor system for medication adherence prediction.

Science.gov (United States)

Kalantarian, Haik; Motamed, Babak; Alshurafa, Nabil; Sarrafzadeh, Majid

2016-05-01

Studies have revealed that non-adherence to prescribed medication can lead to hospital readmissions, clinical complications, and other negative patient outcomes. Though many techniques have been proposed to improve patient adherence rates, they suffer from low accuracy. Our objective is to develop and test a novel system for assessment of medication adherence. Recently, several smart pill bottle technologies have been proposed, which can detect when the bottle has been opened, and even when a pill has been retrieved. However, very few systems can determine if the pill is subsequently ingested or discarded. We propose a system for detecting user adherence to medication using a smart necklace, capable of determining if the medication has been ingested based on the skin movement in the lower part of the neck during a swallow. This, coupled with existing medication adherence systems that detect when medicine is removed from the bottle, can detect a broader range of use-cases with respect to medication adherence. Using Bayesian networks, we were able to correctly classify between chewable vitamins, saliva swallows, medication capsules, speaking, and drinking water, with average precision and recall of 90.17% and 88.9%, respectively. A total of 135 instances were classified from a total of 20 subjects. Our experimental evaluations confirm the accuracy of the piezoelectric necklace for detecting medicine swallows and disambiguating them from related actions. Further studies in real-world conditions are necessary to evaluate the efficacy of the proposed scheme. Copyright © 2016 Elsevier B.V. All rights reserved.

System of regional centres of first aid in cases of radiation accidents in Germany

International Nuclear Information System (INIS)

Fehringer, F.; Seitz, G.

1996-01-01

When in the seventies the number of occupational radiation exposed persons in the Federal Republic of Germany increased from about 35,000 (1974) to about 160,000 (1978) the Industrial Injuries Insurance Institutes felt prompted to reflect about special measures to prevent radiation accidents and provide health care for this special cases. They did so without any actual occasion: accidents were persons have been exposed by ionizing radiation were in the seventies just as rare as today. But that fact does not allow the Industrial Injuries Insurance Institutes to neglect the existing potential for severe accidents. So the Industrial Injuries Insurance Institute for the Electrical Industry including Precision Mechanics and the Industrial Injuries Insurance Institute for the Chemical Industry created the Institute for Radiation Protection in 1978. The primary task of that Institute is to guarantee an effective first aid in the case of a radiation accident. To realize that task the Institute contracted 11 wellknown institutions like radiological departments of large hospitals or the medical departments of research centres where the i knowledge on diagnostic and therapy of radiation effects is present. They are called 'Regionale Strahlenschutzzentren', Regional Centres for Radiation Protection (RCRP). In the case of radiation accidents these RCRP are the logistical centres for all arising questions of treatment. They have facilities for reconstructing exposure situations and assessing and evaluating doses, including measurements of internal contamination as well as for medical inpatient or out-patient treating like internal or external decontamination. Another important task of the RCRP is to advise employers in ad radiation protection questions which arise with the industrial application of ionizing radiation. Of course the centres give also answer to many question from members of the public, for example the personal effects of the power plant accident at Chernobyl

Trichomonas vaginalis infection in a low-risk women attended in Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre

Institute of Scientific and Technical Information of China (English)

Norhayati Moktar; Nor Liyana Ismail; Phoy Cheng Chun; Mohamad Asyrab Sapie; Nor Farahin Abdul Kahar; Yusof Suboh; Noraina Abdul Rahim; Nor Azlin Mohamed Ismail; Tengku Shahrul Anuar

2016-01-01

Objective: To investigate the presence of trichomoniasis among women attending the Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre.Methods: A total of 139 high vaginal swabs were taken from the subjects and sent to the laboratory in Amies gel transport media. The specimens were examined for the presence of Trichomonas vaginalis using wet mount, Giemsa staining and cultured in Diamond’s medium. Sociodemographic characteristics and gynaecological complaints were obtained in private using structured questionnaire applied by one investigator.Results: The median age was 32 years, with an interquartile interval of 9.96. Most of the subjects were Malays(76.9%) and the remaining were Chinese(15.1%), Indians(2.2%)and other ethnic groups(5.8%). One hundred and thirty eight(99.3%) of the women were married and 98.6% had less than 6 children. More than half(75.5%) of the women’s last child birth was less than 6 years ago. Forty seven percent of them were involved in supporting administrative work and 64.7% of the women gave a history of previous or current vaginal discharge.Conclusions: The present study reported zero incidence rate of trichomoniasis. The low incidence rate was postulated due to all women who participated in this study were categorized into a low-risk group.

Trichomonas vaginalis infection in a low-risk women attended in Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre

Institute of Scientific and Technical Information of China (English)

Norhayati Moktar; Nor Liyana Ismail; Phoy Cheng Chun; Mohamad Asyrab Sapie; Nor Farahin Abdul Kahar; Yusof Suboh; Noraina Abdul Rahim; Nor Azlin Mohamed Ismail; Tengku Shahrul Anuar

2016-01-01

Objective: To investigate the presence of trichomoniasis among women attending the Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre. Methods: A total of 139 high vaginal swabs were taken from the subjects and sent to the laboratory in Amies gel transport media. The specimens were examined for the presence of Trichomonas vaginalis using wet mount, Giemsa staining and cultured in Diamond's medium. Sociodemographic characteristics and gynaecological complaints were obtained in private using structured questionnaire applied by one investigator. Results: The median age was 32 years, with an interquartile interval of 9.96. Most of the subjects were Malays (76.9%) and the remaining were Chinese (15.1%), Indians (2.2%) and other ethnic groups (5.8%). One hundred and thirty eight (99.3%) of the women were married and 98.6%had less than 6 children. More than half (75.5%) of the women's last child birth was less than 6 years ago. Forty seven percent of them were involved in supporting administrative work and 64.7% of the women gave a history of previous or current vaginal discharge. Conclusions: The present study reported zero incidence rate of trichomoniasis. The low incidence rate was postulated due to all women who participated in this study were categorized into a low-risk group.

A Greater Extent of Insomnia Symptoms and Physician-Recommended Sleep Medication Use Predict Fall Risk in Community-Dwelling Older Adults.

Science.gov (United States)

Chen, Tuo-Yu; Lee, Soomi; Buxton, Orfeu M

2017-11-01

Cross-sectional studies suggest that insomnia symptoms are associated with falls in later life. This longitudinal study examines the independent and interactive effects of the extent of insomnia symptoms (i.e., multiple co-existing insomnia symptoms) and sleep medications on fall risk over a 2-year follow-up among community-dwelling older adults. Using data from the Health and Retirement Study (2006-2014, N = 6882, Mage = 74.5 years ± 6.6 years), we calculated the extent of insomnia symptoms (range = 0-4) participants reported (i.e., trouble falling asleep, waking up during the night, waking up too early, and not feeling rested). At each wave, participants reported recent sleep medications use and falls since the last wave, and were evaluated for balance and walking speed. A greater burden of insomnia symptoms and using physician-recommended sleep medications at baseline independently predicted falling after adjusting for known risk factors of falling. The effects of insomnia symptoms on fall risk differed by sleep medications use. The extent of insomnia symptoms exhibited a positive, dose-response relation with risk of falling among those not using sleep medications. Older adults using physician-recommended sleep medications exhibited a consistently higher fall risk irrespective of the extent of insomnia symptoms. The number of insomnia symptoms predicts 2-year fall risk in older adults. Taking physician-recommended sleep medications increases the risks for falling in older adults, irrespective of the presence of insomnia symptoms. Future efforts should be directed toward treating insomnia symptoms, and managing and selecting sleep medications effectively to decrease the risk of falling in older adults. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Curricular trends in Malaysian medical schools: innovations within.

Science.gov (United States)

Azila, Nor Mohd Adnan; Rogayah, Jaafar; Zabidi-Hussin, Zabidi Azhar Mohd Hussin

2006-09-01

Various curricular innovations were adopted by medical schools worldwide in an attempt to produce medical graduates that could meet future healthcare needs of society locally and globally. This paper presents findings on curricular approaches implemented in Malaysian medical schools, in trying to meet those needs. Information was obtained from published records, responses from various questionnaires, personal communication and involvement with curricular development. Curricular innovations tended to be implemented in new medical schools upon their establishment. Established medical schools seemed to implement these innovations much later. Curricular trends appear to move towards integration, student-centred and problem-based learning as well as community-oriented medical education, with the Student-centred learning, Problem-based learning, Integrated teaching, Community-based education, Electives and Systematic programme (SPICES) model used as a reference. The focus is based on the premise that although the short-term aim of undergraduate medical education in Malaysia is to prepare graduates for the pre-registration house officer year, they must be able to practise and make decisions independently and be sensitive to the needs of the country's multiracial, multi-religious, and often remote communities. In most cases, curricular planning starts with a prescriptive model where planners focus on several intended outcomes. However, as the plan is implemented and evaluated it becomes descriptive as the planners reassess the internal and external factors that affect outcomes. A common trend in community-oriented educational activities is evident, with the introduction of interesting variations, to ensure that the curriculum can be implemented, sustained and the intended outcomes achieved.

Studies on possibility of building radiation centre in Hunan Province

International Nuclear Information System (INIS)

Tang Chuandao

1987-01-01

Hunan province is rich in agriculture products and their by-products. The processing and preservation of those products after porduction is an urgent problem to solve. However, radiation techniques can solve the problem of the processing and preservation of part of those products which can not be solved by normal ways. Only in Changsha area, the products such as leather and their products, dried and fresh fruit, medical equipments, industrial chemicals and so on, which can be provided to irradiate, weigh over 1 x 10 5 tons a year. In order to advance the research and application of radiation techniques in the province, over 40 units have been investigated in the province and other provinces. Since 1983, six informal discussions or demonstration meetings were held. 15 pieces of various reports and materials have been put forward. The necessity, possibility, size, place, development aim and united research of building a radiation centre have been scientificly demonstrated and a certain basis have been provided for building radiation centre

The role of the counsellor in a medical centre.

Science.gov (United States)

Harray, A S

1975-12-10

The counsellor is one member of the para-medical team being used more and more frequently by doctors. His role is allied to, but distinct from the doctor. He is not an authority figure who diagnoses and prescribes, but acts so as to help the patient diagnose the nature of his own dysfunction and assist him to draw on his own resources for growth and change. The methods the counsellor uses vary, but his goal harmonises with the doctor--the removal of disease from the psychosomatic unity of the patient.

Experimental and numerical analysis for potential heat reuse in liquid cooled data centres

International Nuclear Information System (INIS)

Carbó, Andreu; Oró, Eduard; Salom, Jaume; Canuto, Mauro; Macías, Mario; Guitart, Jordi

2016-01-01

Highlights: • The potential heat reuse of a liquid data centre has been characterized. • Dynamic behaviours of a liquid cooled data centre have been studied. • A dynamic energy model of liquid cooling data centres is developed. • The dynamic energy model has been validated with experimental data. • Server usage and consumption relation was developed for different IT loads. - Abstract: The rapid increase of data centre industry has stimulated the interest of both researchers and professionals in order to reduce energy consumption and carbon footprint of these unique infrastructures. The implementation of energy efficiency strategies and the use of renewables play an important role to reduce the overall data centre energy demand. Information Technology (IT) equipment produce vast amount of heat which must be removed and therefore waste heat recovery is a likely energy efficiency strategy to be studied in detail. To evaluate the potential of heat reuse a unique liquid cooled data centre test bench was designed and built. An extensive thermal characterization under different scenarios was performed. The effective liquid cooling capacity is affected by the inlet water temperature. The lower the inlet water temperature the higher the liquid cooling capacity; however, the outlet water temperature will be also low. Therefore, the requirements of the heat reuse application play an important role in the optimization of the cooling configuration. The experimental data was then used to validate a dynamic energy model developed in TRNSYS. This model is able to predict the behaviour of liquid cooling data centres and can be used to study the potential compatibility between large data centres with different heat reuse applications. The model also incorporates normalized power consumption profiles for heterogeneous workloads that have been derived from realistic IT loads.

Les télécentres, centres de communications polyvalents | CRDI ...

International Development Research Centre (IDRC) Digital Library (Canada)

12 juil. 2011 ... ... la raison de leur absence et beaucoup répondent qu'ils ont eu une ... fournisseur de service Internet du télécentre, qui se trouve à Maputo ... Le télécentre s'est révélé être un fournisseur de services utile et recherché par les ...

Accuracy assessment of pharmacogenetically predictive warfarin dosing algorithms in patients of an academic medical center anticoagulation clinic.

Science.gov (United States)

Shaw, Paul B; Donovan, Jennifer L; Tran, Maichi T; Lemon, Stephenie C; Burgwinkle, Pamela; Gore, Joel

2010-08-01

The objectives of this retrospective cohort study are to evaluate the accuracy of pharmacogenetic warfarin dosing algorithms in predicting therapeutic dose and to determine if this degree of accuracy warrants the routine use of genotyping to prospectively dose patients newly started on warfarin. Seventy-one patients of an outpatient anticoagulation clinic at an academic medical center who were age 18 years or older on a stable, therapeutic warfarin dose with international normalized ratio (INR) goal between 2.0 and 3.0, and cytochrome P450 isoenzyme 2C9 (CYP2C9) and vitamin K epoxide reductase complex subunit 1 (VKORC1) genotypes available between January 1, 2007 and September 30, 2008 were included. Six pharmacogenetic warfarin dosing algorithms were identified from the medical literature. Additionally, a 5 mg fixed dose approach was evaluated. Three algorithms, Zhu et al. (Clin Chem 53:1199-1205, 2007), Gage et al. (J Clin Ther 84:326-331, 2008), and International Warfarin Pharmacogenetic Consortium (IWPC) (N Engl J Med 360:753-764, 2009) were similar in the primary accuracy endpoints with mean absolute error (MAE) ranging from 1.7 to 1.8 mg/day and coefficient of determination R (2) from 0.61 to 0.66. However, the Zhu et al. algorithm severely over-predicted dose (defined as >or=2x or >or=2 mg/day more than actual dose) in twice as many (14 vs. 7%) patients as Gage et al. 2008 and IWPC 2009. In conclusion, the algorithms published by Gage et al. 2008 and the IWPC 2009 were the two most accurate pharmacogenetically based equations available in the medical literature in predicting therapeutic warfarin dose in our study population. However, the degree of accuracy demonstrated does not support the routine use of genotyping to prospectively dose all patients newly started on warfarin.

Attitudes of Medical Students, Clinicians and Sports Scientists Towards Exercise Counselling

OpenAIRE

Gnanendran, Abbyrhamy; Pyne, David B.; Fallon, Kieran E.; Fricker, Peter A.

2011-01-01

We compared the amount of exercise undertaken by medical students, clinicians, and sport scientists with the National Australian Physical Activity (NAPA) Guidelines. A second aim was to compare attitudes to exercise counselling as preventive medicine between university- and clinic-based professionals. The research setting was a university medical school and a sports science sports medicine centre. A 20-item questionnaire was completed by 216 individuals (131 medical students, 43 clinicians an...

HUG sets up an emergency operations centre on the CERN site

CERN Multimedia

Antonella Del Rosso

2015-01-01

Discussions between CERN and the Hôpitaux universitaires de Genève (HUG), under the aegis of the Swiss authorities, have resulted in the setting-up of an emergency operations centre on the CERN site. This will be the operations base for an emergency doctor, a medical emergency vehicle and a driver. Located on the Swiss part of the Meyrin site, close to Building 57, it will be inaugurated on 20 May.   SMUR team based at CERN. CERN’s medical staff and fire-fighters dispense first aid but in medical emergencies they are obliged to call on outside services to treat and transfer patients to hospital. In the Canton of Geneva, this service is provided by HUG via the 144 emergency line. But HUG is based on the eastern side of Geneva, a long way from CERN, and response times can be substantial. In order to improve the safety of the growing number of people on the site, CERN asked Switzerland, as one of its Host States, to help it reduce the medical emergency response t...

Training centres - organization and management

International Nuclear Information System (INIS)

Kovar, P.

1986-01-01

In the lecture 'Training centres - organization and management' some principles and requirements which influence the organization, management and activity pattern of nuclear training centres, are briefly introduced. It is demonstrated, step by step, how these general principles are implemented in the development of the Czechoslovak nuclear power programme, it means, how the training of the NPP personnel proceeds in Czechoslovak nuclear training centres. General principles which are selected: a connection between the capacity of the training centre and the scope and needs of the nuclear power programme, a position of the training center within the institutional set-up, a structure and organization of the training system which complies with the system of NPP construction, reflect the pattern and the activity of the nuclear training centre and nuclear power technical level, a research group of workers in the nuclear training centre, main tasks and technical facilities, management of the training process and a transfer of knowledge and research results into the training process. The lecture is supplemented by pictures and slides. (orig.)

Perceived and normative needs, utilization of oral healthcare services, and barriers to utilization of dental care services at peripheral medical centre: Poonjeri, Mamallapuram, India

Directory of Open Access Journals (Sweden)

Prabhu Subramani

2017-01-01

Full Text Available Introduction: Dental care utilization is limited, and teeth are often left untreated or extracted in India. Several barriers exist for the utilization of dental services. The present study was undertaken to assess the oral healthcare needs, utilization pattern of oral healthcare services, and barriers to utilization of oral healthcare services among the outpatients of Peripheral Medical Centre, Poonjeri, Mamallapuram, India. Materials and Methods: Simple random sampling was conducted among outpatients and their attenders reporting to the health centre; demographic profile of the patients were recorded followed by interviewer-administered questionnaire for recording the self-perceived dental needs and barriers in utilizing dental care services followed by Type II clinical examination to assess normative dental treatment needs. Results: N =282 study participants participated in the present study; majority of the study participants were from upper lower class and lower middle class. Among the study subjects n = 124 (44% have not accessed any dentist, n = 112 (39.7% had visited dentist for toothache. Common reason cited as Self – perceived barriers for dental care are n = 184 (65.2% – 'Unaware of the dental problems' and n = 118 (41.8% 'Fear of dental treatment'. Logistic regression showed that significant difference was seen in gender, socioeconomic status, and barriers to dental care (P < 0.05 in influencing the utilization pattern of dental care. Conclusion: Perceived and normative dental needs were high among the study population due to problem-oriented care, and it is influenced by various barriers such as unawareness of dental problems, fear, cost, accessibility, and time.

CAN INITIAL βHCG VALUES PREDICT THE NEED FOR SECOND DOSE OF METHOTREXATE IN MEDICAL MANAGEMENT OF ECTOPIC PREGNANCY?

Directory of Open Access Journals (Sweden)

Priya Narayanan

2016-09-01

Full Text Available INTRODUCTION Prediction of requirement of second dose of methotrexate in patients treated with single dose would help in guiding treatment and counseling. The aim of this study is to determine whether pretreatment beta HCG values can predict the need for second dose of methotrexate in medically managed ectopic pregnancy. MATERIALS AND METHODS 46 women with ectopic pregnancies who were managed medically were included. The median of beta HCG titres on day 1, day 4 and day 7 was assessed in patients who responded to single dose methotrexate and those who required a second dose. RESULTS Out of the 46 patients studied, 41 responded to medical treatment (success 91%. 14 out of 41 required second dose of methotrexate (34%. Two patients required third dose of methotrexate. Five patients required surgery. DISCUSSION The median of day 1 and day 4 beta HCG values were not statistically different between those who responded to single dose methotrexate and those who required a second dose. Only day 7 values were found to be different. CONCLUSION The beta-hCG titre on day 1 and day 4 is not a predictor of requirement of second dose of methotrexate.

Nutrition guidelines for undergraduate medical curricula: a six-country comparison

OpenAIRE

Crowley, Jennifer; Ball, Lauren; Laur, Celia; Wall, Clare; Arroll, Bruce; Poole, Phillippa; Ray, Sumantra

2015-01-01

Jennifer Crowley,1 Lauren Ball,2 Celia Laur,3 Clare Wall,1 Bruce Arroll,4 Phillippa Poole,5 Sumantra Ray3 1Discipline of Nutrition, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; 2Centre for Health Practice Innovation, Griffith University, Gold Coast, QLD, Australia; 3Need for Nutrition Education/Innovation Programme, Medical Research Council Human Nutrition Research, Cambridge, UK; 4Department of General Practice and Pri...

Call Centre- Computer Telephone Integration

Directory of Open Access Journals (Sweden)

Dražen Kovačević

2012-10-01

Full Text Available Call centre largely came into being as a result of consumerneeds converging with enabling technology- and by the companiesrecognising the revenue opportunities generated by meetingthose needs thereby increasing customer satisfaction. Regardlessof the specific application or activity of a Call centre, customersatisfaction with the interaction is critical to the revenuegenerated or protected by the Call centre. Physical(v, Call centreset up is a place that includes computer, telephone and supervisorstation. Call centre can be available 24 hours a day - whenthe customer wants to make a purchase, needs information, orsimply wishes to register a complaint.

Addressing the challenges of patient-centred design

Directory of Open Access Journals (Sweden)

Karen LaBat

2009-11-01

Full Text Available Patient-centred design is a relatively new term, but a longstanding concept in clinical practice. This discussion looks at patient-centred design and explores the relationships of patient-centred design to universal design, user-centred design and the newer human-centred design. It also explores why interdisciplinary approaches are needed for patient-centred design and how interdisciplinary collaboration works to address the challenges of patient centred design. Successful patient-centred solutions can grow from collaborations which include shared visions, understanding of both the nature and degree of variation in the patient,materials, and the designed solution, clear regular communication among all parties with careful definition of terms, and respect for the inherent cultures of all disciplines involved.

Predicting Risk of Suicide Attempt Using History of Physical Illnesses From Electronic Medical Records

Science.gov (United States)

Luo, Wei; Tran, Truyen; Berk, Michael; Venkatesh, Svetha

2016-01-01

Background Although physical illnesses, routinely documented in electronic medical records (EMR), have been found to be a contributing factor to suicides, no automated systems use this information to predict suicide risk. Objective The aim of this study is to quantify the impact of physical illnesses on suicide risk, and develop a predictive model that captures this relationship using EMR data. Methods We used history of physical illnesses (except chapter V: Mental and behavioral disorders) from EMR data over different time-periods to build a lookup table that contains the probability of suicide risk for each chapter of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes. The lookup table was then used to predict the probability of suicide risk for any new assessment. Based on the different lengths of history of physical illnesses, we developed six different models to predict suicide risk. We tested the performance of developed models to predict 90-day risk using historical data over differing time-periods ranging from 3 to 48 months. A total of 16,858 assessments from 7399 mental health patients with at least one risk assessment was used for the validation of the developed model. The performance was measured using area under the receiver operating characteristic curve (AUC). Results The best predictive results were derived (AUC=0.71) using combined data across all time-periods, which significantly outperformed the clinical baseline derived from routine risk assessment (AUC=0.56). The proposed approach thus shows potential to be incorporated in the broader risk assessment processes used by clinicians. Conclusions This study provides a novel approach to exploit the history of physical illnesses extracted from EMR (ICD-10 codes without chapter V-mental and behavioral disorders) to predict suicide risk, and this model outperforms existing clinical assessments of suicide risk. PMID:27400764

Prediction skill of rainstorm events over India in the TIGGE weather prediction models

Science.gov (United States)

Karuna Sagar, S.; Rajeevan, M.; Vijaya Bhaskara Rao, S.; Mitra, A. K.

2017-12-01

Extreme rainfall events pose a serious threat of leading to severe floods in many countries worldwide. Therefore, advance prediction of its occurrence and spatial distribution is very essential. In this paper, an analysis has been made to assess the skill of numerical weather prediction models in predicting rainstorms over India. Using gridded daily rainfall data set and objective criteria, 15 rainstorms were identified during the monsoon season (June to September). The analysis was made using three TIGGE (THe Observing System Research and Predictability Experiment (THORPEX) Interactive Grand Global Ensemble) models. The models considered are the European Centre for Medium-Range Weather Forecasts (ECMWF), National Centre for Environmental Prediction (NCEP) and the UK Met Office (UKMO). Verification of the TIGGE models for 43 observed rainstorm days from 15 rainstorm events has been made for the period 2007-2015. The comparison reveals that rainstorm events are predictable up to 5 days in advance, however with a bias in spatial distribution and intensity. The statistical parameters like mean error (ME) or Bias, root mean square error (RMSE) and correlation coefficient (CC) have been computed over the rainstorm region using the multi-model ensemble (MME) mean. The study reveals that the spread is large in ECMWF and UKMO followed by the NCEP model. Though the ensemble spread is quite small in NCEP, the ensemble member averages are not well predicted. The rank histograms suggest that the forecasts are under prediction. The modified Contiguous Rain Area (CRA) technique was used to verify the spatial as well as the quantitative skill of the TIGGE models. Overall, the contribution from the displacement and pattern errors to the total RMSE is found to be more in magnitude. The volume error increases from 24 hr forecast to 48 hr forecast in all the three models.

Improving prediction of fall risk among nursing home residents using electronic medical records.

Science.gov (United States)

Marier, Allison; Olsho, Lauren E W; Rhodes, William; Spector, William D

2016-03-01

Falls are physically and financially costly, but may be preventable with targeted intervention. The Minimum Data Set (MDS) is one potential source of information on fall risk factors among nursing home residents, but its limited breadth and relatively infrequent updates may limit its practical utility. Richer, more frequently updated data from electronic medical records (EMRs) may improve ability to identify individuals at highest risk for falls. The authors applied a repeated events survival model to analyze MDS 3.0 and EMR data for 5129 residents in 13 nursing homes within a single large California chain that uses a centralized EMR system from a leading vendor. Estimated regression parameters were used to project resident fall probability. The authors examined the proportion of observed falls within each projected fall risk decile to assess improvements in predictive power from including EMR data. In a model incorporating fall risk factors from the MDS only, 28.6% of observed falls occurred among residents in the highest projected risk decile. In an alternative specification incorporating more frequently updated measures for the same risk factors from the EMR data, 32.3% of observed falls occurred among residents in the highest projected risk decile, a 13% increase over the base MDS-only specification. Incorporating EMR data improves ability to identify those at highest risk for falls relative to prediction using MDS data alone. These improvements stem chiefly from the greater frequency with which EMR data are updated, with minimal additional gains from availability of additional risk factor variables. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Women's attitudes towards the medicalization of childbirth and their associations with planned and actual modes of birth.

Science.gov (United States)

Benyamini, Yael; Molcho, Maya Lila; Dan, Uzi; Gozlan, Miri; Preis, Heidi

2017-10-01

Rates of medical interventions in childbirth have greatly increased in the Western world. Women's attitudes affect their birth choices. To assess women's attitudes towards the medicalization of childbirth and their associations with women's background as well as their fear of birth and planned and unplanned modes of birth. This longitudinal observational study included 836 parous woman recruited at women's health centres and natural birth communities in Israel. All women filled in questionnaires about attitudes towards the medicalization of childbirth, fear of birth, and planned birth choices. Women at birth. Attitudes towards medicalization were more positive among younger and less educated women, those who emigrated from the former Soviet Union, and those with a more complicated obstetric background. Baseline attitudes did not differ by parity yet became less positive throughout pregnancy only for primiparae. More positive attitudes were related to greater fear of birth. The attitudes were significantly associated with planned birth choices and predicted emergency caesareans and instrumental births. Women form attitudes towards the medicalization of childbirth which may still be open to change during the first pregnancy. More favourable attitudes are related to more medical modes of birth, planned and unplanned. Understanding women's views of childbirth medicalization may be key to understanding their choices and how they affect labour and birth. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Tinnitus and psychiatric comorbidities in liaison psychiatry analysis of three years in an audiophonology centre.

Science.gov (United States)

Jacques, Denis; Nozeret, Yves; Zdanowicz, Nicolas; Reynaert, Christine; Garin, Pierre; Gilain, Chantal

2013-09-01

Patients who are suffering from tinnitus are rarely directly referred to an audiophonology centre. Often, they have tried several medications and met with several doctors. Sometimes, they are also referred too quickly to a psychiatrist without a complete ENT assessment. Nevertheless, they frequently develop psychiatric comorbidities in regard to the tinnitus. On the basis of structured interviews with the "Mini International Neuropsychiatric Interview" and on a review of records, we assessed the associated psychiatric diagnoses in patients who consulted for tinnitus as their main complaint at the audiophonology centre from the University Hospital Centre of Mont-Godinne-Dinant between 2009 and 2012. Of the 80 patients who consulted for tinnitus, 28% suffered from a major depressive disorder, 27.5% from a somatoform disorder, 23.7% from sleep disorder, 22.5% from an anxiety disorder and 16% from alcoholic dependence. On the basis of these results, we developed clinical considerations concerning the treatment approach and options for patients suffering from tinnitus with psychiatric comorbidities. The interdisciplinary approach (ENT and liaison psychiatry) in an audiophonology centre seems to be a factor for better treatment adherence for patients with severe and chronic tinnitus.

Neighbourhood Centres – Organisation, Management and Finance

DEFF Research Database (Denmark)

Larsen, Jacob Norvig

to identify different financial models and analyse economic sustainability. As regards organisational and management models data were collected through documentary sources and by means of personal interviews and field visits to ten centres. Even within the analysed limited population of centres economic...... public subsidy. Some of the centres have high number of users on a daily basis, whereas others are only rarely used. It is explored how organisation, management and financial set-up differs among the centres. Quantitative data on financial issues and annual accounts of fifteen centres were analysed...... and institutional sustainability varies significantly. In organisational terms centres range from fully-integrated in the municipal administration to independent voluntary managed centres. In terms of financial, or economic, models variation is less pronounced as all centres to some degree are dependent on current...

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

Science.gov (United States)

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.

A systematic review of the challenges to implementation of the patient-centred medical home: lessons for Australia.

Science.gov (United States)

Janamian, Tina; Jackson, Claire L; Glasson, Nicola; Nicholson, Caroline

2014-08-04

To review the available literature to identify the major challenges and barriers to implementation and adoption of the patient-centred medical home (PCMH) model, topical in current Australian primary care reforms. Systematic review of peer-reviewed literature. PubMed and Embase databases were searched in December 2012 for studies published in English between January 2007 and December 2012. Studies of any type were included if they defined PCMH using the Patient-Centered Primary Care Collaborative Joint Principles, and reported data on challenges and barriers to implementation and adoption of the PCMH model. One researcher with content knowledge in the area abstracted data relating to the review objective and study design from eligible articles. A second researcher reviewed the abstracted data alongside the original article to check for accuracy and completeness. Thematic synthesis was used to in three stages: free line-by-line coding of data; organisation of "free codes" into related areas to construct "descriptive" themes and develop "analytical" themes. The main barriers identified related to: challenges with the transformation process; difficulties associated with change management; challenges in implementing and using an electronic health record that administers principles of PCMH; challenges with funding and appropriate payment models; insufficient resources and infrastructure within practices; and inadequate measures of performance. This systematic review documents the key challenges and barriers to implementing the PCMH model in United States family practice. It provides valuable evidence for Australian clinicians, policymakers, and organisations approaching adoption of PCMH elements within reform initiatives in this country.

The therapeutic relationship and adherence to antipsychotic medication in schizophrenia.

Directory of Open Access Journals (Sweden)

Rosemarie McCabe

Full Text Available OBJECTIVE: Previous research has shown that a better therapeutic relationship (TR predicts more positive attitudes towards antipsychotic medication, but did not address whether it is also linked with actual adherence. This study investigated whether the TR is associated with adherence to antipsychotics in patients with schizophrenia. METHODS: 134 clinicians and 507 of their patients with schizophrenia or a related psychotic disorder participated in a European multi-centre study. A logistic regression model examined how the TR as rated by patients and by clinicians is associated with medication adherence, adjusting for clinician clustering and symptom severity. RESULTS: Patient and clinician ratings of the TR were weakly inter-correlated (r(s = 0.13, p = 0.004, but each was independently linked with better adherence. After adjusting for patient rated TR and symptom severity, each unit increase in clinician rated TR was associated with an increase of the odds ratio of good compliance by 65.9% (95% CI: 34.6% to 104.5%. After adjusting for clinician rated TR and symptom severity, for each unit increase in patient rated TR the odds ratio of good compliance was increased by 20.8% (95% CI: 4.4% to 39.8%. CONCLUSIONS: A better TR is associated with better adherence to medication among patients with schizophrenia. Patients' and clinicians' perspectives of the TR are both important, but may reflect distinct aspects.

retrospective data analysis in the Fertility Centre from 1995 to 2000

OpenAIRE

Nahid, Hiwa

2016-01-01

Introduction: It is estimated that worldwide seven to nine percent of couples of reproductive age suffer from infertility and more than 6 million children were already born with the support of in vitro fertilization (IVF). Methodology: In the first part of this study, the medical records of 4136 patients in the Fertility Centre Berlin over a period of time from 1995 to 2000 in terms of duration of infertility were evaluated retrospectively. The age of women, the age difference between the ...

Doctor-patient interaction in Finnish primary health care as perceived by first year medical students

Directory of Open Access Journals (Sweden)

Mäntyselkä Pekka

2005-09-01

Full Text Available Abstract Background In Finland, public health care is the responsibility of primary health care centres, which render a wide range of community level preventive, curative and rehabilitative medical care. Since 1990's, medical studies have involved early familiarization of medical students with general practice from the beginning of the studies, as this pre-clinical familiarisation helps medical students understand patients as human beings, recognise the importance of the doctor-patient relationship and identify practicing general practitioners (GPs as role models for their professional development. Focused on doctor-patient relationship, we analysed the reports of 2002 first year medical students in the University of Kuopio. The students observed GPs' work during their 2-day visit to primary health care centres. Methods We analysed systematically the texts of 127 written reports of 2002, which represents 95.5% of the 133 first year pre-clinical medical students reports. The reports of 2003 (N = 118 and 2004 (N = 130 were used as reference material. Results Majority of the students reported GPs as positive role models. Some students reported GPs' poor attitudes, which they, however, regarded as a learning opportunity. Students generally observed a great variety of responsibilities in general practice, and expressed admiration for the skills and abilities required. They appreciated the GPs' interest in patients concerns. GPs' communication styles were found to vary considerably. Students reported some factors disturbing the consultation session, such as the GP staring at the computer screen and other team members entering the room. Working with marginalized groups, the chronically and terminally ill, and dying patients was seen as an area for development in the busy Finnish primary health care centres. Conclusion During the analysis, we discovered that medical students' perceptions in this study are in line with the previous findings about the

Preclinical medical students' performance in and reflections on ...

African Journals Online (AJOL)

Background. An effective patient-centred consultation requires the seamless integration of procedural (technical) and communication skills. Research has shown that the two sets of skills should not be taught or assessed separately; yet, clinical communication education has become separated from other parts of medical ...

Challenges in interprofessional collaboration: Experiences of care providers and policymakers in a newly set-up Dutch assault centre

NARCIS (Netherlands)

Zijlstra, J.E.; Lo Fo Wong, S.H.; Teerling, A.; Hutschemaekers, G.J.M.; Lagro-Janssen, A.

2018-01-01

Background: Sexual and family violence are problems that affect many women and men, and the negative health consequences of violence are numerous. As adequate acute interprofessional care can prevent negative health consequences and improve forensic medical examination, a Centre for Sexual and

Energy centre microgrid model

Energy Technology Data Exchange (ETDEWEB)

Pasonen, R.

2011-09-15

A simulation model of Energy centre microgrid made with PSCAD simulation software version 4.2.1 has been built in SGEM Smart Grids and Energy Markets (SGEM) work package 6.6. Microgrid is an autonomous electric power system which can operate separate from common distribution system. The idea of energy centre microgrid concept was considered in Master of Science thesis 'Community Microgrid - A Building block of Finnish Smart Grid'. The name of energy centre microgrid comes from a fact that production and storage units are concentrated into a single location, an energy centre. This centre feeds the loads which can be households or industrial loads. Power direction flow on the demand side remains same compared to the current distribution system and allows to the use of standard fuse protection in the system. The model consists of photovoltaic solar array, battery unit, variable frequency boost converter, inverter, isolation transformer and demand side (load) model. The model is capable to automatically switch to islanded mode when there is a fault in outside grid and back to parallel operation mode when fault is removed. The modelled system responses well to load changes and total harmonic distortion related to 50Hz base frequency is kept under 1.5% while operating and feeding passive load. (orig.)

The prediction of the in-hospital mortality of acutely ill medical patients by electrocardiogram (ECG) dispersion mapping compared with established risk factors and predictive scores--a pilot study.

LENUS (Irish Health Repository)

Kellett, John

2011-08-01

ECG dispersion mapping (ECG-DM) is a novel technique that analyzes low amplitude ECG oscillations and reports them as the myocardial micro-alternation index (MMI). This study compared the ability of ECG-DM to predict in-hospital mortality with traditional risk factors such as age, vital signs and co-morbid diagnoses, as well as three predictive scores: the Simple Clinical Score (SCS)--based on clinical and ECG findings, and two Medical Admission Risk System scores--one based on vital signs and laboratory data (MARS), and one only on laboratory data (LD).

RTEMS CENTRE- Support and Maintenance CENTRE to RTEMS Operating System

Science.gov (United States)

Silva, H.; Constantino, A.; Coutunho, M.; Freitas, D.; Faustino, S.; Mota, M.; Colaço, P.; Zulianello, M.

2008-08-01

RTEMS stands for Real-Time Operating System for Multiprocessor Systems. It is a full featured Real Time Operating System that supports a variety of open APIs and interface standards. It provides a high performance environment for embedded applications, including a fixed-priority preemptive/non-preemptive scheduler, a comprehensive set of multitasking operations and a large range of supported architectures. Support and maintenance CENTRE to RTEMS operating system (RTEMS CENTRE) is a joint initiative of ESA-Portugal Task force, aiming to build a strong technical competence in the space flight (on- board) software, to offer support, maintenance and improvements to RTEMS. This paper provides a high level description of the current and future activities of the RTEMS CENTRE. It presents a brief description of the RTEMS operating system, a description of the tools developed and distributed to the community [1] and the improvements to be made to the operating system, including facilitation for the qualification of RTEMS (4.8.0) [2] for the space missions.

[Risk factors of venous thromboembolism recurrence and the predictive value of simplified pulmonary embolism severity index in medical inpatients].

Science.gov (United States)

Shi, C L; Zhou, H X; Tang, Y J; Wang, L; Yi, Q; Liang, Z A

2016-04-12

To explore the risk factors of venous thromboembolism (VTE) recurrence and the predictive value of simplified pulmonary embolism severity index (sPESI) in medical inpatients. A total of 149 consecutive patients with first diagnosed VTE from the medical departments of West China Hospital of Sichuan University from January 2011 and December 2012 were enrolled and followed-up for 24 months. The VTE recurrence rate was calculated and univariate and multivariate cox proportional hazards regression analysis were performed to identify the risk factors associated with VTE recurrence. All the patients were evaluated by sPESI, and survival analysis was used to explore its value in predicting VTE recurrence in these medical patients. Out of the included 149 patients, 23(15.4%) patients had VTE recurrence during the 2 years' follow-up and median recurrence time was 167 days. The univariate analysis showed bed rest, severe lung disease, nephrotic syndrome, inappropriate anticoagulant therapy, smoking, diabetes, and malignant neoplasm might be associated with VTE recurrence (P=0.043, 0.006, 0.009, 0.032, 0.098, 0.048, 0.021). Among these risk factors, the multivariate analysis revealed severe lung disease, nephrotic syndrome, and malignant neoplasm were the independent risk factors (HR=3.45, 5.67, 3.60; P=0.020, 0.020, 0.047); while for inappropriate anticoagulant therapy, the P value was marginal (HR=3.94, 95% CI: 0.99-15.63, P=0.051). The median sPESI scores of the patients with VTE recurrence was higher than that of the patients without VTE recurrence[1(1, 2) vs 0(0, 1), P=0.001], and patients with sPESI≥1 were associated with 5.57-fold increased risk of VTE recurrence compared with patients with sPESI=0 (95%CI: 1.79-17.30, P=0.001). Survival analysis also showed that the 2-year cumulative VTE recurrence rate of patients with sPESI≥1 was significant higher than that of patients with sPESI=0 (38.4% vs 5.7%, P=0.001). The medical VTE patients have high VTE recurrence risk

Do medical students’ scores using different assessment instruments predict their scores in clinical reasoning using a computer-based simulation?

Directory of Open Access Journals (Sweden)

Fida M

2015-02-01

Full Text Available Mariam Fida,1 Salah Eldin Kassab2 1Department of Molecular Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain; 2Department of Medical Education, Faculty of Medicine, Suez Canal University, Ismailia, Egypt Purpose: The development of clinical problem-solving skills evolves over time and requires structured training and background knowledge. Computer-based case simulations (CCS have been used for teaching and assessment of clinical reasoning skills. However, previous studies examining the psychometric properties of CCS as an assessment tool have been controversial. Furthermore, studies reporting the integration of CCS into problem-based medical curricula have been limited. Methods: This study examined the psychometric properties of using CCS software (DxR Clinician for assessment of medical students (n=130 studying in a problem-based, integrated multisystem module (Unit IX during the academic year 2011–2012. Internal consistency reliability of CCS scores was calculated using Cronbach's alpha statistics. The relationships between students' scores in CCS components (clinical reasoning, diagnostic performance, and patient management and their scores in other examination tools at the end of the unit including multiple-choice questions, short-answer questions, objective structured clinical examination (OSCE, and real patient encounters were analyzed using stepwise hierarchical linear regression. Results: Internal consistency reliability of CCS scores was high (α=0.862. Inter-item correlations between students' scores in different CCS components and their scores in CCS and other test items were statistically significant. Regression analysis indicated that OSCE scores predicted 32.7% and 35.1% of the variance in clinical reasoning and patient management scores, respectively (P<0.01. Multiple-choice question scores, however, predicted only 15.4% of the variance in diagnostic performance scores (P<0.01, while

The Impact on Tan Tock Seng Hospital’s Teaching Culture of Transforming into an Academic Health Centre

OpenAIRE

Tham, K. Y.

2016-01-01

Tan Tock Seng Hospital (TTSH), Singapore has a commendable “teaching culture” that teaches medical students well. The first research question is to understand how the teaching culture has been built in TTSH. In 2009 the Nanyang Technological University (NTU) invited TTSH to be its partner to start a new medical school, transforming TTSH into an academic health centre (AHC). The second research question is, “What is the impact on TTSH’s teaching culture of transforming into an AHC?” Qualitativ...

Behaviour and burnout in medical students.

Science.gov (United States)

Cecil, Jo; McHale, Calum; Hart, Jo; Laidlaw, Anita

2014-01-01

Burnout is prevalent in doctors and can impact on job dissatisfaction and patient care. In medical students, burnout is associated with poorer self-rated health; however, it is unclear what factors influence its development. This study investigated whether health behaviours predict burnout in medical students. Medical students (n=356) at the Universities of St Andrews and Manchester completed an online questionnaire assessing: emotional exhaustion (EE), depersonalisation (DP), personal accomplishment (PA), alcohol use, physical activity, diet, and smoking. Approximately 55% (54.8%) of students reported high levels of EE, 34% reported high levels of DP, and 46.6% reported low levels of PA. Linear regression analysis revealed that year of study, physical activity, and smoking status significantly predicted EE whilst gender, year of study, and institution significantly predicted DP. PA was significantly predicted by alcohol binge score, year of study, gender, and physical activity. Burnout is present in undergraduate medical students in the United Kingdom, and health behaviours, particularly physical activity, predict components of burnout. Gender, year of study, and institution also appear to influence the prevalence of burnout. Encouraging medical students to make healthier lifestyle choices early in their medical training may reduce the likelihood of the development of burnout.

Assessing patient-centred communication in teaching: a systematic review of instruments.

Science.gov (United States)

Brouwers, Marianne; Rasenberg, Ellemieke; van Weel, Chris; Laan, Roland; van Weel-Baumgarten, Evelyn

2017-11-01

Patient-centred communication is a key component of patient centredness in medical care. Therefore, adequate education in and assessment of patient-centred communication skills are necessary. In general, feedback on communication skills is most effective when it is provided directly and is systematic. This calls for adequate measurement instruments. The aim of this study was to provide a systematic review of existing instruments that measure patient centredness in doctor-patient communication and can be used to provide direct feedback. A systematic review was conducted using an extensive validated search strategy for measurement instruments in PubMed, EMBASE, PsycINFO and CINAHL. The databases were searched from their inception to 1 July 2016. Articles describing the development or evaluation of the measurement properties of instruments that measure patient centredness (by applying three or more of the six dimensions of a published definition of patient centredness) in doctor-patient communication and that can be used for the provision of direct feedback were included. The methodological quality of measurement properties was evaluated using the COSMIN checklist. Thirteen articles describing 14 instruments measuring patient centredness in doctor-patient communication were identified. These studies cover a wide range of settings and patient populations, and vary in the dimensions of patient centredness applied and in methodological quality on aspects of reliability and validity. This review gives a comprehensive overview of all instruments available for the measurement of patient centredness in doctor-patient communication that can be used for the provision of direct feedback and are described in the literature. Despite the widely felt need for valid and reliable instruments for the measurement of patient-centred communication, most of the instruments currently available have not been thoroughly investigated. Therefore, we recommend further research into and

The politics of patient-centred care.

Science.gov (United States)

Kreindler, Sara A

2015-10-01

Despite widespread belief in the importance of patient-centred care, it remains difficult to create a system in which all groups work together for the good of the patient. Part of the problem may be that the issue of patient-centred care itself can be used to prosecute intergroup conflict. This qualitative study of texts examined the presence and nature of intergroup language within the discourse on patient-centred care. A systematic SCOPUS and Google search identified 85 peer-reviewed and grey literature reports that engaged with the concept of patient-centred care. Discourse analysis, informed by the social identity approach, examined how writers defined and portrayed various groups. Managers, physicians and nurses all used the discourse of patient-centred care to imply that their own group was patient centred while other group(s) were not. Patient organizations tended to downplay or even deny the role of managers and providers in promoting patient centredness, and some used the concept to advocate for controversial health policies. Intergroup themes were even more obvious in the rhetoric of political groups across the ideological spectrum. In contrast to accounts that juxtaposed in-groups and out-groups, those from reportedly patient-centred organizations defined a 'mosaic' in-group that encompassed managers, providers and patients. The seemingly benign concept of patient-centred care can easily become a weapon on an intergroup battlefield. Understanding this dimension may help organizations resolve the intergroup tensions that prevent collective achievement of a patient-centred system. © 2013 John Wiley & Sons Ltd.

On organization of medical radionuclides production in Ukraine

International Nuclear Information System (INIS)

Zelens'kij, V.F.; Pilipenko, M.Yi.; Shulyika, M.G.; Skibyin, V.Yi.; Kostyin, V.Ya.; Vyikman, Ya.E.; Kalmikov, L.Z.; Nesterov, V.G.; Krasnoperova, A.P.

1994-01-01

Annual demand for radiopharmaceuticals in Ukraine is about 50.000 GBq and expenses for their purchase are about 1 - 2 mln US dollars per year. It determines expediency of their production in Ukraine. Taking into consideration the fact that one of the aftereffects of the accident at Chernobyl Atomic Power Station is inevitable increase of the number of oncological diseases (including malignant growths of the thyroid gland) the demand for radionuclides will be increasing steadily. Therefore, it is clear that organization of the centre for radiopharmaceuticals production will not solve the problem of providing radiological departments with them. One of the possible ways to solve the problem is creation of a network of regional centres for radioactive isotopes production. Realisation of the suggested program will allow to solve the problem of providing the medical establishments of Ukraine with medical radionuclides. Performed technical and economical evaluation shows that the expenses will be compensated in 2.9 years

Communications strategy for the Chernobyl Centre

International Nuclear Information System (INIS)

Kurilchik, Mykola; Green, Len

2000-01-01

This Communications Strategy was developed for the International Chernobyl Centre (ICC) as part of a joint UK/Ukraine project, sponsored by the Department of Trade and Industry and NNC Limited. The Plan was developed during four weeks of workshop discussions in the UK between staff from the centre and experienced PR Professionals from NNC Limited. The requirements for a sustained communications activity at the ICC go much further than simply enhancing or promoting the Centre's scientific and technical activities. Raising sufficient awareness of the Centre among potential funding agents and commercial partners is critical to its future development as a major centre for international co-operation and research. It is only through establishing and developing effective communications that the Centre will become well enough known and understood both within the Ukraine, and internationally, to secure its long term future. However, as the workshop programme unfolded, it also became clear that communications was in itself a legitimate and necessary function of the Centre, and part of the foundations of its existence. The Centre has a fundamental role as an 'information exchange', collecting and communicating information from within the Ukraine to the rest of the world, and interpreting world interest and attitudes to the Ukraine Government and nuclear industry. As such compliments the efforts of individual power plant and corporate PR functions within the Ukraine nuclear energy sector

The predictive accuracy of PREDICT: a personalized decision-making tool for Southeast Asian women with breast cancer.

Science.gov (United States)

Wong, Hoong-Seam; Subramaniam, Shridevi; Alias, Zarifah; Taib, Nur Aishah; Ho, Gwo-Fuang; Ng, Char-Hong; Yip, Cheng-Har; Verkooijen, Helena M; Hartman, Mikael; Bhoo-Pathy, Nirmala

2015-02-01

Web-based prognostication tools may provide a simple and economically feasible option to aid prognostication and selection of chemotherapy in early breast cancers. We validated PREDICT, a free online breast cancer prognostication and treatment benefit tool, in a resource-limited setting. All 1480 patients who underwent complete surgical treatment for stages I to III breast cancer from 1998 to 2006 were identified from the prospective breast cancer registry of University Malaya Medical Centre, Kuala Lumpur, Malaysia. Calibration was evaluated by comparing the model-predicted overall survival (OS) with patients' actual OS. Model discrimination was tested using receiver-operating characteristic (ROC) analysis. Median age at diagnosis was 50 years. The median tumor size at presentation was 3 cm and 54% of patients had lymph node-negative disease. About 55% of women had estrogen receptor-positive breast cancer. Overall, the model-predicted 5 and 10-year OS was 86.3% and 77.5%, respectively, whereas the observed 5 and 10-year OS was 87.6% (difference: -1.3%) and 74.2% (difference: 3.3%), respectively; P values for goodness-of-fit test were 0.18 and 0.12, respectively. The program was accurate in most subgroups of patients, but significantly overestimated survival in patients aged discrimination; areas under ROC curve were 0.78 (95% confidence interval [CI]: 0.74-0.81) and 0.73 (95% CI: 0.68-0.78) for 5 and 10-year OS, respectively. Based on its accurate performance in this study, PREDICT may be clinically useful in prognosticating women with breast cancer and personalizing breast cancer treatment in resource-limited settings.

[The First World War and medical school of Petrograd].

Science.gov (United States)

Rostovtsev, E A; Sidorchuk, I V

2014-09-01

The article is devoted to the history of higher medical education of the Petrograd just before and during the First World War. The topical issue is the lack of information concerning this period of the history of Russian medicine and medical education, and the history of development of domestic medicine during the First World War, the centenary of which is celebrated this year. On the basis of a wide range of published and archival sources the authors show the basic vectors of development of medical education and exploring the role of St. Petersburg as one of the leading academic medical centres in the country.

Effect of obstetric team training on team performance and medical technical skills: a randomised controlled trial

NARCIS (Netherlands)

Fransen, A.F.; Ven, van de J.; Merién, A.E.R.; Wit-Zuurendonk, de L.D.; Houterman, S.; Mol, B.W.J.; Oei, S.G.

2012-01-01

Objective To determine whether obstetric team training in a medical simulation centre improves the team performance and utilisation of appropriate medical technical skills of healthcare professionals. Design Cluster randomised controlled trial. Setting The Netherlands. Sample The obstetric

Aligning Islamic Spirituality to Medical Imaging.

Science.gov (United States)

Zainuddin, Zainul Ibrahim

2017-10-01

This paper attempts to conceptualize Islamic spirituality in medical imaging that deals with the humanistic and technical dimensions. It begins with establishing an understanding concerning spirituality, an area that now accepted as part of patient-centred care. This is followed by discussions pertaining to Islamic spirituality, related to the practitioner, patient care and the practice. Possible avenues towards applying Islamic spirituality in medical imaging are proposed. It is hoped that the resultant harmonization between Islamic spirituality and the practice will trigger awareness and interests pertaining to the role of a Muslim practitioner in advocating and enhancing Islamic spirituality.

Discussion on 'Centres of excellence' in Africa

International Nuclear Information System (INIS)

Riad, S.

1999-01-01

In Africa, Centres of Excellence should be oriented to build up scientific and technological capacity in the four topics of international Monitoring System related technologies, namely, seismic monitoring, hydro acoustic monitoring, infrasound monitoring and radionuclides monitoring. Training programs on these topics should be a major objective. A network of such centres should be established in a number of African countries. Centres should be equipped with means and materials for on-line course dispatch to interested training centres or research institutions. African centres should develop strong relationship among themselves through information and data exchange and sharing, harmonization of training programs. National data centres may be established as a component of the African Centre of Excellence. States Signatories may authorize the establishment of a specific fund to support the activities of the African center

To what extent is clinical and laboratory information used to perform medication reviews in the nursing home setting? the CLEAR study

Directory of Open Access Journals (Sweden)

Mestres Gonzalvo C

2015-05-01

Full Text Available Carlota Mestres Gonzalvo,1 Kim PGM Hurkens,2 Hugo AJM de Wit,3 Brigit PC van Oijen,1 Rob Janknegt,1 Jos MGA Schols,4 Wubbo J Mulder,5 Frans R Verhey,6 Bjorn Winkens,7 Paul-Hugo M van der Kuy1 1Department of Clinical Pharmacology and Toxicology, Orbis Medical Centre, Sittard, 2Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Centre, Amsterdam, 3Department of Clinical Pharmacy and Toxicology, Atrium Medical Centre, Heerlen, 4Department of Family Medicine and Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, 5Department of Internal Medicine, Maastricht University Medical Centre, 6Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg/School for Mental Health and Neurosciences, 7Department of Methodology and Statistics, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands Background: The aim of this study was to evaluate to what extent laboratory data, actual medication, medical history, and/or drug indication influence the quality of medication reviews for nursing home patients. Methods: Forty-six health care professionals from different fields were requested to perform medication reviews for three different cases. Per case, the amount of information provided varied in three subsequent stages: stage 1, medication list only; stage 2, adding laboratory data and reason for hospital admission; and stage 3, adding medical history/drug indication. Following a slightly modified Delphi method, a multidisciplinary team performed the medication review for each case and stage. The results of these medication reviews were used as reference reviews (gold standard. The remarks from the participants were scored, according to their potential clinical impact, from relevant to harmful on a scale of 3 to -1. A total score per case and stage was calculated and expressed as a percentage of the total score from the expert

Detecting medication errors in the New Zealand pharmacovigilance database: a retrospective analysis.

Science.gov (United States)

Kunac, Desireé L; Tatley, Michael V

2011-01-01

Despite the traditional focus being adverse drug reactions (ADRs), pharmacovigilance centres have recently been identified as a potentially rich and important source of medication error data. To identify medication errors in the New Zealand Pharmacovigilance database (Centre for Adverse Reactions Monitoring [CARM]), and to describe the frequency and characteristics of these events. A retrospective analysis of the CARM pharmacovigilance database operated by the New Zealand Pharmacovigilance Centre was undertaken for the year 1 January-31 December 2007. All reports, excluding those relating to vaccines, clinical trials and pharmaceutical company reports, underwent a preventability assessment using predetermined criteria. Those events deemed preventable were subsequently classified to identify the degree of patient harm, type of error, stage of medication use process where the error occurred and origin of the error. A total of 1412 reports met the inclusion criteria and were reviewed, of which 4.3% (61/1412) were deemed preventable. Not all errors resulted in patient harm: 29.5% (18/61) were 'no harm' errors but 65.5% (40/61) of errors were deemed to have been associated with some degree of patient harm (preventable adverse drug events [ADEs]). For 5.0% (3/61) of events, the degree of patient harm was unable to be determined as the patient outcome was unknown. The majority of preventable ADEs (62.5% [25/40]) occurred in adults aged 65 years and older. The medication classes most involved in preventable ADEs were antibacterials for systemic use and anti-inflammatory agents, with gastrointestinal and respiratory system disorders the most common adverse events reported. For both preventable ADEs and 'no harm' events, most errors were incorrect dose and drug therapy monitoring problems consisting of failures in detection of significant drug interactions, past allergies or lack of necessary clinical monitoring. Preventable events were mostly related to the prescribing and

WISB: Warwick Integrative Synthetic Biology Centre.

Science.gov (United States)

McCarthy, John

2016-06-15

Synthetic biology promises to create high-impact solutions to challenges in the areas of biotechnology, human/animal health, the environment, energy, materials and food security. Equally, synthetic biologists create tools and strategies that have the potential to help us answer important fundamental questions in biology. Warwick Integrative Synthetic Biology (WISB) pursues both of these mutually complementary 'build to apply' and 'build to understand' approaches. This is reflected in our research structure, in which a core theme on predictive biosystems engineering develops underpinning understanding as well as next-generation experimental/theoretical tools, and these are then incorporated into three applied themes in which we engineer biosynthetic pathways, microbial communities and microbial effector systems in plants. WISB takes a comprehensive approach to training, education and outreach. For example, WISB is a partner in the EPSRC/BBSRC-funded U.K. Doctoral Training Centre in synthetic biology, we have developed a new undergraduate module in the subject, and we have established five WISB Research Career Development Fellowships to support young group leaders. Research in Ethical, Legal and Societal Aspects (ELSA) of synthetic biology is embedded in our centre activities. WISB has been highly proactive in building an international research and training network that includes partners in Barcelona, Boston, Copenhagen, Madrid, Marburg, São Paulo, Tartu and Valencia. © 2016 The Author(s).

How health leaders can benefit from predictive analytics.

Science.gov (United States)

Giga, Aliyah

2017-11-01

Predictive analytics can support a better integrated health system providing continuous, coordinated, and comprehensive person-centred care to those who could benefit most. In addition to dollars saved, using a predictive model in healthcare can generate opportunities for meaningful improvements in efficiency, productivity, costs, and better population health with targeted interventions toward patients at risk.

The Aube centre

International Nuclear Information System (INIS)

1996-07-01

This educational booklet is devoted to a general presentation of the Aube radioactive wastes storage centre. After a short presentation of the Andra, the French national agency for the management of radioactive wastes, it gives some general information about radioactive wastes (origin, classification), containers (quality assurance and different types), wastes transportation (planning, safety), and about the Aube centre itself: description, treatment and conditioning of drums (compacting and injection), storage facilities, geological situation of the site, and environmental controls. (J.S.)

Clinical spectrum and various forms of thyrotoxcosis in endocrine clinic of Jinnah Postgraduate Medical Centre

International Nuclear Information System (INIS)

Ahsan, T.; Banu, Z.; Jabeen, R.; Farooq, M. U.

2013-01-01

Objective: To evaluate clinical symptoms, signs and various forms of thyrotoxicosis, and to assess the thyroid function status at the first 6-week follow-up. Methods: The retrospective chart review involved thyrotoxic patients presenting at the Endocrine Clinic of Jinnah Postgraduate Medical Centre, Karachi, between April 2007 and January 2011. All hyperthyroid patients were included with the exception of those with suspected or proven malignancy. The records were maintained on a structured proforma and analysed statistically to work out frequencies and percentages. Results: A total of 507 patients were included. Most common form of thyrotoxicosis was Graves disease, with diffuse toxic goiter affecting 269 (53%) patients; followed by toxic multinodular goiter in 102 (20.1%); solitary toxic nodule in 56 (11%); thyrotoxicosis without goiter in 44 (8.7%); subclinical hyperthyroidism in 22 (4.3.%); thyroiditis in 9 (1.8%); and thyrotoxicosis with solitary cold nodule in 4 (0.9%). The common presenting symptoms and signs were goiter (n=415; 85.7%), with eye signs present in 137 (27.7%) patients and heart failure in 20 (4.8%) patients. Of the 321 patients who attended the first six-week follow-up, 309 (94.4%) had their FT4 levels checked. Out of them, 130(42.1%) had euthyroid levels; 113 (36.6%) had lower but still toxic level; 36 (11.7%) had no change; and 30(9.7%) became hypothyroid. TSH levels at first follow-up remained suppressed in 211 (73%) patients; normal in 47(16.3%); and increased in 31 (10.7%). Conclusions: Graves disease was found to be the most common cause of hyperthyroidism. At first follow-up 10.4% of patients had become hypothyroid. Therefore the starting dose of antithyroid drugs was reduced in the clinic. Thyroid stimulating hormone assay was of little help in adjusting treatment at the 6-week follow-up, as almost all cases of hypothyroidism could have been picked up on FT4 assay alone. (author)

[Determination and analysis of cost and production measures in physicians' practices and hospitals for the objective evaluation of medical measures].

Science.gov (United States)

Gessner, U; Horisberger, B

1981-05-01

The complete data on 7200 practising physicians in Switzerland were analyzed in the first phase of the project. The 2600 GP's and the 4600 specialists (in 18 medical specialties) were categorized as to year of graduation and geographic regions (population centres). The distributions of the practising physician of the different specialties over the population centres (defined by 30-min. catchment area) areas were evaluated. Trends towards specialization in larger settlement areas were analyzed. The results are being used as a basis for formation of samples for further studies. The inventories of medical technical equipment and medical procedures are in the process of systematization.

Field size and centring for conventional X-ray equipment

International Nuclear Information System (INIS)

Klimpel, H.; Kreienfeld, H.; Overbeck, R.

1989-01-01

Since 1973, all X-ray equipment for medical applications in the Federal Republic of Germany has had to be examined according to the requirements of the German ''Rontgenverordnung'' before it is used on patients and after each essential modification of design or construction. These examinations are carried out by inspectors appointed by the authorities, e.g. TUV. The field size adjustment and the centring of the radiation beam in relation to the image reception area is checked, along with other tests. To increase quality assurance in X-ray diagnosis, since the mid-1980s X-ray equipment has also been subject to in-service inspections to an increasing extent. (author)

To study the existing system of surgical safety for cataract surgery at tertiary care ophthalmic centre to implement WHO surgical safety checklist

OpenAIRE

Ruchi Garg; Neeraj Garg; Shakti Kumar Gupta; J. S. Titiyal; R. Mahesh

2016-01-01

Background: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, named after the first President of India, was established on the 10th of March, 1967 as a National centre for ophthalmic science, to provide state of the art patient care, expand human resources for medical education and undertake research to find solutions to eye health problems of national importance. Average numbers of cataract surgeries performed per month are 700 to 1000. Methods: Anticipating implementation in 50% cases...

The right to be informed and fear of disclosure: sustainability of a full error disclosure policy at an Italian cancer centre/clinic.

Science.gov (United States)

D'Errico, Stefano; Pennelli, Sara; Colasurdo, Antonio Prospero; Frati, Paola; Sicuro, Lorella; Fineschi, Vittorio

2015-04-01

The aim of this study was to investigate the behaviour of physicians in cases of medical error as well as the nature of the information that should be given to the patient and to ascertain whether it is possible to institute a full error disclosure policy. Data was collected through the completion of anonymous questionnaires by medical directors of the IRCCS CROB (the Oncology Centre of Basilicata, Italy). An anonymous questionnaire consisting of 15 questions was prepared and administered to all the physicians working at the IRCCS CROB - the Oncology Centre of Basilicata. The main aim of the research was to evaluate the feasibility of adopting a full disclosure policy and the extent to which such a policy could help reduce administration and legal costs. The physicians interviewed unanimously recognize the importance of error disclosure, given that they themselves would want to be informed if they were the patients. However, 50% have never disclosed a medical error to their patients. Fear of losing the patient's trust (33%) and fear of lawsuits (31%) are the main obstacles to error disclosure. The authors found that physicians were in favour of a full policy disclosure at the IRCCS CROB - the Oncology Centre of Basilicata. Many more studies need to be carried out in order to comprehend the economic impact of a full error disclosure policy.

Pediatric сlinic of Odessa National Medical University: the quality of emergency medical care for children

Directory of Open Access Journals (Sweden)

E.A. Starets

2017-04-01

guidelines of the United States, Great Britain, Canada, Australia; Ukrainian National Formulary; British National Formulary for Children. All medicines included in these local guidelines are presented in the WHO Model List of Essential Medicines (April 2015. In the Pediatric Clinic the medical care is patient-centred, responsive to and respectful of the patient’s values and choices to promote patient satisfaction and fulfillment of human rights. We use the patient-centred technologies: mothers and infants to remain together 24 hours a day; the preference is given to oral rehydration, rather than intravenous fluid administration; the minimization of pain for all manipulations, to refuse any intramuscular injections; to usage of screening test systems for the diagnosis of Beta-hemolytic streptococcus, rotavirus, influenza, bacteriuria; the humidification of air around the patient. The average period of staying in the ICU is 2 days. The culture of patient safety is a priority in the Pediatric Clinic. The culture of patient’s safety includes: the changing of the attitudes of medical staffs towards the safety of medical care; the identification of triggers and risks of medical care; the identification of all medi-cal errors/“no harm events”/“near miss events”; the implementation of safe technologies, simple algorithms; learning of medical staff. There were more than 40 lectures and practices for medical staff of the Pediatric Clinic, including the training courses CODE BLUE. Conclusions. The measures aimed at improving the quality of emergency medical care for children in the Pediatric Clinic of the Odessa National Medical University are: 1 the organization of ICU and equipping it with mo-dern equipment for diagnose and treatment of children; 2 the triage of patients according to the condition severity by the objective criteria; 3 the reducing of terms of hospitalization due to optimization of treatment in ICU; 4 standardization of medical care by developing local

Comparison of initial and tertiary centre second opinion reads of multiparametric magnetic resonance imaging of the prostate prior to repeat biopsy

Energy Technology Data Exchange (ETDEWEB)

Hansen, Nienke L. [University Hospital RWTH Aachen, Department of Diagnostic and Interventional Radiology, Aachen (Germany); Addenbrooke' s Hospital and University of Cambridge, CamPARI Clinic, Cambridge (United Kingdom); Koo, Brendan C.; Gallagher, Ferdia A. [Addenbrooke' s Hospital and University of Cambridge, CamPARI Clinic, Cambridge (United Kingdom); Addenbrooke' s Hospital and University of Cambridge, Department of Radiology, Cambridge (United Kingdom); Warren, Anne Y. [Addenbrooke' s Hospital and University of Cambridge, CamPARI Clinic, Cambridge (United Kingdom); Addenbrooke' s Hospital, Department of Pathology, Cambridge (United Kingdom); Doble, Andrew; Gnanapragasam, Vincent; Bratt, Ola; Kastner, Christof [Addenbrooke' s Hospital and University of Cambridge, CamPARI Clinic, Cambridge (United Kingdom); Addenbrooke' s Hospital, Department of Urology, Cambridge (United Kingdom); Barrett, Tristan [Addenbrooke' s Hospital and University of Cambridge, CamPARI Clinic, Cambridge (United Kingdom); Addenbrooke' s Hospital and University of Cambridge, Department of Radiology, Cambridge (United Kingdom); University of Cambridge School of Clinical Medicine, Department of Radiology, Box 218, Cambridge (United Kingdom)

2017-06-15

To investigate the value of second-opinion evaluation of multiparametric prostate magnetic resonance imaging (MRI) by subspecialised uroradiologists at a tertiary centre for the detection of significant cancer in transperineal fusion prostate biopsy. Evaluation of prospectively acquired initial and second-opinion radiology reports of 158 patients who underwent MRI at regional hospitals prior to transperineal MR/untrasound fusion biopsy at a tertiary referral centre over a 3-year period. Gleason score (GS) 7-10 cancer, positive predictive value (PPV) and negative (NPV) predictive value (±95 % confidence intervals) were calculated and compared by Fisher's exact test. Disagreement between initial and tertiary centre second-opinion reports was observed in 54 % of cases (86/158). MRIs had a higher NPV for GS 7-10 in tertiary centre reads compared to initial reports (0.89 ± 0.08 vs 0.72 ± 0.16; p = 0.04), and a higher PPV in the target area for all cancer (0.61 ± 0.12 vs 0.28 ± 0.10; p = 0.01) and GS 7-10 cancer (0.43 ± 0.12 vs 0.2 3 ± 0.09; p = 0.02). For equivocal suspicion, the PPV for GS 7-10 was 0.12 ± 0.11 for tertiary centre and 0.11 ± 0.09 for initial reads; p = 1.00. Second readings of prostate MRI by subspecialised uroradiologists at a tertiary centre significantly improved both NPV and PPV. Reporter experience may help to reduce overcalling and avoid overtargeting of lesions. (orig.)

IOMP - Challenges for advancing medical physic globally

International Nuclear Information System (INIS)

Nusslin, F.

2010-01-01

environment. Education, Training, Certification IOMP Policy Statement No. 1: The Medical Physicist: Role and Responsibilities IOMP Policy Statement No. 2: Basic Requirements for Education and Training of Medical Physicists IOMP Guidelines: Professional Certification of the Medical Physicist Science - Interlinkage of Science and Education - Initiating and fostering national projects for Research in Medical Physics. e.g International Council of Science (ICSU), an International Centre for Medical Physics (Proposal). This is to be located in a developing country and to have permanent and visiting scientific staff. Its main roles will be research, development, education and professional advice. The centre is to focus on: – Needs and priorities of third world countries – Techniques for sustainable development – Technology Transfer – Education and Training Courses – Advice to international bodies Specific actions in LMI countries. E.g. - Collaboration with WHO and IAEA - IUPESM: Health Technology Task Group (HTTG) - Equipment Donation Programme - Library Programme - Travel Assistance

Centre for urban ecotechnology in ``Oeksnehallen``

Energy Technology Data Exchange (ETDEWEB)

1992-03-01

The Lord Mayor`s Department of the municipality of Copenhagen, Denmark, has with support from this project made a proposal for the establishment of the Centre for Urban Ecotechnology in ``Oeksnehallen``, located in the Vesterbro area of the city. The centre should contribute to the dissemination of knowledge on ecological techniques (regarding passive solar energy etc.) to the inhabitants of Vesterbro and other citizens of Copenhagen, and also serve as a centre in an European context. The ecological demonstration centre will cover an area of two thousand square meters and will also include a cafe, a room for showing coloured slides, facilities for exhibitions created by the center and interested firms etc. The centre should play an important role as part of the ecological concept of urban renewal in Vesterbro. (author).

Do primary health centres and hospitals contribute equally towards achievement of the transversal clinical competencies of medical students? Performance on the Objective Structured Clinical Examination (OSCE) in competency acquisition.

Science.gov (United States)

Soler-González, Jorge; Buti, Miquel; Boada, Jordi; Ayala, Victoria; Peñascal, Eduard; Rodriguez, Toni

2016-01-01

The adaptation of the educational programmes of European faculties of medicine to the European Higher Education Area guidelines has focused curricula design on competence acquisition. Competencies are defined as the achievements of a predetermined level of efficacy in real-world scenarios. Our objective was to assess whether performance on a common competence evaluation test, the Objective Structured Clinical Examination (OSCE), resulted in different scores for second-year students after a practical medical training course took place in a primary health centre (PHC) or in a hospital. A descriptive study was conducted during the 2010-2014 academic year of the OSCE test scores obtained by all second-year students. Faculty of Medicine at the University of Lleida (Catalonia, Spain). We performed a correlation analysis between students who completed their practical medical training at the PHC and hospitals utilising Student's t-test for comparison of means. 423 students who completed internships at the PHC and at hospitals obtained OSCE mean scores of 7.32 (SD; IC) (0.82; 7.18-7.47) points and 7.17 (0.83; 6.07-7.26) points, respectively (p=0.07). Second-year medical students acquired similar competency levels in the two analysed training scenarios. The two areas both serve their teaching purpose. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Netherlands Reactor Centre

International Nuclear Information System (INIS)

Anon.

1976-01-01

Briefly reviews the last year's work of the twenty year old Netherlands Reactor Centre (RCN) in the fields of reactor safety, fissile material, nuclear fission, non-nuclear energy systems and overseas co-operation. The annual report thus summarised is the last one to appear under the name of RCN. The terms of reference of the organisation having been broadened to include research into energy supply in general, it is to be known in future as the Netherlands Energy Research Centre (ECN). (D.J.B.)

Redesign of a health science centre: reflections on co-leadership.

Science.gov (United States)

MacTavish, M; Norton, P

1995-01-01

Since 1988, the Sunnybrook Health Science Centre has been proactive in re-designing its system toward decentralized management, the purpose being to further enhance patient care. This process has involved numerous changes, among which were the establishment of three large clinical units. These clinical units are not defined following the historic medical model, but group patients with similar service and care needs. Subsequently, each of the clinical units defined Patient Service Units (PSUs). The hospital has chosen a co-leadership model for the lead management at each of the unit levels. This paper describes the model for clinical units.

High ratings of satisfaction with fertility treatment are common: findings from the Copenhagen Multi-centre Psychosocial Infertility (COMPI) Research Programme

DEFF Research Database (Denmark)

Schmidt, L; Holstein, B E; Boivin, J

2003-01-01

BACKGROUND: The aims were: (i). to identify gender differences in evaluation of medical and patient-centred (psychosocial) care in fertility clinics and (ii). to identify predictors of satisfaction. METHODS: An epidemiological prospective study based on questionnaire responses among all new coupl...

Does foreign aid crowd out government investments? Evidence from rural health centres in Rwanda

Science.gov (United States)

Lu, Chunling; Cook, Benjamin; Desmond, Chris

2017-01-01

Background Rural healthcare facilities in low-income countries play a major role in providing primary care to rural populations. We examined the link of foreign aid with government investments and medical service provision in rural health centres in Rwanda. Methods Using the District Health System Strengthening Tool, a web-based database built by the Ministry of Health in Rwanda, we constructed two composite indices representing provision of (1) child and maternal care and (2) HIV, tuberculosis (TB) and malaria services in 330 rural health centres between 2009 and 2011. Financing variables in a healthcare centre included received funds from various sources, including foreign donors and government. We used multilevel random-effects model in regression analyses and examined the robustness of results to a range of alternative specification, including scale of dependent variables, estimation methods and timing of aid effects. Findings Both government and foreign donors increased their direct investments in the 330 rural healthcare centres during the period. Foreign aid was positively associated with government investments (0.13, 95% CI 0.06 to 0.19) in rural health centres. Aid in the previous year was positively associated with service provision for child and maternal health (0.008, 95% CI 0.002 to 0.014) and service provision for HIV, TB and malaria (0.014, 95% CI 0.004 to 0.022) in the current year. The results are robust when using fixed-effects models. Conclusions These findings suggest that foreign aid did not crowd out government investments in the rural healthcare centres. Foreign aid programmes, conducted in addition to government investments, could benefit rural residents in low-income countries through increased service provision in rural healthcare facilities. PMID:29082015

Computational intelligence models to predict porosity of tablets using minimum features

Directory of Open Access Journals (Sweden)

Khalid MH

2017-01-01

Full Text Available Mohammad Hassan Khalid,1 Pezhman Kazemi,1 Lucia Perez-Gandarillas,2 Abderrahim Michrafy,2 Jakub Szlęk,1 Renata Jachowicz,1 Aleksander Mendyk1 1Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland; 2Centre National de la Recherche Scientifique, Centre RAPSODEE, Mines Albi, Université de Toulouse, Albi, France Abstract: The effects of different formulations and manufacturing process conditions on the physical properties of a solid dosage form are of importance to the pharmaceutical industry. It is vital to have in-depth understanding of the material properties and governing parameters of its processes in response to different formulations. Understanding the mentioned aspects will allow tighter control of the process, leading to implementation of quality-by-design (QbD practices. Computational intelligence (CI offers an opportunity to create empirical models that can be used to describe the system and predict future outcomes in silico. CI models can help explore the behavior of input parameters, unlocking deeper understanding of the system. This research endeavor presents CI models to predict the porosity of tablets created by roll-compacted binary mixtures, which were milled and compacted under systematically varying conditions. CI models were created using tree-based methods, artificial neural networks (ANNs, and symbolic regression trained on an experimental data set and screened using root-mean-square error (RMSE scores. The experimental data were composed of proportion of microcrystalline cellulose (MCC (in percentage, granule size fraction (in micrometers, and die compaction force (in kilonewtons as inputs and porosity as an output. The resulting models show impressive generalization ability, with ANNs (normalized root-mean-square error [NRMSE] =1% and symbolic regression (NRMSE =4% as the best-performing methods, also exhibiting reliable predictive

Implementation of regional centres for SPECT QC/QA in Brazil

International Nuclear Information System (INIS)

Robilotta, C.C.; Dias-Neto, A.L.; Abe, R.; Khoury, H.J.; Silva, D.C. da; Martini, J.C.; Brunetto, S.; Ney, C.

2002-01-01

Aims: SPECT technology was introduced in Brazil at the early 80s and, presently, there are more than 230 systems installed in the whole country. In order to establish a quality standard for these systems, a RCP was submitted and received partial support from IAEA for the implementation of regional centres, so that clinics in different regions could be evaluated using the same protocols. Materials and Methods: Six centres were created in 5 public (federal and state) universities and one private philanthropic medical school in: USP-Sao Paulo, UNICAMP-Campinas, CNEN-Rio de Janeiro, UFBA-Salvador, UFPE-Recife and FM/Santa Casa-Porto Alegre. All sites have teaching and technical supports available and there is at least one nuclear medicine physicist in charge. The basic QC/QA set included: 57 Co sheet source, orthogonal hole phantom, quadrant bar phantom, calibrated sources for dose calibrator ( 57 Co, 133 Ba, and 137 Cs) and a DeLuxe SPECT phantom from Data Spectrum Corp. Basic and complete/acceptance protocols were defined as the reference procedures. Measurements and evaluations were performed in 21 (<10%) centres and inter-comparisons were made amongst the groups. Results: Some information about the centres and evaluated systems are presented. A large number of the visited clinics never had any QC tests done except for the manufacturer's installation tests and the daily uniformity test. On the average, most of the cameras needed tuning and one of them had to have the PM tubes re-coupled. The main difficulties encountered by all groups were the lack of physicists in almost all the visited clinics and the inadequate training of many local technologists, especially in the remote areas. In spite of the misunderstanding and scepticism from some of the visited MDs, the majority recognized the importance of proper QC/QA testing. Conclusions: It was shown that regional centres are essential if one aims quality and reliability in the nuclear medicine clinics, especially in a

The Future of Medical Dosimetry

Energy Technology Data Exchange (ETDEWEB)

Adams, Robert D., E-mail: robert_adams@med.unc.edu

2015-07-01

The world of health care delivery is becoming increasingly complex. The purpose of this manuscript is to analyze current metrics and analytically predict future practices and principles of medical dosimetry. The results indicate five potential areas precipitating change factors: a) evolutionary and revolutionary thinking processes, b) social factors, c) economic factors, d) political factors, and e) technological factors. Outcomes indicate that significant changes will occur in the job structure and content of being a practicing medical dosimetrist. Discussion indicates potential variables that can occur within each process and change factor and how the predicted outcomes can deviate from normative values. Finally, based on predicted outcomes, future opportunities for medical dosimetrists are given.

Business Centre Development Model of Airport Area in Supporting Airport Sustainability in Indonesia

Science.gov (United States)

Setiawan, MI; Surjokusumo, S.; Ma'soem, DM; Johan, J.; Hasyim, C.; Kurniasih, N.; Sukoco, A.; Dhaniarti, I.; Suyono, J.; Sudapet, IN; Nasihien, RD; Mudjanarko, SW; Wulandari, A.; Ahmar, Ansari S.; Wajdi, MBN

2018-01-01

Airport is expected to play the role in enhancing the economic level of the region, especially the local people around the airport. The Aero City concept in developing an airport might also develop a city centreed in the airport that combining airport oriented business development, business actors and local people around the airport area. This study aims to generate development model of business centre at the airports in Indonesia. This is a mixed method based study. The population includes 296 airports under government management, government subsidiary and military. By using stratified random sampling, there were 151 sample airports. The results show that business centre development in the airport area will be related with the airport management and the commercial property (business centre) growth at the airport. Aero City in Indonesia can be developed by partnership system between government and private sector that consists of construction, development, and implementation of commercial property such as hotel, apartment, retail, office, etc. Based on the result of T-Value test, Airport Performance variable predicted to have significant influence on Gross Regional Domestic Product Central Business District performance.

The dismantling of nuclear installations in the Grenoble CEA centre - Press book 2013

International Nuclear Information System (INIS)

Laveissiere, Stephane; Coronini, Vincent

2013-01-01

After having outlined the importance of the project for the Grenoble CEA centre, this document presents the objectives, issues and challenges of dismantling activities performed on various nuclear installations located in the CEA centre of Grenoble. Objectives are presented in terms of agenda, predicted production of radioactive wastes, budget, personnel and steering committee. The various nuclear installations are presented: experimental reactors (Melusine, Siloe, Siloette), LAMA (laboratory of analysis of active materials), STED (station for the treatment of effluents and wastes). The safety and protection of workers is addressed in terms of protection and monitoring measures, and of exposure to radiations. The next part deals with the monitoring of the environment (actors, history of control of the centre's releases, control points, releases, atmosphere monitoring, and hydrological monitoring). A second part presents the global strategy of the CEA for its activities of sanitation and nuclear dismantling: present operations, dismantling activities in Fontenay-aux-Roses and in Marcoule, economic organization, contribution of advanced technology in radiological measurement and control, simulation and modelling, decontamination techniques, cutting operations, and remotely controlled operations

Kenya develops tool to predict malaria | IDRC - International ...

International Development Research Centre (IDRC) Digital Library (Canada)

2010-10-13

Oct 13, 2010 ... In collaboration with scientists from the Kenya Meteorological Department and the International Centre ... a scientific model that uses weather predictions, information about the reproductive mechanisms of ... Related articles ...

Predicting Falls in Parkinson Disease: What Is the Value of Instrumented Testing in OFF Medication State?

Directory of Open Access Journals (Sweden)

Martina Hoskovcová

Full Text Available Falls are a common complication of advancing Parkinson's disease (PD. Although numerous risk factors are known, reliable predictors of future falls are still lacking. The objective of this prospective study was to investigate clinical and instrumented tests of balance and gait in both OFF and ON medication states and to verify their utility in the prediction of future falls in PD patients.Forty-five patients with idiopathic PD were examined in defined OFF and ON medication states within one examination day including PD-specific clinical tests, instrumented Timed Up and Go test (iTUG and computerized dynamic posturography. The same gait and balance tests were performed in 22 control subjects of comparable age and sex. Participants were then followed-up for 6 months using monthly fall diaries and phone calls.During the follow-up period, 27/45 PD patients and 4/22 control subjects fell one or more times. Previous falls, fear of falling, more severe motor impairment in the OFF state, higher PD stage, more pronounced depressive symptoms, higher daily levodopa dose and stride time variability in the OFF state were significant risk factors for future falls in PD patients. Increased stride time variability in the OFF state in combination with faster walking cadence appears to be the most significant predictor of future falls, superior to clinical predictors.Incorporating instrumented gait measures into the baseline assessment battery as well as accounting for both OFF and ON medication states might improve future fall prediction in PD patients. However, instrumented testing in the OFF state is not routinely performed in clinical practice and has not been used in the development of fall prevention programs in PD. New assessment methods for daylong monitoring of gait, balance and falls are thus required to more effectively address the risk of falling in PD patients.

Fuel cycle centres

International Nuclear Information System (INIS)

Hagen, M.

1977-01-01

The concept of co-locating and integrating fuel cycle facilities at one site is discussed. This concept offers considerable advantages, especially in minimizing the amount of radioactive material to be transported on public roads. Safeguards and physical protection as relating to such an integrated system of facilities are analysed in detail, also industrial and commercial questions. An overall risk-benefit evaluation turns out to be in favour of fuel cycle centres. These centres seem to be specifically attractive with regard to the back end of the fuel cycle, including on-site disposal of radioactive wastes. The respective German approach is presented as an example. Special emphasis is given to the site selection procedures in this case. Time scale and cost for the implementation of this concept are important factors to be looked at. Since participation of governmental institutions in these centres seems to be indispensable their respective roles as compared to industry must be clearly defined. The idea of adjusting fuel cycle centres to regional rather than national use might be an attractive option, depending on the specific parameters in the region, though results of existing multinational ventures are inconclusive in this respect. Major difficulties might be expected e.g. because of different national safety regulations and standards as well as commercial conditions among partner countries. Public acceptance in the host country seems to be another stumbling block for the realization of this type of multinational facilities

Developing collaborative person-centred practice: a pilot project on a palliative care unit.

Science.gov (United States)

Hall, Pippa; Weaver, Lynda; Gravelle, Debbie; Thibault, Hélène

2007-02-01

Maximizing interprofessional collaborative patient-centred practice holds promise for improving patient care and creating satisfying work roles. In Canada's evolving health care system, there are demands for increased efficiency, cost-effectiveness, and quality improvement. Interprofessional collaboration warrants re-examination because maximizing interprofessional collaboration, especially nurse-physician collaboration, holds promise for improving patient care and creating satisfying work roles. A palliative care team seized the opportunity to pilot a different approach to patient and family care when faced with a reduction in medical staff. Grounded in a collaborative patient-centred practice approach, the Canadian Hospice Palliative Care Association's National Model to Guide Hospice Palliative Care (2002), and outcomes from program retreats and workgroups, a collaborative person-centred model of care was developed for a 12-bed pilot project. Preliminary findings show that the pilot project team perceived some specific benefits in continuity of care and interprofessional collaboration, while the presence of the physician was reduced to an average of 3.82 hours on the pilot wing, compared with 8 hours on the non-pilot wings. This pilot study suggests that a person-centred model, when focused on the physician-nurse dyad, may offer improved efficiency, job satisfaction and continuity of care on a palliative care unit. Incorporating all team members and developing strategies to successfully expand the model across the whole unit are the next challenges. Further research into the impact of these changes on the health care professionals, management and patients and families is essential.

[The medical French-speaking world].

Science.gov (United States)

Gouazé, André

2002-01-01

Medicine has always been and remains the most solid base of the French-speaking world which was born in Africa and Indochina with the admirable action of "colonial" military physicians, the implantation of the Pasteur Institutes and the emergence of resulting overseas medical schools. Obviously, we are referring to the French-speaking medical world. Since the first International Conference of the Deans of French-Speaking Medical Schools in Abidjan in 1981, today medical schools from 40 French-speaking countries participate. The conference undertakes co-operative medical school initiatives in a multi-lateral spirit, comprised by concrete, practical actions to assist universities in developing countries strive for excellence. These actions, which are conducted with the help of both institutional (AUF, MAE, WHO, UNESCO) and private partners mainly concentrate on promoting medical education of medicine, the evaluation of medical schools, the development of scientific and technical information and training teachers in the methodology of scientific clinical research and in public health. For the future, the Conference has three important objectives, to assist in training researchers and consequently in the development of research centres in emerging countries, to promote continuing medical education in rural areas far from medical schools by taking advantage of modern computer technology, and finally to open horizons toward other communities which speak other languages, and first of all, towards non French-speaking countries who live in a French-speaking environment.

Construct-level predictive validity of educational attainment and intellectual aptitude tests in medical student selection: meta-regression of six UK longitudinal studies

Science.gov (United States)

2013-01-01

Background Measures used for medical student selection should predict future performance during training. A problem for any selection study is that predictor-outcome correlations are known only in those who have been selected, whereas selectors need to know how measures would predict in the entire pool of applicants. That problem of interpretation can be solved by calculating construct-level predictive validity, an estimate of true predictor-outcome correlation across the range of applicant abilities. Methods Construct-level predictive validities were calculated in six cohort studies of medical student selection and training (student entry, 1972 to 2009) for a range of predictors, including A-levels, General Certificates of Secondary Education (GCSEs)/O-levels, and aptitude tests (AH5 and UK Clinical Aptitude Test (UKCAT)). Outcomes included undergraduate basic medical science and finals assessments, as well as postgraduate measures of Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP(UK)) performance and entry in the Specialist Register. Construct-level predictive validity was calculated with the method of Hunter, Schmidt and Le (2006), adapted to correct for right-censorship of examination results due to grade inflation. Results Meta-regression analyzed 57 separate predictor-outcome correlations (POCs) and construct-level predictive validities (CLPVs). Mean CLPVs are substantially higher (.450) than mean POCs (.171). Mean CLPVs for first-year examinations, were high for A-levels (.809; CI: .501 to .935), and lower for GCSEs/O-levels (.332; CI: .024 to .583) and UKCAT (mean = .245; CI: .207 to .276). A-levels had higher CLPVs for all undergraduate and postgraduate assessments than did GCSEs/O-levels and intellectual aptitude tests. CLPVs of educational attainment measures decline somewhat during training, but continue to predict postgraduate performance. Intellectual aptitude tests have lower CLPVs than A-levels or GCSEs

Preparation of emergency care centre exercises

International Nuclear Information System (INIS)

Schnadt, H.; Miska, H.

2011-01-01

Setup and operation of emergency care centres (sometimes also addressed as emergency reception centres) are part of emergency response in the environs of nuclear power plants. The preparation of an exercise scenario for such a centre is very demanding on the responsible agency. Therefore, a computer code has been developed which helps to translate the exercise objectives into instructions for figurants which simulate the affected population. These instructions are intended to steer a determined flow of people through the emergency care centre by providing fictitious radiological readings and by injecting the demand for additional actions of response personnel by statements and questions. (orig.)

Re: Factors Predicting Outcomes of Micropercutaneous Nephrolithotomy: Results from a Large Single-Centre Experience

Directory of Open Access Journals (Sweden)

Yakup Bostancı

2016-09-01

Full Text Available The recently developed micropercutaneous nephrolithotomy (microperc is the miniaturized version of mini-percutaneous nephrolithotomy (PCNL and standard-PCNL that allows for safe access and stone disintegration under direct vision. In this single-centre study, the authors aimed to define the role of microperc in the management of renal calculi and analyse factors predicting outcomes. A total of 139 patients, who underwent microperc between June 2010 and November 2014, were enrolled in this study. Microperc was successful in 119 (91.53% patients, while in 11 patients (8.46% some residual fragments were seen on imaging. Of the total study group, conversion to mini- or standard PCNL was required in nine patients (6.47%. Overall complication rate of 11.53%, primarily minor complications comprising renal colic and urinary tract infection. On multivariate analysis, stone density (HU, stone number and stone volume were significantly associated with the dependent variable stone clearance. Multivariate analysis showed that intra-operative complications and stone number were significantly associated with conversion to mini- or standard PCNL. Stone volume threshold of 1.000 mm3 was a significant predictor of stone clearance in univariate and multivariate analyses, regardless of the stone location. Some limitations of this study, relatively small sample size and particularly the retrospective and non-comparative design, should be highlighted. EAU guidelines recommend shockwave lithotripsy (SWL or retrograde intrarenal surgery as the primary treatment modality for stones <10 mm in size. Although microperc is presently being used for small to moderate stones, the very indication that holds for SWL as well, it is notable that SWL is influenced by stone location and pelvicalyceal anatomy, and may require multiple sessions. Nevertheless, microperc has an inherent limitation in that the stone fragments cannot be retrieved for analysis. It has been noted that the

The predictive value of an acute octreotide suppression test in patients with acromegaly

Directory of Open Access Journals (Sweden)

Mateja Strinović

2015-12-01

Full Text Available Acromegaly is a rare chronic disorder that is in 95% of cases caused by growth hormone (GH secreting pituitary tumors. Endonasal transphenoidal surgery is usually considered the first line of treatment, followed by medical therapy for residual disease. The long-acting somatostatin (SA analogues have an important role in the medical treatment of these patients. SA exert their biological effects by activating somatostatin receptors (SSTR. The predominant types of SSTR receptors in GH-secreting pituitary tumors are subtypes 2 (SSTR2 and 5 (SSTR5. The efficacy of somatostatin analog therapy (SAT is determined by its effect on tumor shrinkage which is reported to be between 20 and 50%. Approximately 10-30% of GH-secreting pituitary tumors are resistant to SA because of variable or reduced tumoral expression of SSTR2 or SSTR5. In many centres a test dose (TD of octreotide is administered before commencing SAT in order to predict the long term response to treatment. There has been a great interest in identifying factors that predict a good response to SAT. To date, several studies that have examined the relationship between the TD of octreotide and SAT. It is crucial how we define response during the OST. Nadir of GH to 5mU/l or less during the OST has an excelent predictive value for evaluation of long-term response to SAT. On the other hand, if we define response as percentage of change of GH from it’s baseline values, then the OST is not usefull diagnostic test.

Predicting Outcome in Patients With Work-Related Upper Extremity Disorders: A Prospective Study of Medical, Physical, Ergonomic, and Psychosocial Risk Factors

National Research Council Canada - National Science Library

Huang, Grant D

1999-01-01

.... Over the past few decades, empirical investigations have found that medical, physical, ergonomic, and psychosocial factors are correlated with and/or predictive of these disorders (e.g., Armstrong et al., 1993; Bongers et al., 1993; Hales AND Bernard, 1996).

Medical Abortion: The Tunisian Experience | Hajri | African Journal ...

African Journals Online (AJOL)

This paper reports the Tunisian experience of medical abortion. The project started in 1998 with a small introductory study at the obstetric and gynaecology department of a university hospital and was later extended step by step to other family planning and public health centres that provided abortion services. The study was ...

Council celebrates CERN Control Centre

CERN Multimedia

2006-01-01

With the unveiling of its new sign, the CERN Control Centre was officially inaugurated on Thursday 16 March. To celebrate its startup, CERN Council members visited the sleek centre, a futuristic-looking room filled with a multitude of monitoring screens.

Glad you brought it up: a patient-centred programme to reduce proton-pump inhibitor prescribing in general medical practice.

Science.gov (United States)

Murie, Jill; Allen, Jane; Simmonds, Ray; de Wet, Carl

2012-01-01

Many patients unnecessarily receive proton-pump inhibitor (PPI) drugs long term with significant financial and safety implications. Educating, empowering and supporting patients to self-manage their symptoms can lead to significant and sustained reductions in PPI prescribing. We aimed to implement a programme to reduce inappropriate PPI prescribing. Eligible patients in one general medical practice in rural Scotland were invited for participation between November 2008 and February 2010. Patients attended special nurse advisor clinics, completed dyspepsia questionnaires, received information, formulated self-management plans and were offered flexible support. Of the study population, 437/2883 (15%) were prescribed PPIs. Of these, 166 (38%) were judged eligible for participation. After 12 months, 138/157 (83%) had reduced or stopped their PPIs, while 19/157 (11%) had reverted. The estimated annual net saving in the prescribing budget was ?3180.67. Self-reported understanding of symptom self-management increased from 6/20 (30%) to 18/20 (90%) patients after participation in the programme. A patient-centred programme delivered by a specialist nurse significantly reduced PPI prescribing with financial and potential therapeutic benefits. The vast majority of eligible patients were able to 'step down and off' or 'step off' PPI use after 12 months without any complications or deteriorating symptom control. Further research with larger cohorts of practices and patients is needed to develop a feasible, acceptable and effective programme if similar benefits are to be achieved for primary care in general.

AI based HealthCare Platform for Real Time, Predictive and Prescriptive Analytics using Reactive Programming

Science.gov (United States)

Kaur, Jagreet; Singh Mann, Kulwinder, Dr.

2018-01-01

AI in Healthcare needed to bring real, actionable insights and Individualized insights in real time for patients and Doctors to support treatment decisions., We need a Patient Centred Platform for integrating EHR Data, Patient Data, Prescriptions, Monitoring, Clinical research and Data. This paper proposes a generic architecture for enabling AI based healthcare analytics Platform by using open sources Technologies Apache beam, Apache Flink Apache Spark, Apache NiFi, Kafka, Tachyon, Gluster FS, NoSQL- Elasticsearch, Cassandra. This paper will show the importance of applying AI based predictive and prescriptive analytics techniques in Health sector. The system will be able to extract useful knowledge that helps in decision making and medical monitoring in real-time through an intelligent process analysis and big data processing.

Medical aspects of the Chernobyl accident

International Nuclear Information System (INIS)

1988-07-01

From 11 to 13 May 1988, the All-Union Scientific Centre of Radiation Medicine convened a Conference on Medical Aspects of the Chernobyl Accident in Kiev. This was the first conference on this subject with international participation held in the Soviet Union. There were 310 specialists representing Soviet scientific establishments and over 60 experts from 23 other countries and international organizations participated in the Conference. Participants at the Conference discussed medical aspects of accident mitigation, including therapeutic, psychological, demographic, epidemiological and dosimetric problems. These proceedings include 29 reports presented by Soviet scientists during the four sessions as well as summaries of discussions and opening addresses. Refs, figs and tabs

Ectopic germinal centre-like structures in minor salivary gland biopsy predict lymphoma occurrence in patients with primary Sjögren syndrome.

Science.gov (United States)

Sène, Damien; Ismael, Sophie; Forien, Marine; Charlotte, Frédéric; Kaci, Rachid; Cacoub, Patrice; Abdourahmane, Diallo; Dieudé, Philippe; Lioté, Frédéric

2018-04-18

The objective was to determine risk factors of pSS-associated lymphoma in a multicenter cohort of patients, including in analyzed variables the presence of including ectopic germinal centre-like structures in minor salivary gland biopsy (MSGB). 115 pSS-patients were included and their MSGB were retrospectively examined focusing on the presence of ectopic germinal centre-like structures. Epidemiological, clinical, biological, immunological and histological data were collected at pSS diagnosis. Patients with a Non-Hodgkin Lymphoma (NHL) were compared to those without NHL during the follow-up period, using a Cox proportional hazards multiple regression model. NHL was diagnosed in 8 patients (6.96%), and ectopic germinal centre-like structures in 19 patients (16.5%). The presence of ectopic germinal centre-like structures was associated with a 7.8-fold risk of lymphoma occurrence (95%CI = 1.73-34.86; P = 0.0075). Other independent predictors included positive cryoglobulin (HR = 7.10; 95%CI = 1.74-28.92; P = 0.006), male gender (HR = 28.73; 95%CI = 4.46-144.87; P = 0.0004), sensorimotor neuropathy (HR = 35.48; 95%CI = 5.79-217.39; P = 0.0001) and splenomegaly (HR = 19.9; 95%CI = 4.4-90; P = 0.0001). In addition to traditional clinical and biological predictors, the presence of ectopic germinal centre-like structures in MSGB is associated to the risk of lymphoma occurrence in pSS patients. These data reinforce the major role of MSGB in pSS, for the diagnosis and identification a priori of a subgroup of patients with the highest risk of lymphoma. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.