WorldWideScience

Sample records for significant medical implications

  1. Intraspecific venom variation in the medically significant Southern Pacific Rattlesnake (Crotalus oreganus helleri): biodiscovery, clinical and evolutionary implications.

    Science.gov (United States)

    Sunagar, Kartik; Undheim, Eivind A B; Scheib, Holger; Gren, Eric C K; Cochran, Chip; Person, Carl E; Koludarov, Ivan; Kelln, Wayne; Hayes, William K; King, Glenn F; Antunes, Agosthino; Fry, Bryan Grieg

    2014-03-17

    Due to the extreme variation of venom, which consequently results in drastically variable degrees of neutralization by CroFab antivenom, the management and treatment of envenoming by Crotalus oreganus helleri (the Southern Pacific Rattlesnake), one of the most medically significant snake species in all of North America, has been a clinician's nightmare. This snake has also been the subject of sensational news stories regarding supposed rapid (within the last few decades) evolution of its venom. This research demonstrates for the first time that variable evolutionary selection pressures sculpt the intraspecific molecular diversity of venom components in C. o. helleri. We show that myotoxic β-defensin peptides (aka: crotamines/small basic myotoxic peptides) are secreted in large amounts by all populations. However, the mature toxin-encoding nucleotide regions evolve under the constraints of negative selection, likely as a result of their non-specific mode of action which doesn't enforce them to follow the regime of the classic predator-prey chemical arms race. The hemorrhagic and tissue destroying snake venom metalloproteinases (SVMPs) were secreted in larger amounts by the Catalina Island and Phelan rattlesnake populations, in moderate amounts in the Loma Linda population and in only trace levels by the Idyllwild population. Only the Idyllwild population in the San Jacinto Mountains contained potent presynaptic neurotoxic phospholipase A2 complex characteristic of Mohave Rattlesnake (Crotalus scutulatus) and Neotropical Rattlesnake (Crotalus durissus terrificus). The derived heterodimeric lectin toxins characteristic of viper venoms, which exhibit a diversity of biological activities, including anticoagulation, agonism/antagonism of platelet activation, or procoagulation, appear to have evolved under extremely variable selection pressures. While most lectin α- and β-chains evolved rapidly under the influence of positive Darwinian selection, the β-chain lectin of

  2. Cannabinoids: Medical implications.

    Science.gov (United States)

    Schrot, Richard J; Hubbard, John R

    2016-01-01

    Herbal cannabis has been used for thousands of years for medical purposes. With elucidation of the chemical structures of tetrahydrocannabinol (THC) and cannabidiol (CBD) and with discovery of the human endocannabinoid system, the medical usefulness of cannabinoids has been more intensively explored. While more randomized clinical trials are needed for some medical conditions, other medical disorders, like chronic cancer and neuropathic pain and certain symptoms of multiple sclerosis, have substantial evidence supporting cannabinoid efficacy. While herbal cannabis has not met rigorous FDA standards for medical approval, specific well-characterized cannabinoids have met those standards. Where medical cannabis is legal, patients typically see a physician who "certifies" that a benefit may result. Physicians must consider important patient selection criteria such as failure of standard medical treatment for a debilitating medical disorder. Medical cannabis patients must be informed about potential adverse effects, such as acute impairment of memory, coordination and judgment, and possible chronic effects, such as cannabis use disorder, cognitive impairment, and chronic bronchitis. In addition, social dysfunction may result at work/school, and there is increased possibility of motor vehicle accidents. Novel ways to manipulate the endocannbinoid system are being explored to maximize benefits of cannabinoid therapy and lessen possible harmful effects.

  3. Implications of Medical Tourism.

    Science.gov (United States)

    Cesario, Sandra K

    2018-06-01

    Medical tourism is an emerging industry that facilitates travel to another country for people who seek medical, surgical, or dental care that is unavailable or more affordable than in their home countries. Rapid advances in electronic communication and the ease of international travel have fueled the growth of this industry. More than half of medical travelers are women, especially for services related to cosmetic or reproductive conditions. Medical tourism creates both opportunities and challenges for nurses and other health care providers. Consumers' increased access to the global health care market necessitates the development of a structure that shapes the medical tourism industry and addresses evolving ethical, political, and human rights concerns related to this industry. Copyright © 2018 AWHONN. Published by Elsevier Inc. All rights reserved.

  4. Medical significance of the essential biological metals

    International Nuclear Information System (INIS)

    Davies, I.J.T.

    1977-01-01

    The medical significance of the essential biological metals such as zinc, copper and molybdenum as well as their nutritional and biochemical importance are reviewed. The following topics are treated: biochemical actions of the essential biological metals; the concept of essentiality; the development of knowledge about the essential biological metals. Data are given on zinc deficiency and hypogonadismi in humans, zinc and acrodermatitis enterophatica, zinc and the skin, zinc in diabetes mellitus, zinc and insulin, zinc and the liver; copper functions, copper deficiency - ''sway back'' in sheep, copper and haemopoiesis, copper and the function of blood vessels; molybdenum and dental caries in humans, oesophageal carcinoma and molybdenum deficiency in humans. (T.G.)

  5. [Biofilms and their significance in medical microbiology].

    Science.gov (United States)

    Cernohorská, L; Votava, M

    2002-11-01

    Microorganisms are able to adhere to various surfaces and to form there a three-dimensional structure known as biofilm. In biofilms, microbial cells show characteristics and behaviours different from those of plankton cells. Intercellular signalizations of the quorum-sensing type regulate interaction between members of the biofilm. Bacteria embedded in the biofilm can escape and form well known planktonic forms, that are obviously only a part of the bacterial life cycle. Bacteria adhere also to medically important surfaces such as catheters, either urinary or intravenous ones, artificial heart valves, orthopedic implants and so on and contribute to device-related infections like cystitis, catheter-related sepsis, endocarditis etc. Once a biofilm has been established on a surface, the bacteria harboured inside are less exposed to the host's immune response and less susceptible to antibiotics. As an important cause of nosocomial infections the biofilm must remain in the centre of the microbiologist's attention.

  6. Medical Significance of Microorganisms in Spacecraft Environment

    Science.gov (United States)

    Pierson, Duane L.; Ott, C. Mark

    2007-01-01

    Microorganisms can spoil food supplies, contaminate drinking water, release noxious volatile compounds, initiate allergic responses, contaminate the environment, and cause infectious diseases. International acceptability limits have been established for bacterial and fungal contaminants in air and on surfaces, and environmental monitoring is conducted to ensure compliance. Allowable levels of microorganism in water and food have also been established. Environmental monitoring of the space shuttle, the Mir, and the ISS have allowed for some general conclusions. Generally, the bacteria found in air and on interior surfaces are largely of human origin such as Staphylococcus spp., Micrococcus spp. Common environmental genera such as Bacillus spp. are the most commonly isolated bacteria from all spacecraft. Yeast species associated with humans such as Candida spp. are commonly found. Aspergillus spp., Penicillium spp., and Cladosporium spp. are the most commonly isolated filamentous fungi. Microbial levels in the environment differ significantly depending upon humidity levels, condensate accumulation, and availability of carbon sources. However, human "normal flora" of bacteria and fungi can result in serious, life-threatening diseases if human immunity is compromised. Disease incidence is expected to increase as mission duration increases.

  7. Inhaler Reminders Significantly Improve Asthma Patients' Use of Controller Medications

    Science.gov (United States)

    ... controller medications Share | Inhaler reminders significantly improve asthma patients’ use of controller medications Published Online: July 22, ... the burden and risk of asthma, but many patients do not use them regularly. This poor adherence ...

  8. [The framing effect: medical implications].

    Science.gov (United States)

    Mazzocco, Ketti; Cherubini, Paolo; Rumiati, Rino

    2005-01-01

    Over the last 20 years, many studies explored how the way information is presented modifies choices. This sort of effect, referred to as "framing effects", typically consists of the inversion of choices when presenting structurally identical decision problems in different ways. It is a common assumption that physicians are unaffected (or less affected) by the surface description of a decision problem, because they are formally trained in medical decision making. However, several studies showed that framing effects occur even in the medical field. The complexity and variability of these effects are remarkable, making it necessary to distinguish among different framing effects, depending on whether the effect is obtained by modifying adjectives (attribute framing), goals of a behavior (goal framing), or the probability of an outcome (risky choice framing). A further reason for the high variability of the framing effects seems to be the domain of the decision problem, with different effects occurring in prevention decisions, disease-detection decisions, and treatment decisions. The present work reviews the studies on framing effects, in order to summarize them and clarify their possible role in medical decision making.

  9. Dictionary Pruning with Visual Word Significance for Medical Image Retrieval.

    Science.gov (United States)

    Zhang, Fan; Song, Yang; Cai, Weidong; Hauptmann, Alexander G; Liu, Sidong; Pujol, Sonia; Kikinis, Ron; Fulham, Michael J; Feng, David Dagan; Chen, Mei

    2016-02-12

    Content-based medical image retrieval (CBMIR) is an active research area for disease diagnosis and treatment but it can be problematic given the small visual variations between anatomical structures. We propose a retrieval method based on a bag-of-visual-words (BoVW) to identify discriminative characteristics between different medical images with Pruned Dictionary based on Latent Semantic Topic description. We refer to this as the PD-LST retrieval. Our method has two main components. First, we calculate a topic-word significance value for each visual word given a certain latent topic to evaluate how the word is connected to this latent topic. The latent topics are learnt, based on the relationship between the images and words, and are employed to bridge the gap between low-level visual features and high-level semantics. These latent topics describe the images and words semantically and can thus facilitate more meaningful comparisons between the words. Second, we compute an overall-word significance value to evaluate the significance of a visual word within the entire dictionary. We designed an iterative ranking method to measure overall-word significance by considering the relationship between all latent topics and words. The words with higher values are considered meaningful with more significant discriminative power in differentiating medical images. We evaluated our method on two public medical imaging datasets and it showed improved retrieval accuracy and efficiency.

  10. [Significance of the doctorate in scientific medical education].

    Science.gov (United States)

    Frosch, Matthias

    2018-02-01

    According to European and German law, the medical education of physicians must take place in a scientific degree program at a university or under the supervision of a university. To keep up the ideal of a scientific degree program, various organizations and associations, such as the German Research Foundation, the German Council of Science and Humanities and the German Medical Faculty Association, see the need for an even stronger anchoring of academic learning content in the course of study. Traditionally, a scientific project, which is carried out during the studies, provides the basis for the Doctor of Medicine (Dr. med.) after graduation, although the research projects as a basis for medical degrees are currently not obligatory parts of the curricula. The number of medical students performing such research projects is significantly decreasing, thus they are missing major skills for working in science. To counteract these developments, faculties of medicine are currently developing model curricula including deepened scientific education. Despite these efforts, the German Association of Faculties of Medicine argues that the performance of research projects leading to the doctoral degree is most suitable for obtaining expertise in scientific work. According to recommendations by the German Council of Science on the requirements for quality assurance of graduation doctoral degree programs have been introduced. This and further measures, like MD/PhD programs or research-based additional study programs serving the scientific qualification of medical students, are the subject of this article.

  11. Ventilator-associated pneumonia: clinical significance and implications for nursing.

    Science.gov (United States)

    Grap, M J; Munro, C L

    1997-01-01

    Pneumonia is the second most common nosocomial infection in the United States and the leading cause of death from nosocomial infections. Intubation and mechanical ventilation greatly increase the risk of bacterial pneumonia. Ventilator-associated pneumonia (VAP) occurs in a patient treated with mechanical ventilation, and it is neither present nor developing at the time of intubation; it is a serious problem--with significant morbidity and mortality rates. Aspiration of bacteria from the oropharynx, leakage of contaminated secretions around the endotracheal tube, patient position, and cross-contamination from respiratory equipment and health care providers are important factors in the development of VAP. Nurses caring for patients treated with mechanical ventilation must recognize risk factors and include strategies for reducing these factors as part of their nursing care. This article summarizes the literature related to VAP: its incidence, associated factors, diagnosis, and current therapies, with an emphasis on nursing implications in the care of these patients.

  12. The medical implications of space tourism.

    Science.gov (United States)

    Tarzwell, R

    2000-06-01

    Commercial space travel may soon be a reality. If so, microgravity, high acceleration, and radiation exposure, all known hazards, will be accessible to the general public. Therefore, space tourism has medical implications. Even though the first flights will feature space exposure times of only a few minutes, the potential may someday exist for exposure times long enough to warrant careful consideration of the potential hazards to the space-faring public. The effects of acceleration and microgravity exposure are well known on the corps of astronauts and cosmonauts. The effects of space radiation are partially known on astronauts, but much remains to be discovered. However, there are problems using astronaut data to make inferences about the general public. Astronauts are not necessarily representative of the general public, since they are highly fit, highly screened individuals. Astronaut data can tell us very little about the potential hazards of microgravity in pediatric, obstetric and geriatric populations, all of whom are potential space tourists. Key issues in standard setting will be determining acceptable limits of pre-existing disease and inferring medical standards from mission profiles. It will not be a trivial task drafting minimal medical standards for commercial space travel. It will require the collaboration of space medicine physicians, making the best guesses possible, based on limited amounts of data, with limited applicability. A helpful departure point may be the USAF Class 3 medical standard, applicable to NASA payload specialists. It is time to begin preliminary discussions toward defining those standards. acceleration, aerospace medicine, medical standards, microgravity, radiation, space, space tourism, environmental hazards, environmental medicine.

  13. [Significance of COI disclosure in medical research in Japan].

    Science.gov (United States)

    Sone, Saburo

    2011-11-01

    In medical research, remarkable increase in collaboration with industry, public organizations such as universities, research institutions, and academic societies makes researchers to be more deeply involved with the activities of commercial entities. Activities of education and research, which are the responsibilities of academic institutions and societies, conflict with the interests of individuals associated with industrial-academic collaboration. Management of such conflict of interest (COI) is of much importance for academic institutions and societies to appropriately promote industrial-academic collaborative activities. Particularly, participation not only by healthy individuals, but also patients, is essential in the medical field as subjects of clinical research. For those involved in medical research, the deeper the level of COI with commercial entities, who are the financial or benefit provider, becomes serious, the more human rights of subjects could be violated, safety of life could be endangered, and research methods, data analysis and interpretation of results could be distorted. It is also possible that research may be unfairly evaluated or not published, even if the results are accurate, sometimes resulting in the ascertained effects of reporting bias included the overestimation of efficacy and the underestimation of safety risks of interventions. According to the COI management guideline of the Japanese Association of Medical Science (JAMS), significance of COI management is discussed.

  14. [Medical Humanities--the Historical Significance and Mission in Medical Education].

    Science.gov (United States)

    Fujino, Akihiro

    2015-12-01

    In this paper we consider the significance and mission of medical humanities in medical education from the following six viewpoints: (1) misunderstanding of the medical humanities; (2) its historical development; (3) the criteria for the ideal physician; (4) the contents of current Medical Humanities education; (5) the basic philosophy; and (6) its relation to medical professionalism. Medical humanities consists of the three academic components of bioethics, clinical ethics and medical anthropology, and it is a philosophy and an art which penetrate to the fundamental essence of medicine. The purpose of medical humanities is to develop one's own humanity and spirituality through medical practice and contemplation by empathizing with patients' illness narratives through spiritual self-awakening and by understanding the mutual healing powers of human relations by way of the realization of primordial life. The basic philosophy is "the coincidence of contraries". The ultimate mission of medical humanities is to cultivate physicians to educate themselves and have a life-long philosophy of devotion to understanding, through experience, the coincidence of contraries.

  15. Drug shortages: Implications for medical toxicology.

    Science.gov (United States)

    Mazer-Amirshahi, Maryann; Hawley, Kristy L; Zocchi, Mark; Fox, Erin; Pines, Jesse M; Nelson, Lewis S

    2015-07-01

    Drug shortages have significantly increased over the past decade. There are limited data describing how shortages impact medical toxicology of drugs. To characterize drug shortages affecting the management of poisoned patients. Drug shortage data from January 2001 to December 2013 were obtained from the University of Utah Drug Information Service. Shortage data for agents used to treat poisonings were analyzed. Information on drug type, formulation, reason for shortage, shortage duration, marketing, and whether the drug was available from a single source was collected. The availability of a substitute therapy and whether substitutes were in shortage during the study period were also investigated. Of 1,751 shortages, 141 (8.1%) impacted drugs used to treat poisoned patients, and as of December 2013, 21 (14.9%) remained unresolved. New toxicology shortages increased steadily from the mid-2000s, reaching a high of 26 in 2011. Median shortage duration was 164 days (interquartile range: 76-434). Generic drugs were involved in 85.1% of shortages and 41.1% were single-source products. Parenteral formulations were often involved in shortages (89.4%). The most common medications in shortage were sedative/hypnotics (15.6%). An alternative agent was available for 121 (85.8%) drugs; however, 88 (72.7%) alternatives were also affected by shortages at some point during the study period. When present, the most common reasons reported were manufacturing delays (22.0%) and supply/demand issues (17.0%). Shortage reason was not reported for 48.2% of drugs. Toxicology drug shortages are becoming increasingly prevalent, which can result in both suboptimal treatment and medication errors from using less familiar alternatives. Drug shortages affected a substantial number of critical agents used in the management of poisoned patients. Shortages were often of long duration and for drugs without alternatives. Providers caring for poisoned patients should be aware of current shortages and

  16. Adab and its significance for an Islamic medical ethics.

    Science.gov (United States)

    Sartell, Elizabeth; Padela, Aasim I

    2015-09-01

    Discussions of Islamic medical ethics tend to focus on Sharī'ah-based, or obligation-based, ethics. However, limiting Islamic medical ethics discourse to the derivation of religious duties ignores discussions about moulding an inner disposition that inclines towards adherence to the Sharī'ah. In classical Islamic intellectual thought, such writings are the concern of adab literature. In this paper, we call for a renewal of adabi discourse as part of Islamic medical ethics. We argue that adab complements Sharī'ah-based writings to generate a more holistic vision of Islamic medical ethics by supplementing an obligation-based approach with a virtue-based approach. While Sharī'ah-based medical ethics focuses primarily on the moral status of actions, adab literature adds to this genre by addressing the moral formation of the agent. By complementing Sharī'ah-based approaches with adab-focused writings, Islamic medical ethics discourse can describe the relationship between the agent and the action, within a moral universe informed by the Islamic intellectual tradition. 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.

  17. Pensions, tax and the anaesthetist: significant implications for workforce planning.

    Science.gov (United States)

    Pandit, J J

    2016-08-01

    This paper shows how recent tax changes to pensions (i.e. new lifetime and annual allowance contribution limits) mean that NHS consultants will need to adopt one of four rational strategies to work and financial planning. Two of those strategies (termed 'Earn Fast, Drop Out' and 'Never Enter') involve a break between work and pensions. The logical consequence of this break is that consultants may exercise options to maximise their total income, which in turn will result in less work within the NHS and more work in alternative higher paying (e.g. private) sectors. A third strategy ('Go Slow, Stay Low') also involves less-than-full-time NHS work. Only one option ('Do Nothing' as a result of the tax changes) has no effect. In short, the tax changes will predictably lead to future senior consultants devoting proportionately much less of their time to NHS work than before. The article discusses the important implications of this conclusion for NHS workforce planning. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

  18. Electronic medical records in dermatology: Practical implications

    Directory of Open Access Journals (Sweden)

    Kaliyadan Feroze

    2009-01-01

    Full Text Available Background: Electronic medical records (EMRs can be of great use in dermatological data recording. Unfortunately, not many studies have been carried out in this specific area. Aims: We attempt to evaluate the use of an EMR system in dermatology, comparing it with a conventional paper-based system. Methods: Two hundred patient records of patients attending the dermatology outpatient department were studied over a 3-month period. Half the reports were entered in the conventional paper-based format while the other half was entered in an EMR system. The time taken for each consultation was recorded and the same was carried out for the first subsequent follow-up visit. Results: The average time taken for the completion of the EMR-based consultation for new cases was 19.15 min (range, 10-30 min; standard deviation, 6.47. The paper-based consultation had an average time of 15.70 min (range, 5-25 min; standard deviation, 6.78. The P-value (T-test was used was 0.002, which was significant. The average time taken for consultations and entering progress notes in the follow-up cases was slightly less than 10 min (9.7 for EMR while it was slightly more than 10 min (10.3 for the paper format. The difference was not statistically significant. The doctors involved also mentioned what they felt were the advantages and disadvantages of the system along with suggestions for improvement. Conclusion: The use of an EMR system in dermatology (or for that matter in any specialty may overawe most users at the beginning, but once a comfort level is established, EMR is likely to outscore conventional paper recording systems. More time-motion-case studies are required to ascertain the optimal usage of EMR systems.

  19. Accurate coding in sepsis: clinical significance and financial implications.

    Science.gov (United States)

    Chin, Y T; Scattergood, N; Thornber, M; Thomas, S

    2016-09-01

    Sepsis is a major healthcare problem and leading cause of death worldwide. UK hospital mortality statistics and payments for patient episodes of care are calculated on clinical coding data. The accuracy of these data depends on the quality of coding. This study aimed to investigate whether patients with significant bacteraemia are coded for sepsis and to estimate the financial costs of miscoding. Of 54 patients over a one-month period with a significant bacteraemia, only 19% had been coded for sepsis. This is likely to lead to falsely high calculated hospital mortality. Furthermore, this resulted in an underpayment of £21,000 for one month alone. Copyright © 2016 The Healthcare Infection Society. All rights reserved.

  20. Use of Portfolios by Medical Students: Significance of Critical Thinking

    Directory of Open Access Journals (Sweden)

    Samy A. Azer

    2008-07-01

    Full Text Available Portfolios have been used in the medical curriculum to evaluate difficult-to-assess areas such as students' attitudes, professionalism and teamwork. However, their use early in a problem-based learning (PBL course to foster deep learning and enhance students' self-directed learning has not been adequately studied. The aims of this paper are to: (1 understand the uses of portfolios and the rationale for using reflection in the early years of a PBL curriculum; (2 discuss how to introduce portfolios and encourage students' critical thinking skills, not just reflection; and (3 provide students with tips that could enhance their skills in constructing good portfolios.

  1. Medical Services - A Significant Component of the Economic Activity

    Directory of Open Access Journals (Sweden)

    Mihalache Patricia

    2017-01-01

    The current consumer of health services is more educated and more concerned with health needs than in the past. The marketing of these services has begun to be viewed from a new perspective, more aggressive and more marketing-oriented and business oriented. The most important methods of promoting medical services refer to advertising in mass media, the Internet, social networks, professional advertising vs. institutional advertising. Private healthcare services are very well promoted in comparison with the health services in the public health system.

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

    African Journals Online (AJOL)

    African Journal of Psychiatry ... They are also at increased risk of contracting HIV. ... As medical practice becomes more specialized and arguably compartmentalized it may increasingly fail to integrate health care for patients with severe mental ...

  3. Employment status, medical support and Income as significant ...

    African Journals Online (AJOL)

    significant differences in affordability between individuals who had full time paid employment and those who ... Studies have shown that the direct costs of healthcare services2, travel time, patients' income, and ..... and age was their real ages.

  4. The biochemistry and medical significance of the flavonoids.

    Science.gov (United States)

    Havsteen, Bent H

    2002-01-01

    Flavonoids are plant pigments that are synthesised from phenylalanine, generally display marvelous colors known from flower petals, mostly emit brilliant fluorescence when they are excited by UV light, and are ubiquitous to green plant cells. The flavonoids are used by botanists for taxonomical classification. They regulate plant growth by inhibition of the exocytosis of the auxin indolyl acetic acid, as well as by induction of gene expression, and they influence other biological cells in numerous ways. Flavonoids inhibit or kill many bacterial strains, inhibit important viral enzymes, such as reverse transcriptase and protease, and destroy some pathogenic protozoans. Yet, their toxicity to animal cells is low. Flavonoids are major functional components of many herbal and insect preparations for medical use, e.g., propolis (bee's glue) and honey, which have been used since ancient times. The daily intake of flavonoids with normal food, especially fruit and vegetables, is 1-2 g. Modern authorised physicians are increasing their use of pure flavonoids to treat many important common diseases, due to their proven ability to inhibit specific enzymes, to simulate some hormones and neurotransmitters, and to scavenge free radicals.

  5. Paradigm shifts in medical education: implications for medical/health ...

    African Journals Online (AJOL)

    Contemporary health and medical education in the present information dispensation must actively engage healthcare providers in opportunities for knowledge seeking, learning to learn, and motivation to continue learning. The favored pedagogical design to achieve this is Problem-Based Learning (PBL) enhanced with the ...

  6. Implications of WWW technologies for exchanging medical records

    Directory of Open Access Journals (Sweden)

    Maurice Dixon

    1999-09-01

    Full Text Available This article addresses some of the implications for medical record exchange of very recent developments in technology and tools that support the World Wide Web. It argues that XML (Extensible Mark-up Language is a very good enabling technology for medical record exchange. XML provides a much cheaper way of executing the exchange of medical information that circumvents the need for proprietary software. Use of XML can also simplify solutions to the problems associated with coping with the evolution of medical systems in time. However XML on its own does not resolve all the semantic heterogeneities.

  7. Medical Malpractice Implications of Clinical Practice Guidelines.

    Science.gov (United States)

    Ruhl, Douglas S; Siegal, Gil

    2017-08-01

    Clinical practice guidelines aim to improve medical care by clarifying and making useful recommendations to providers. Although providers should account for patients' unique characteristics when determining a treatment plan, it is generally perceived as good practice to follow guidelines when applicable. This is of interest in malpractice litigation, where it is essential to establish a standard of care to evaluate the performances of providers. Although the opinions of expert witnesses are used to determine standards of care, guidelines are expected to play a leading role. Guidelines alone should not establish a legal standard but may help inform this discussion in the courtroom. Therefore, it is incumbent that excellent, practical, and timely guidelines are continually created and updated in a transparent way. These guidelines must be very clear and underscore the various strengths of recommendation based on the quality of available evidence.

  8. Medical humanities and their discontents: definitions, critiques, and implications.

    Science.gov (United States)

    Shapiro, Johanna; Coulehan, Jack; Wear, Delese; Montello, Martha

    2009-02-01

    The humanities offer great potential for enhancing professional and humanistic development in medical education. Yet, although many students report benefit from exposure to the humanities in their medical education, they also offer consistent complaints and skepticism. The authors offer a pedagogical definition of the medical humanities, linking it to medicine as a practice profession. They then explore three student critiques of medical humanities curricula: (1) the content critique, examining issues of perceived relevance and intellectual bait-and-switch, (2) the teaching critique, which examines instructor trustworthiness and perceived personal intrusiveness, and (3) the structural/placement critique, or how and when medical humanities appear in the curriculum. Next, ways are suggested to tailor medical humanities to better acknowledge and reframe the needs of medical students. These include ongoing cross-disciplinary reflective practices in which intellectual tools of the humanities are incorporated into educational activities to help students examine and, at times, contest the process, values, and goals of medical practice. This systematic, pervasive reflection will organically lead to meaningful contributions from the medical humanities in three specific areas of great interest to medical educators: professionalism, "narrativity," and educational competencies. Regarding pedagogy, the implications of this approach are an integrated required curriculum and innovative concepts such as "applied humanities scholars." In turn, systematic integration of humanities perspectives and ways of thinking into clinical training will usefully expand the range of metaphors and narratives available to reflect on medical practice and offer possibilities for deepening and strengthening professional education.

  9. Individual radiation sensitivity: implications in medical practice

    Energy Technology Data Exchange (ETDEWEB)

    Gisone, P.; Dubner, D.; Perez, M.D.R.; Michelin, S.; Di Giogio, M. [Autoridad Regulatoria Nuclear, Buenos Aires (Argentina); Bourguignon, M. [Direction Generale de la Surete Nucleaire et de la Radioprotection, Paris (France)

    2006-07-01

    Important advances in radiotherapy and nuclear medicine towards better treatment modalities and safer applications have taken place in recent years. Progress in medical imaging, better tumour targeting and optimization of radiation delivery have allowed for dose escalation and improved patient outcome. However, the tolerance of normal tissues constitutes the limiting factor for dose escalation in therapeutical uses of ionizing radiation (IR). Patients vary considerably in their normal tissue response to IR even after similar treatments. As many as 5% of cancer patients develop severe effects to external radiation therapy in normal tissues within the treatment field: they may include acute effects such as erythema and desquamation of the exposed skin and mucosa that appear during or directly after radiotherapy, late effects developed months or years later, such as fibrosis and telangiectasia and cancer induction. Several patient and treatment related factors are known to influence the variability of side effects, however up to a 70% of the total variance of normal tissue radiation response remained unexplained. Thus, individual sensitivity to IR, i.e. hypersensitivity to carcinogenic risks (stochastic effects) and hypersensitivity to deterministic effects, is becoming an important issue in oncology and raises questions regarding the underlying mechanisms. The mechanisms of DNA repair, the signalling pathways involved in radiation sensitivity and non-targeted effects are key aspects, essential to understanding radiation effects at genetic level. Moreover, human genetic diseases that combine higher incidence of cancer and hypersensitivity to IR are associated with defects in cell response to DNA damage. Therefore, much interest has raised during the last years in the developing of predictive tests capable to detect in advance such hypersensitive conditions. The goal of this presentation is to review the possible mechanisms involved in genetic and epigenetic

  10. Individual radiation sensitivity: implications in medical practice

    International Nuclear Information System (INIS)

    Gisone, P.; Dubner, D.; Perez, M.D.R.; Michelin, S.; Di Giogio, M.; Bourguignon, M.

    2006-01-01

    Important advances in radiotherapy and nuclear medicine towards better treatment modalities and safer applications have taken place in recent years. Progress in medical imaging, better tumour targeting and optimization of radiation delivery have allowed for dose escalation and improved patient outcome. However, the tolerance of normal tissues constitutes the limiting factor for dose escalation in therapeutical uses of ionizing radiation (IR). Patients vary considerably in their normal tissue response to IR even after similar treatments. As many as 5% of cancer patients develop severe effects to external radiation therapy in normal tissues within the treatment field: they may include acute effects such as erythema and desquamation of the exposed skin and mucosa that appear during or directly after radiotherapy, late effects developed months or years later, such as fibrosis and telangiectasia and cancer induction. Several patient and treatment related factors are known to influence the variability of side effects, however up to a 70% of the total variance of normal tissue radiation response remained unexplained. Thus, individual sensitivity to IR, i.e. hypersensitivity to carcinogenic risks (stochastic effects) and hypersensitivity to deterministic effects, is becoming an important issue in oncology and raises questions regarding the underlying mechanisms. The mechanisms of DNA repair, the signalling pathways involved in radiation sensitivity and non-targeted effects are key aspects, essential to understanding radiation effects at genetic level. Moreover, human genetic diseases that combine higher incidence of cancer and hypersensitivity to IR are associated with defects in cell response to DNA damage. Therefore, much interest has raised during the last years in the developing of predictive tests capable to detect in advance such hypersensitive conditions. The goal of this presentation is to review the possible mechanisms involved in genetic and epigenetic

  11. Adult ADHD Medications and Their Cardiovascular Implications

    Directory of Open Access Journals (Sweden)

    A. Sinha

    2016-01-01

    Full Text Available Attention-deficit/hyperactivity disorder (ADHD is a chronic neurobiological disorder exhibited by difficulty maintaining attention, as well as hyperactivity and impulsive behavior. Central nervous system (CNS stimulants are the first line of treatment for ADHD. With the increase in number of adults on CNS stimulants, the question that arises is how well do we understand the long-term cardiovascular effects of these drugs. There has been increasing concern that adults with ADHD are at greater risk for developing adverse cardiovascular events such as sudden death, myocardial infarction, and stroke as compared to pediatric population. Cardiovascular response attributed to ADHD medication has mainly been observed in heart rate and blood pressure elevations, while less is known about the etiology of rare cardiovascular events like acute myocardial infarction (AMI, arrhythmia, and cardiomyopathy and its long-term sequelae. We present a unique case of AMI in an adult taking Adderall (mixed amphetamine salts and briefly discuss the literature relevant to the cardiovascular safety of CNS stimulants for adult ADHD.

  12. The quest for significance model of radicalization: implications for the management of terrorist detainees.

    Science.gov (United States)

    Dugas, Michelle; Kruglanski, Arie W

    2014-01-01

    Radicalization and its culmination in terrorism represent a grave threat to the security and stability of the world. A related challenge is effective management of extremists who are detained in prison facilities. The major aim of this article is to review the significance quest model of radicalization and its implications for management of terrorist detainees. First, we review the significance quest model, which elaborates on the roles of motivation, ideology, and social processes in radicalization. Secondly, we explore the implications of the model in relation to the risks of prison radicalization. Finally, we analyze the model's implications for deradicalization strategies and review preliminary evidence for the effectiveness of a rehabilitation program targeting components of the significance quest. Based on this evidence, we argue that the psychology of radicalization provides compelling reason for the inclusion of deradicalization efforts as an essential component of the management of terrorist detainees. Copyright © 2014 John Wiley & Sons, Ltd.

  13. Deeply discounted medications: Implications of generic prescription drug wars.

    Science.gov (United States)

    Czechowski, Jessica L; Tjia, Jennifer; Triller, Darren M

    2010-01-01

    To describe the history of generic prescription pricing programs at major pharmacy chains and their potential implications on prescribing, quality of care, and patient safety. Publicly available generic prescription discount program drug lists as of May 1, 2009. Fierce competition among major pharmacy chains such as Walgreens, CVS, and Walmart has led to a generic prescription pricing war with unclear public health implications. Introduced in 2006, currently 7 of the 10 largest pharmacy chains advertise a version of a deeply discounted medication (DDM) program, accounting for more than 25,000 locations nationally. By early 2008, almost 70 million Americans had used these programs. Although DDM programs lower drug costs for many patients, DDM formularies include potentially ineffective or harmful medications, have the potential to influence physician prescribing behavior, and may impair pharmacists' ability to review complete drug-dispensing records. DDMs are widespread but have the potential for unintended consequences on patients, providers, and the health care system. A systematic review of DDMs needs to evaluate the clinical, economic, and system-level implications of such programs.

  14. The new Medical College Admission Test: Implications for teaching psychology.

    Science.gov (United States)

    Mitchell, Karen; Lewis, Richard S; Satterfield, Jason; Hong, Barry A

    2016-01-01

    This year's applicants to medical school took a newly revised version of the Medical College Admission Test. Unlike applicants in the past, they were asked to demonstrate their knowledge and use of concepts commonly taught in introductory psychology courses. The new Psychological, Social, and Biological Foundations of Behavior Test asked applicants to demonstrate the ways in which psychological, social, and biological factors influence perceptions and reactions to the world; behavior and behavior change; what people think about themselves and others; the cultural and social differences that influence well-being; and the relationships among social stratification, access to resources, and well-being. Building from the classic biopsychosocial model, this article provides the rationale for testing psychology concepts in application to medical school. It describes the concepts and skills that the new exam tests and shows how they lay the foundation for learning in medical school about the behavioral and sociocultural determinants of health. This article discusses the implications of these changes for undergraduate psychology faculty and psychology curricula as well as their importance to the profession of psychology at large. (c) 2016 APA, all rights reserved).

  15. Significance of genetic predisposition and genomic instability for individual sensitivity to radiation. Implications for radiation protection

    International Nuclear Information System (INIS)

    Heller, H.

    2001-01-01

    At its closed-door meeting on 20/21 January 2000 the Radiation Protection Committee dedicated much of its attention to the significance of genetic predisposition and genetic instability for individual radiation sensitivity and to the implication of this for radiation protection. The statements and contributions to the closing plenary discussion touched on many aspects of ethics, personal rights, occupational medicine and insurance issues relating to this subject, all of which extend far beyond the purely technical issues of radiation protection. The present volume contains the lecture manuscripts of the meeting as well as a summarising assessment by the Radiation Protection Committee [de

  16. A shift from significance test to hypothesis test through power analysis in medical research.

    Science.gov (United States)

    Singh, G

    2006-01-01

    Medical research literature until recently, exhibited substantial dominance of the Fisher's significance test approach of statistical inference concentrating more on probability of type I error over Neyman-Pearson's hypothesis test considering both probability of type I and II error. Fisher's approach dichotomises results into significant or not significant results with a P value. The Neyman-Pearson's approach talks of acceptance or rejection of null hypothesis. Based on the same theory these two approaches deal with same objective and conclude in their own way. The advancement in computing techniques and availability of statistical software have resulted in increasing application of power calculations in medical research and thereby reporting the result of significance tests in the light of power of the test also. Significance test approach, when it incorporates power analysis contains the essence of hypothesis test approach. It may be safely argued that rising application of power analysis in medical research may have initiated a shift from Fisher's significance test to Neyman-Pearson's hypothesis test procedure.

  17. A shift from significance test to hypothesis test through power analysis in medical research

    Directory of Open Access Journals (Sweden)

    Singh Girish

    2006-01-01

    Full Text Available Medical research literature until recently, exhibited substantial dominance of the Fisher′s significance test approach of statistical inference concentrating more on probability of type I error over Neyman-Pearson′s hypothesis test considering both probability of type I and II error. Fisher′s approach dichotomises results into significant or not significant results with a P value. The Neyman-Pearson′s approach talks of acceptance or rejection of null hypothesis. Based on the same theory these two approaches deal with same objective and conclude in their own way. The advancement in computing techniques and availability of statistical software have resulted in increasing application of power calculations in medical research and thereby reporting the result of significance tests in the light of power of the test also. Significance test approach, when it incorporates power analysis contains the essence of hypothesis test approach. It may be safely argued that rising application of power analysis in medical research may have initiated a shift from Fisher′s significance test to Neyman-Pearson′s hypothesis test procedure.

  18. New medical diagnoses and length of stay of acutely unwell older patients: Implications for funding models.

    Science.gov (United States)

    Basic, David; Khoo, Angela

    2015-09-01

    To examine the relationship between newly made medical diagnoses and length of stay (LOS) of acutely unwell older patients. Consecutive patients admitted under the care of four geriatricians were randomly allocated to a model development sample (n = 937) or a model validation sample (n = 855). Cox regression was used to model LOS. Variables considered for inclusion in the development model were established risk factors for LOS and univariate predictors from our dataset. Variables selected in the development sample were tested in the validation sample. A median of five new medical diagnoses were made during a median LOS of 10 days. New diagnoses predicted an increased LOS (hazard ratio 0.90, 95% confidence interval 0.88-0.92). Other significant predictors of increased LOS in both samples were malnutrition and frailty. Identification of new medical diagnoses may have implications for Diagnosis Related Groups-based funding models and may improve the care of older people. © 2015 AJA Inc.

  19. Predictors of leadership styles of medical students: implications for medical education.

    Science.gov (United States)

    Sriratanaban, J; Chiravisit, M; Viputsiri, O

    1999-09-01

    Providing effective health care services for a population involves a great deal of team-work among health care workers and leadership of physicians. The primary purpose of this study was to assess the leadership styles of medical students, and to explore factors that may be associated with them. Leadership questionnaires were used to assess leadership styles of 97 sixth-year medical students of the 1995 class at Chulalongkorn University attending the community medicine III program which was designed to introduce basic knowledge and skills in health care management. The baseline leadership styles of the students were more people-oriented than task-oriented. Multivariate analyses revealed that administrative experiences from extracurricular activities and perceived importance of a health administration course were significantly associated with leadership styles. Medical students should be encouraged to participate in extracurricular activities during their medical studies, taking leader positions, in order to develop an optimal leadership style to be effective health team leaders.

  20. Abdominal macrochaetae of female Hylesia oratex Dyar, 1913 (Insecta: Lepidoptera: Saturniidae: external morphology and medical significance

    Directory of Open Access Journals (Sweden)

    ROSÂNGELA BRITO

    2015-09-01

    Full Text Available The representatives of the genus Hylesia Hübner, [1820] are significant among the medically important Lepidoptera. Adult females use abdominal setae to wrap and protect the eggs that remain for months in nature. These setae, in contact with human skin, may cause allergic reactions including swelling, itching and local erythema, known as lepidopterism. The morphology of the abdominal scales and setae from the female H. oratex Dyar, 1913 is herein described and aspects related to their medical significance are discussed. Portions of each abdominal segment were examined through a scanning electron microscope. Two types of scales without medical importance, and two types of setae with medical importance, classified as "true setae" and "modified setae" were found. The true setae, which are slightly fusiform and have radially arranged lateral projections, are responsible for the allergic reactions caused by skin penetration. The modified setae, which are larger, curved, with the median enlarged and serrated margins, can be responsible for the release of chemical substances. This information provides a better understanding of the structure of the urticating setae, which are responsible for lepidopterism outbreaks in humans, and contributes towards the identification of the moth species involved.

  1. Exploring the implications of the influence of organisational culture on work-life balance practices: evidence from Nigerian medical doctors

    OpenAIRE

    Adisa, Toyin Ajibade; Modi, Chima; Osabutey, Ellis L. C.

    2017-01-01

    Purpose - Whilst significant evidence of western work-life balance (WLB) challenges exists, studies that explore Sub-Saharan Africa (SSA) are scarce. This article explores how organisational culture in Nigerian medical organisations influences doctors’ WLB and examines the implications of supportive and unsupportive cultures on doctors’ WLB. \\ud \\ud Methodology - The paper uses qualitative data gleaned from semi-structured interviews of 60 medical doctors across the six geo-political zones of...

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

    Science.gov (United States)

    Engels, Paul T; de Gara, Chris

    2010-06-30

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

  3. The medical implications of nuclear power plant accidents

    International Nuclear Information System (INIS)

    Tyror, J.G.; Pearson, G.W.

    1989-11-01

    This paper examines the UK position regarding the potential for an accident at a nuclear power plant, the safeguards in place to prevent such an accident occurring and the emergency procedures designed to cope with the consequences should one occur. It focuses on the role of the medical services and examines previous accidents to suggest the nature and likely scale of response that may need to be provided. It is apparent that designs of UK nuclear power stations are robust and that the likelihood of a significant accident occurring is extremely remote. Emergency arrangements are, however, in place to deal with the eventuality should it arise and these incorporate sufficient flexibility to accommodate a wide range of accidents. Analysis of previous nuclear accidents at Windscale, Three Mile Island and Chernobyl provide a limited but valuable insight into the diversity and potential scale of response that may be required. It is concluded that above all, the response must be flexible to enable medical services to deal with the wide range of effects that may arise. (author)

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

    Directory of Open Access Journals (Sweden)

    de Gara Chris

    2010-06-01

    Full Text Available Abstract Background Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn. Methods The Kolb Learning Style Inventory, which divides individual learning styles into Accommodating, Diverging, Converging, and Assimilating categories, was administered to the second year undergraduate medical students, general surgery resident body, and general surgery faculty at the University of Alberta. Results A total of 241 faculty, residents, and students were surveyed with an overall response rate of 73%. The predominant learning style of the medical students was assimilating and this was statistically significant (p Conclusions We conclude that medical students have a significantly different learning style from general surgical trainees and general surgeons. This has important implications in the education of general surgery residents.

  5. Visual presentation of a medical physiology seminar modifies dental students' perception of its clinical significance.

    Science.gov (United States)

    Vuletic, L; Spalj, S; Peros, K

    2016-02-01

    The primary objective of this study was to assess whether exposing dental students to visual stimuli related to dental profession during the medical physiology seminar could affect their perception of the clinical relevance of the topic. A self-administered questionnaire on attitudes towards medical physiology was conducted amongst 105 students of the School of Dental Medicine in Zagreb, Croatia, aged 19-24 years (80% females) following a seminar on respiratory system physiology. Power-point presentation accompanying the seminar for a total of 52 students (study group) was enriched with pictures related to dental practice in order to assess whether these pictures could make the topic appear more clinically relevant for a future dentist. The results of the survey indicated that dental students in the study group perceived the topic of the seminar as more important for them as future dentists when compared to the perception of the control group (P = 0.025). The results of this survey encourage physiology lecturers to present medical physiology as clinically relevant for dental students whenever possible as this could increase students' interest in the subject and their motivation for learning. Such an approach could be particularly beneficial if there is a significant time gap between basic courses and involvement of students into clinical training for it could promote meaningful learning. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Significance of gender in the attitude towards doctor-patient communication in medical students and physicians.

    Science.gov (United States)

    Löffler-Stastka, Henriette; Seitz, Tamara; Billeth, Sabrina; Pastner, Barbara; Preusche, Ingrid; Seidman, Charles

    2016-09-01

    Gender-specific differences in the attitudes towards doctor-patient communication among medical students and physicians were assessed. A total of 150 medical students and 51 physicians from different departments took part in the study. The association, attitude and experiences regarding doctor-patient communication were assessed with a series of tools and questionnaires. Female doctors and students tended to describe the doctor-patient communication with positive attributes, such as "helpful", "sentimental", "voluble", "sociable", "gentle", "yielding" and "peaceful". Male students and physicians, on the other hand, described doctor-patient communication as "overbearing", "robust" and "inhibited". The most frequent associations females had with the term doctor-patient communication were "empathy", "confidence", "openess", while the most frequent association of the male colleagues was "medical history". Female doctors reported speaking about the psychosocial situation of the patient significantly more often and believed in higher patient satisfaction by sharing more information. Furthermore, they reported having longer conversations with a more equal partnership than their male colleagues. Compared to male students, female students were willing to take part in training their communication skills more often and had more interest in research about doctor-patient communication. Male medical students reported self-doubt during conversations with female patients, while one third of the male physicians talked about "the power over the patient". This study indicates a gender-dependent communication style influenced by stereotypes. At the establishment of communication training these differences should be taken into account, especially to strengthen male communication skills and improve their attitudes.

  7. Significance of experts' overall ratings for medical student competence in relation to history-taking

    Directory of Open Access Journals (Sweden)

    Luiz Ernesto de Almeida Troncon

    Full Text Available CONTEXT AND OBJECTIVE: Overall ratings (ORs of competence, given by expert physicians, are increasingly used in clinical skills assessments. Nevertheless, the influence of specific components of competence on ORs is incompletely understood. The aim here was to investigate whether ORs for medical student history-taking competence are influenced by performance relating to communication skills, completeness of questioning and asking contentdriven key questions. DESIGN AND SETTING: Descriptive, quantitative study at Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. METHODS: Thirty-six medical students were examined in a 15-station high-stake objective structured clinical examination (OSCE. At four stations devoted to history-taking, examiners filled out checklists covering the components investigated and independently rated students’ overall performance using a five-point scale from 1 (poor to 5 (excellent. Physician ratings were aggregated for each student. Nonparametric correlations were made between ORs. RESULTS: ORs presented significant correlations with checklist scores (Spearman’s rs = 0.38; p = 0.02 and OSCE general results (rs = 0.52; p < 0.001. Scores for "communication skills" tended to correlate with ORs (rs = 0.31, but without reaching significance (p = 0.06. Neither the scores for "completeness" (rs = 0.26; p = 0.11 nor those for "asking key questions" (rs = 0.07; p = 0.60 correlated with ORs. CONCLUSIONS: Experts’ overall ratings for medical student competence regarding history-taking is likely to encompass a particular dimension, since ratings were only weakly influenced by specific components of performance.

  8. Psychotropics without borders: ethics and legal implications of internet-based access to psychiatric medications.

    Science.gov (United States)

    Klein, Carolina A

    2011-01-01

    Medical practitioners are revisiting many of the ethics and the legal implications surrounding the clinical frameworks within which we operate. In today's world, distinguishing between virtual and physical reality continues to be increasingly difficult. The physician may be found grappling with the decision of whether to continue to treat a patient who may be obtaining psychotropic medications through the Internet. This article approaches some of the clinical and legal implications and the ethics regarding the availability of prescription psychotropics over the Internet.

  9. [Significant increase in the colonisation of Staphylococcus aureus among medical students during their hospital practices].

    Science.gov (United States)

    Rodríguez-Avial, Carmen; Alvarez-Novoa, Andrea; Losa, Azucena; Picazo, Juan J

    2013-10-01

    Staphylococcus aureus is a pathogen of major concern. The emergence of methicillin-resistant S. aureus (MRSA) has increasingly complicated the therapeutic approach of hospital-acquired infections. Surveillance of MRSA and control measures must be implemented in different healthcare settings, including screening programs for carriers. Our first aim was to determine the prevalence of methicillin-susceptible S. aureus (MSSA) and MRSA nasal carriage in medical students from the Clínico San Carlos Hospital (Madrid). As the MRSA carrier rate in healthcare workers is higher than in the general population, we hypothesised that carrier rate could be increased during their clinical practice in their last three years. We performed an epidemiologic al study of the prevalence of S. aureus colonisation among a group of medical students, who were sampled in 2008 in their third-year, and in 2012 when this class was in its sixth year. We have found a significant increase in MSSA carriage, from 27% to 46%. There were no MRSA colonisations in the third-year, but one was found in the sixth-year group. The large majority of strains (89%) of strains were resistant to penicillin, and 27% to erythromycin and clindamycin. As 19 coagulase-negative Staphylococcus MR were also identified, a horizontal transfer of genes, such as mecA gene to S. aureus, could have occurred. Medical students are both, at risk for acquiring, and a potential source of nosocomial pathogens, mainly MSSA. Therefore, they should take special care for hygienic precautions, such as frequent and proper hand washing, while working in the hospital. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  10. Medical Tourism and Its Implication on Malaysia's Economic Growth

    OpenAIRE

    Tang, Chor Foon

    2015-01-01

    Policymakers in the developed and developing countries already heading toward medical tourism to stimulate economic growth. Nonetheless, the actual impact of medical tourism on economic growth remains ambiguous. Although medical tourism may spur economic growth via its impact on foreign currency earnings, investments, tax revenue, and employment opportunities, it may also leave numerous negative externalities that either direct or indirectly harmful the process of economic growth. Undeniably,...

  11. Lithium battery fires: implications for air medical transport.

    Science.gov (United States)

    Thomas, Frank; Mills, Gordon; Howe, Robert; Zobell, Jim

    2012-01-01

    Lithium-ion batteries provide more power and longer life to electronic medical devices, with the benefits of reduced size and weight. It is no wonder medical device manufacturers are designing these batteries into their products. Lithium batteries are found in cell phones, electronic tablets, computers, and portable medical devices such as ventilators, intravenous pumps, pacemakers, incubators, and ventricular assist devices. Yet, if improperly handled, lithium batteries can pose a serious fire threat to air medical transport personnel. Specifically, this article discusses how lithium-ion batteries work, the fire danger associated with them, preventive measures to reduce the likelihood of a lithium battery fire, and emergency procedures that should be performed in that event. Copyright © 2012 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

  12. Radiation poisoning with Po-210 in London: The medical implications

    International Nuclear Information System (INIS)

    Perkins, A.C.

    2007-01-01

    Full text: The death of Alexander Litvinenko on 23 November 2006 has elevated the prospect of a deliberate radiation poisoning from a theoretical possibility to a reality. This was an unprecedented event in the UK. Poison that was certainly not the work of an amateur assassin was found, and it is possible that there have been previous killings of this nature outside the UK. Po-210 is a highly toxic radioactive heavy metal with a half-life of 138 days that decays, giving off 5.3MeV alpha particles having a range of 40-50mm in tissue. The poison was probably administered in a small volume of liquid or as a solid powder added to food or drink. Dispersal of the material resulted in widespread contamination that was detected across London and on British Airways' flights to the east. Following the event, the main task of the UK Health Protection Agency was of contamination monitoring and reassurance of the general public. With many researchers now investigating the use of targeted alpha therapy, this incident has highlighted the possible effects from the uptake of alpha emitters into the sensitive normal tissues. On reaching the bloodstream, Po- 210 is rapidly deposited in major organs and tissues including the liver, kidneys and bone marrow. The intense alpha radiation within these tissues would result in massive destruction of cells, leading to a rapid decline in health. It has been concluded that ingestion of 1-3 GBq or greater of Po-210 is likely to result in death within a few weeks, assuming there is 10% absorption to blood. Anyone receiving such doses would show symptoms of acute radiation sickness syndrome, with death resulting from multiple organ failure. Remedial medical treatment strategies would be unsuccessful within a few hours of ingestion, once significant amounts of Po-210 had entered the blood stream and deposited in tissues. The surreptitious nature of this act almost escaped detection. The fact that the nature of the poison was not known until the

  13. Medical professionalism on television: student perceptions and pedagogical implications.

    Science.gov (United States)

    Weaver, Roslyn; Wilson, Ian; Langendyk, Vicki

    2014-11-01

    Previous research has pointed to the role television can play in informing health practices and beliefs. Within the academic setting in particular, some educators have raised concerns about the influence of medical dramas on students. Less research, however, draws on the perspectives of students, and this study therefore explores medical students' perceptions of medical practice and professionalism in popular medical television programmes. Qualitative data from surveys of Australian undergraduate medical students showed that students perceived professionalism in dichotomous ways, with three main themes: cure-care, where a doctor's skill is either technical or interpersonal; work-leisure, where a doctor is either dedicated to work or personal life; and clinical-administration, where work is either direct patient care or administration. There continue to be imagined divisions between curing and caring for students, who express concerns about balancing work and leisure, and expectations that doctors should have little administrative work. Given students were able to identify these important contemporary issues around professionalism on television, there is pedagogical value in using popular images of the medical world in medical education. © The Author(s) 2014.

  14. Medication adherence monitoring: implications for patients and providers.

    Science.gov (United States)

    Gheorghiu, Bobby; Nayani, Seema

    2018-05-01

    Non-adherence to medication is a key worldwide issue and can lead to adverse patient outcomes and increased health system costs. Would a process facilitating notification of non-adherence infringe upon the autonomy of individuals or breach expectations of privacy? In contrast, patients who are not taking their medication could unknowingly be putting themselves at risk and all the while prescribers are unaware and without the opportunity to intervene. With the advent of electronic methods of medication adherence monitoring, this ethical dilemma now involves a new layer of complexity. We present two scenarios encountered in clinical practice that reflect issues occurring regularly in the Canadian healthcare system.

  15. Medical implication in the Bible and its relevance to modern medicine.

    Science.gov (United States)

    Sun, Jun-Fang

    2013-11-01

    The Holy Bible, as the root of Western civilization, has imposed great influence in the fields far beyond religion. In this thesis, the author intended to reveal the medical implication in the Holy Bible and its relevance to the modern medical science by exploring the biblical medical information and comparing it with the current medical theory and practice. The conclusion of the exploration is surprising yet inspiring: the Holy Bible, as an ancient religious book, contains rich medical information around themes such as sexual relations, dietary guidelines, hygiene, etc., which is not at odds, but in harmony with the modern medicine.

  16. Experiences from tsunami relief activity: implications for medical education.

    Science.gov (United States)

    Balasubramaniam, Sudharsanam Manni; Mohan, Yogesh; Roy, Gautam

    2012-01-01

    A tsunami struck the coast of Tamilnadu and Pondicherry on 26 December 2004. Jawaharlal Institute of Postgraduate Medical Education & Research, (JIPMER) in Pondicherry played a vital role in providing medical relief. The experiences from the relief activities revealed areas of deficiency in medical education in regards to disaster preparedness. A qualitative study using focus group discussion was employed to find the lacunae in skills in managing medical relief measures. Many skills were identified; the most important of which was addressing the psychological impact of the tsunami on the victims. Limited coordination and leadership skills were also identified. It is recommended that activity-based learning can be included in the curriculum to improve these skills.

  17. Hydrophilic Polymer Embolism: Implications for Manufacturing, Regulation, and Postmarket Surveillance of Coated Intravascular Medical Devices.

    Science.gov (United States)

    Mehta, Rashi I; Mehta, Rupal I

    2018-03-19

    Hydrophilic polymers are ubiquitously applied as surface coatings on catheters and intravascular medical technologies. Recent clinical literature has heightened awareness on the complication of hydrophilic polymer embolism, the phenomenon wherein polymer coating layers separate from catheter and device surfaces, and may be affiliated with a range of unanticipated adverse reactions. Significant system barriers have limited and delayed reporting on this iatrogenic complication, the full effects of which remain underrecognized by healthcare providers and manufacturers of various branded devices. In 2015, the United States Food and Drug Administration acknowledged rising clinical concerns and stated that the agency would work with stakeholders to further evaluate gaps that exist in current national and international device standards for coated intravascular medical technologies. The present article reviews current knowledge on this complication as well as factors that played a role in delaying detection and dissemination of information and new knowledge once hazards and clinical risks were identified. Furthermore, organ-specific effects and adverse reaction patterns are summarized, along with implications for device manufacturing, safety assurance, and regulation. Qualitative and quantitative particulate testing are needed to optimize coated intravascular device technologies. Moreover, general enhanced processes for medical device surveillance are required for timely adverse event management and to ensure patient safety.

  18. What are the implications of implementation science for medical education?

    Directory of Open Access Journals (Sweden)

    David W. Price

    2015-04-01

    Full Text Available Background: Derived from multiple disciplines and established in industries outside of medicine, Implementation Science (IS seeks to move evidence-based approaches into widespread use to enable improved outcomes to be realized as quickly as possible by as many as possible. Methods: This review highlights selected IS theories and models, chosen based on the experience of the authors, that could be used to plan and deliver medical education activities to help learners better implement and sustain new knowledge and skills in their work settings. Results: IS models, theories and approaches can help medical educators promote and determine their success in achieving desired learner outcomes. We discuss the importance of incorporating IS into the training of individuals, teams, and organizations, and employing IS across the medical education continuum. Challenges and specific strategies for the application of IS in educational settings are also discussed. Conclusions: Utilizing IS in medical education can help us better achieve changes in competence, performance, and patient outcomes. IS should be incorporated into curricula across disciplines and across the continuum of medical education to facilitate implementation of learning. Educators should start by selecting, applying, and evaluating the teaching and patient care impact one or two IS strategies in their work.

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

    Science.gov (United States)

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

    2018-02-01

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

  20. [THE SIGNIFICANCE OF THE LEGAL PERSPECTIVE - THE LEGAL WORLD'S CONTRIBUTION TO THE MEDICAL WORLD].

    Science.gov (United States)

    Sigler-Harcavi, Alona; Cohen Ashkenazi, Limor

    2018-04-01

    Working with medical and paramedical teams has taught us that the medical staff does not fully utilize the potential of judicial decisions and precedents as a source for learning, drawing conclusions and motivating progress. Judicial ruling is an essential part of the toolbox used by medical administrators in general, and healthcare risk managers in particular. Knowing the relevant legal rulings, before you embark on any given path, is the equivalent of looking before you leap. This is not necessarily an issue of "holy scripture", but should mainly be considered as a source for expanding your perspective. Knowledge of the relevant rulings has many advantages that stem from the unique characteristics of the legal system. While the medical world has a clear and unequivocal advantage regarding knowledge and experience with respect to medicine, the legal world has various other advantages: a different and wider perspective with respect to economic and/or political considerations; universal fundamental principles, such as autonomy, equality, distributive justice, human dignity, the state's obligations to its citizens; complex systems of checks and balances, such as: desirable vs. available, the benefit of few vs. the good of the many, etc. These tools, typical of the legal world, are especially relevant to medicolegal issues, usually associated with medical administration, such as: the obligation of consultation, obligation of follow-up, treatment continuity, priorities, resource distribution, patient rights, etc. The contribution of the legal world to these issues is both unique and essential. Those who question the ability of judges to understand the medical world and to materially contribute to medical thinking and practice, claiming that they lack medical training and experience, should recognize the diverse contribution of the legal world to the medical world.

  1. The London polonium poisoning: Events and medical implications

    International Nuclear Information System (INIS)

    Perkins, A.C.

    2007-01-01

    The poisoning of Alexander Litvinenko on 23 November 2006 was an unprecedented event. Po-210 is a highly toxic radioactive heavy metal with a physical half-life of 138 days. Dispersal of the material by the perpetrators and the victim resulted in widespread contamination that led to a trail across London and abroad. This resulted in a massive operation for health protection staff and the police service. The surreptitious nature of this act almost escaped detection. The fact that the nature of the poison was not known for a number of weeks after admission to hospital indicates the difficulty in detecting alpha radiation. In this article, the sequence of events, the nature and uses of this radioactive element and the medical consequences of ingestion are outlined. The illicit use of radioactive materials raises important health and security issues. Medical and scientific staff in nuclear medicine and hospital emergency departments should be aware of these issues. (author)

  2. [Cultural diversity and stereotyping: implication for the medical practice].

    Science.gov (United States)

    Durieux-Paillard, S; Loutan, L

    2005-09-28

    Increasing number of migrants worldwide brings doctors to treat patients of various origins. Patients' diversity enriches health professionals but also induces a risk of mutual incomprehension, due to cultural and language barriers. Multicultural context stimulates unwittingly stereotyping, based on a simplistic assessment of the patient's culture. Stereotyping is also influenced by the political and media coverage. Studies underscored that universally, minorities patients have an unequal access to health care in host countries. Health professionals should be aware that racial stereotyping exists in medical practice: it is a first step to bridge cultural gap between them and their patients.

  3. Learning styles of medical students - implications in education.

    Science.gov (United States)

    Buşan, Alina-Mihaela

    2014-01-01

    The term "learning style" refers to the fact that each person has a different way of accumulating knowledge. While some prefer listening to learn better, others need to write or they only need to read the text or see a picture to later remember. According to Fleming and Mills the learning styles can be classified in Visual, Auditory and Kinesthetic. There is no evidence that teaching according to the learning style can help a person, yet this cannot be ignored. In this study, a number of 230 medical students were questioned in order to determine their learning style. We determined that 73% of the students prefer one learning style, 22% prefer to learn using equally two learning style, while the rest prefer three learning styles. According to this study the distribution of the learning styles is as following: 33% visual, 26% auditory, 14% kinesthetic, 12% visual and auditory styles equally, 6% visual and kinesthetic, 4% auditory and kinesthetic and 5% all three styles. 32 % of the students that participated at this study are from UMF Craiova, 32% from UMF Carol Davila, 11% University of Medicine T Popa, Iasi, 9% UMF Cluj Iulius Hatieganu. The way medical students learn is different from the general population. This is why it is important when teaching to considerate how the students learn in order to facilitate the learning.

  4. A history of medical student debt: observations and implications for the future of medical education.

    Science.gov (United States)

    Greysen, S Ryan; Chen, Candice; Mullan, Fitzhugh

    2011-07-01

    Over the last 50 years, medical student debt has become a problem of national importance, and obtaining medical education in the United States has become a loan-dependent, individual investment. Although this phenomenon must be understood in the general context of U.S. higher education as well as economic and social trends in late-20th-century America, the historical problem of medical student debt requires specific attention for several reasons. First, current mechanisms for students' educational financing may not withstand debt levels above a certain ceiling which is rapidly approaching. Second, there are no standards for costs of medical school attendance, and these can vary dramatically between different schools even within a single city. Third, there is no consensus on the true cost of educating a medical student, which limits accountability to students and society for these costs. Fourth, policy efforts to improve physician workforce diversity and mitigate shortages in the primary care workforce are inhibited by rising levels of medical student indebtedness. Fortunately, the current effort to expand the U.S. physician workforce presents a unique opportunity to confront the unsustainable growth of medical student debt and explore new approaches to the financing of medical students' education.

  5. An industry perspective on Canadian patients' involvement in Medical Tourism: implications for public health

    Science.gov (United States)

    2011-01-01

    Background The medical tourism industry, which assists patients with accessing non-emergency medical care abroad, has grown rapidly in recent years. A lack of reliable data about medical tourism makes it difficult to create policy, health system, and public health responses to address the associated risks and shortcomings, such as spread of infectious diseases, associated with this industry. This article addresses this knowledge gap by analyzing interviews conducted with Canadian medical tourism facilitators in order to understand Canadian patients' involvement in medical tourism and the implications of this involvement for public health. Methods Semi-structured phone interviews were conducted with 12 medical facilitators from 10 companies in 2010. An exhaustive recruitment strategy was used to identify interviewees. Questions focused on business dimensions, information exchange, medical tourists' decision-making, and facilitators' roles in medical tourism. Thematic analysis was undertaken following data collection. Results Facilitators helped their Canadian clients travel to 11 different countries. Estimates of the number of clients sent abroad annually varied due to demand factors. Facilitators commonly worked with medical tourists aged between 40 and 60 from a variety of socio-economic backgrounds who faced a number of potential barriers including affordability, fear of the unfamiliar, and lack of confidence. Medical tourists who chose not to use facilitators' services were thought to be interested in saving money or have cultural/familial connections to the destination country. Canadian doctors were commonly identified as barriers to securing clients. Conclusions No effective Canadian public health response to medical tourism can treat medical tourists as a unified group with similar motivations for engaging in medical tourism and choosing similar mechanisms for doing so. This situation may be echoed in other countries with patients seeking care abroad

  6. An industry perspective on Canadian patients' involvement in Medical Tourism: implications for public health

    Directory of Open Access Journals (Sweden)

    Snyder Jeremy

    2011-05-01

    Full Text Available Abstract Background The medical tourism industry, which assists patients with accessing non-emergency medical care abroad, has grown rapidly in recent years. A lack of reliable data about medical tourism makes it difficult to create policy, health system, and public health responses to address the associated risks and shortcomings, such as spread of infectious diseases, associated with this industry. This article addresses this knowledge gap by analyzing interviews conducted with Canadian medical tourism facilitators in order to understand Canadian patients' involvement in medical tourism and the implications of this involvement for public health. Methods Semi-structured phone interviews were conducted with 12 medical facilitators from 10 companies in 2010. An exhaustive recruitment strategy was used to identify interviewees. Questions focused on business dimensions, information exchange, medical tourists' decision-making, and facilitators' roles in medical tourism. Thematic analysis was undertaken following data collection. Results Facilitators helped their Canadian clients travel to 11 different countries. Estimates of the number of clients sent abroad annually varied due to demand factors. Facilitators commonly worked with medical tourists aged between 40 and 60 from a variety of socio-economic backgrounds who faced a number of potential barriers including affordability, fear of the unfamiliar, and lack of confidence. Medical tourists who chose not to use facilitators' services were thought to be interested in saving money or have cultural/familial connections to the destination country. Canadian doctors were commonly identified as barriers to securing clients. Conclusions No effective Canadian public health response to medical tourism can treat medical tourists as a unified group with similar motivations for engaging in medical tourism and choosing similar mechanisms for doing so. This situation may be echoed in other countries with patients

  7. An industry perspective on Canadian patients' involvement in medical tourism: implications for public health.

    Science.gov (United States)

    Johnston, Rory; Crooks, Valorie A; Adams, Krystyna; Snyder, Jeremy; Kingsbury, Paul

    2011-05-31

    The medical tourism industry, which assists patients with accessing non-emergency medical care abroad, has grown rapidly in recent years. A lack of reliable data about medical tourism makes it difficult to create policy, health system, and public health responses to address the associated risks and shortcomings, such as spread of infectious diseases, associated with this industry. This article addresses this knowledge gap by analyzing interviews conducted with Canadian medical tourism facilitators in order to understand Canadian patients' involvement in medical tourism and the implications of this involvement for public health. Semi-structured phone interviews were conducted with 12 medical facilitators from 10 companies in 2010. An exhaustive recruitment strategy was used to identify interviewees. Questions focused on business dimensions, information exchange, medical tourists' decision-making, and facilitators' roles in medical tourism. Thematic analysis was undertaken following data collection. Facilitators helped their Canadian clients travel to 11 different countries. Estimates of the number of clients sent abroad annually varied due to demand factors. Facilitators commonly worked with medical tourists aged between 40 and 60 from a variety of socio-economic backgrounds who faced a number of potential barriers including affordability, fear of the unfamiliar, and lack of confidence. Medical tourists who chose not to use facilitators' services were thought to be interested in saving money or have cultural/familial connections to the destination country. Canadian doctors were commonly identified as barriers to securing clients. No effective Canadian public health response to medical tourism can treat medical tourists as a unified group with similar motivations for engaging in medical tourism and choosing similar mechanisms for doing so. This situation may be echoed in other countries with patients seeking care abroad. Therefore, a call for a comprehensive public

  8. Micrometastatic cancer cells in lymph nodes, bone marrow, and blood: Clinical significance and biologic implications.

    Science.gov (United States)

    Leong, Stanley P L; Tseng, William W

    2014-01-01

    Cancer metastasis may be regarded as a progressive process from its inception in the primary tumor microenvironment to distant sites by way of the lymphovascular system. Although this type of tumor dissemination often occurs in an orderly fashion via the sentinel lymph node (SLN), acting as a possible gateway to the regional lymph nodes, bone marrow, and peripheral blood and ultimately to distant metastatic sites, this is not a general rule as tumor cells may enter the blood and spread to distant sites, bypassing the SLN. Methods of detecting micrometastatic cancer cells in the SLN, bone marrow, and peripheral blood of patients have been established. Patients with cancer cells in their SLN, bone marrow, or peripheral blood have worse clinical outcomes than patients with no evidence of spread to these compartments. The presence of these cells also has important biologic implications for disease progression and the clinician's understanding of the process of cancer metastasis. Further characterization of these micrometastatic cancer cells at each stage and site of metastasis is needed to design novel selective therapies for a more "personalized" treatment. © 2014 American Cancer Society, Inc.

  9. Tacit knowledge and visual expertise in medical diagnostic reasoning: implications for medical education

    DEFF Research Database (Denmark)

    Heiberg Engel, Peter Johan

    2008-01-01

    BACKGROUND: Much education--especially at the university level--has been criticized for having primarily dealt with explicit knowledge, i.e. those aspects of mental activities, which are verbal and conscious. Furthermore, research in medical diagnostic reasoning has been criticized for having...... focused on the specialty of intern medicine, while specialties with other skills, i.e. perceptive skills within pathology and radiology, have been ignored. AIMS: To show that the concept of tacit knowledge is important in medical education-at all levels and in medical diagnostic reasoning. METHODS...... such as "non-analytical reasoning" and "dual process of reasoning." CONCLUSION: It is important that educators are trained in how explicit and implicit knowledge is attained and that tacit knowledge is included in educational programmes of all medical specialties....

  10. Ethical implications of medical crowdfunding: the case of Charlie Gard.

    Science.gov (United States)

    Dressler, Gabrielle; Kelly, Sarah A

    2018-05-04

    Patients are increasingly turning to medical crowdfunding as a way to cover their healthcare costs. In the case of Charlie Gard, an infant born with encephalomyopathic mitochondrial DNA depletion syndrome, crowdfunding was used to finance experimental nucleoside therapy. Although this treatment was not provided in the end, we will argue that the success of the Gard family's crowdfunding campaign reveals a number of potential ethical concerns. First, this case shows that crowdfunding can change the way in which communal healthcare resources are allocated. Second, within the UK's National Health Service, healthcare is ostensibly not a market resource; thus, permitting crowdfunding introduces market norms that could commodify healthcare. Third, pressures inherent to receiving funds from external parties may threaten the ability of patients-cum-recipients to voluntarily consent to treatment. We conclude that while crowdfunding itself is not unethical, its use can have unforeseen consequences that may influence conceptions of healthcare and how it is delivered. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Placental transfer of antidepressant medications: implications for postnatal adaptation syndrome.

    Science.gov (United States)

    Ewing, Grace; Tatarchuk, Yekaterina; Appleby, Dina; Schwartz, Nadav; Kim, Deborah

    2015-04-01

    Seven to thirteen percent of women are either prescribed or taking (depending on the study) an antidepressant during pregnancy. Because antidepressants freely cross into the intrauterine environment, we aim to summarize the current findings on placental transfer of antidepressants. Although generally low risk, antidepressants have been associated with postnatal adaptation syndrome (PNAS). Specifically, we explore whether the antidepressants most closely associated with PNAS (paroxetine, fluoxetine, venlafaxine) cross the placenta to a greater extent than other antidepressants. We review research on antidepressants in the context of placental anatomy, placental transport mechanisms, placental metabolism, pharmacokinetics, as well as non-placental maternal and fetal factors. This provides insight into the complexity involved in understanding how placental transfer of antidepressants may relate to adverse perinatal outcomes. Ultimately, from this data there is no pattern in which PNAS is related to placental transfer of antidepressant medications. In general, there is large interindividual variability for each type of antidepressant. To make the most clinically informed decisions about the use of antidepressants in pregnancy, studies that link maternal, placental and fetal genetic polymorphisms, placental transfer rates and infant outcomes are needed.

  12. The current state of basic medical education in Israel: implications for a new medical school.

    Science.gov (United States)

    Reis, Shmuel; Borkan, Jeffrey M; Weingarten, Michael

    2009-11-01

    The recent government decision to establish a new medical school, the fifth in Israel, is an opportune moment to reflect on the state of Basic Medical Education (BME) in the country and globally. It provides a rare opportunity for planning an educational agenda tailored to local needs. This article moves from a description of the context of Israeli health care and the medical education system to a short overview of two existing Israeli medical schools where reforms have recently taken place. This is followed by an assessment of Israeli BME and an effort to use the insights from this assessment to inform the fifth medical school blueprint. The fifth medical school presents an opportunity for further curricular reforms and educational innovations. Reforms and innovations include: fostering self-directed professional development methods; emphasis on teaching in the community; use of appropriate educational technology; an emphasis on patient safety and simulation training; promoting the humanities in medicine; and finally the accountability to the community that the graduates will serve.

  13. Tacit knowledge and visual expertise in medical diagnostic reasoning: implications for medical education.

    Science.gov (United States)

    Heiberg Engel, Peter Johan

    2008-01-01

    Much education--especially at the university level--has been criticized for having primarily dealt with explicit knowledge, i.e. those aspects of mental activities, which are verbal and conscious. Furthermore, research in medical diagnostic reasoning has been criticized for having focused on the specialty of intern medicine, while specialties with other skills, i.e. perceptive skills within pathology and radiology, have been ignored. To show that the concept of tacit knowledge is important in medical education-at all levels and in medical diagnostic reasoning. Describing how tacit knowledge according to Michael Polany, is experienced and expressed in day-to-day life, it is shown that there is a tacit dimension to all knowledge. Reviewing recent literature on medical diagnostic reasoning, it is shown that tacit knowledge is recognized in connection with concepts such as "non-analytical reasoning" and "dual process of reasoning." It is important that educators are trained in how explicit and implicit knowledge is attained and that tacit knowledge is included in educational programmes of all medical specialties.

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

    Science.gov (United States)

    Cohen, I Glenn

    2017-05-01

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

  15. Continuing medical education revisited: theoretical assumptions and practical implications: a qualitative study.

    Science.gov (United States)

    Dionyssopoulos, Alexander; Karalis, Thanassis; Panitsides, Eugenia A

    2014-12-31

    Recent research has evidenced that although investment in Continuing Medical Education (CME), both in terms of participation as well as financial resources allocated to it, has been steadily increasing to catch up with accelerating advances in health information and technology, effectiveness of CME is reported to be rather limited. Poor and disproportional returns can be attributed to failure of CME courses to address and stimulate an adult audience. The present study initially drew on research findings and adult learning theories, providing the basis for comprehending adult learning, while entailing practical implications on fostering effectiveness in the design and delivery of CME. On a second level, a qualitative study was conducted with the aim to elucidate parameters accounting for effectiveness in educational interventions. Qualitative data was retrieved through 12 in-depth interviews, conducted with a random sample of participants in the 26th European Workshop of Advanced Plastic Surgery (EWAPS). The data underwent a three level qualitative analysis, following the "grounded theory" methodology, comprising 'open coding', 'axial coding' and 'selective coding'. Findings from the EWAPS study come in line with relevant literature, entailing significant implications for the necessity to apply a more effective and efficient paradigm in the design and delivery of educational interventions, advocating for implementing learner-centered schemata in CME and benefiting from a model that draws on the learning environment and social aspects of learning. What emerged as a pivotal parameter in designing educational interventions is to focus on small group educational events which could provide a supportive friendly context, enhance motivation through learner-centered approaches and allow interaction, experimentation and critical reflection. It should be outlined however that further research is required as the present study is limited in scope, having dealt with a limited

  16. Significance of Perceived Social Expectation and Implications to Conservation Education: Turtle Conservation as a Case Study

    Science.gov (United States)

    Lo, Alex Y.; Chow, Alex T.; Cheung, Sze Man

    2012-11-01

    The likelihood of participating in wildlife conservation programs is dependent on social influences and circumstances. This view is validated by a case study of behavioral intention to support conservation of Asian turtles. A total of 776 college students in China completed a questionnaire survey designed to identify factors associated with their intention to support conservation. A regression model explained 48 % of variance in the level of intention. Perceived social expectation was the strongest predictor, followed by attitudes toward turtle protection and perceived behavioral control, altogether explaining 44 %. Strong ethics and socio-economic variables had some statistical significant impacts and accounted for 3 % of the variance. The effects of general environmental awareness, trust and responsibility ascription were modest. Knowledge about turtles was a weak predictor. We conclude that perceived social expectation is a limiting factor of conservation behavior. Sustained interest and commitment to conservation can be created by enhancing positive social influences. Conservation educators should explore the potential of professionally supported, group-based actions that can nurture a sense of collective achievement as part of an educational campaign.

  17. Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia

    OpenAIRE

    Pocock, Nicola S; Phua, Kai Hong

    2011-01-01

    Abstract Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism's growth for health systems, draw...

  18. PATTERNS OF INTERNET USE AND THEIR IMPLICATIONS IN INDIAN MEDICAL STUDENTS: A STUDY FROM A SOUTH INDIAN MEDICAL COLLEGE

    Directory of Open Access Journals (Sweden)

    Ravi Kishore

    2016-05-01

    Full Text Available BACKGROUND Internet has become a platform for recent advances, innovative learning methods and self-assessment. Medical students spend significant time using Internet for academic and non-academic purposes. There is a dearth of clear evidence regarding patterns of internet use among Indian Medical students. An internet usage patterns study in First Year Medical students would help identify the necessity to train students in Internet access in the initial phase of Medical course. AIM To assess the Internet usage patterns in First Year Indian Medical Students. MATERIALS AND METHODS A cross-sectional study in which 132 students studying in First Year undergraduate medical course at MVJ Medical College and Research Hospital, Bangalore, a cosmopolitan city in South India, participated. Data related to internet use was captured using a pretested questionnaire. Statistical analysis was performed using Microsoft Excel version 2007. RESULTS 70% of students used internet for academic and non-academic purposes. Slow internet speed (31% and lack of time (23% were most common amongst impediments to internet use. Majority of students (57% used internet for greater than 7 hours per week. Understanding a topic better (62% seems to be most important motive for academic use of internet. 36% of students did not use any academic website. CONCLUSIONS First Year Indian Medical students spent significant amounts of time using internet for multiple purposes. There is a lack of awareness regarding academic websites and online animations among significant portion of students. Students in our study may be guided appropriately by Internet training sessions at the beginning of the Medical course to enable the best use of internet for academic purpose.

  19. Resurrecting an extinct salmon evolutionarily significant unit: archived scales, historical DNA and implications for restoration.

    Science.gov (United States)

    Iwamoto, Eric M; Myers, James M; Gustafson, Richard G

    2012-04-01

    Archival scales from 603 sockeye salmon (Oncorhynchus nerka), sampled from May to July 1924 in the lower Columbia River, were analysed for genetic variability at 12 microsatellite loci and compared to 17 present-day O. nerka populations-exhibiting either anadromous (sockeye salmon) or nonanadromous (kokanee) life histories-from throughout the Columbia River Basin, including areas upstream of impassable dams built subsequent to 1924. Statistical analyses identified four major genetic assemblages of sockeye salmon in the 1924 samples. Two of these putative historical groupings were found to be genetically similar to extant evolutionarily significant units (ESUs) in the Okanogan and Wenatchee Rivers (pairwise F(ST)  = 0.004 and 0.002, respectively), and assignment tests were able to allocate 77% of the fish in these two historical groupings to the contemporary Okanogan River and Lake Wenatchee ESUs. A third historical genetic grouping was most closely aligned with contemporary sockeye salmon in Redfish Lake, Idaho, although the association was less robust (pairwise F(ST)  = 0.060). However, a fourth genetic grouping did not appear to be related to any contemporary sockeye salmon or kokanee population, assigned poorly to the O. nerka baseline, and had distinctive early return migration timing, suggesting that this group represents a historical ESU originating in headwater lakes in British Columbia that was probably extirpated sometime after 1924. The lack of a contemporary O. nerka population possessing the genetic legacy of this extinct ESU indicates that efforts to reestablish early-migrating sockeye salmon to the headwater lakes region of the Columbia River will be difficult. © 2012 Blackwell Publishing Ltd.

  20. Stratigraphic units overlying the Zambales Ophiolite Complex (ZOC) in Luzon, (Philippines): Tectonostratigraphic significance and regional implications

    Science.gov (United States)

    Queaño, Karlo L.; Dimalanta, Carla B.; Yumul, Graciano P.; Marquez, Edanjarlo J.; Faustino-Eslava, Decibel V.; Suzuki, Shigeyuki; Ishida, Keisuke

    2017-07-01

    The Zambales Ophiolite Complex (ZOC) on the island of Luzon, Philippines is one of the most well-studied crust-mantle sequences in the region. Several massifs comprise the ZOC, one of which is the Coto Block overlain by clastic sedimentary units previously dated as Eocene. Geochronologic studies from diabase, granodiorites and other late-stage magmatic products similarly yielded the same age. Succeeding tectonic models have therefore all been grounded on the assumption that the entire ZOC is Eocene. Recent investigations, however, revealed the presence of chert blocks within the Early to Middle Miocene clastic formation overlying the Acoje Block in the northern part of the ophiolite complex. Radiolarians extracted from the cherts yielded a stratigraphic range that suggests a Late Jurassic to Early Cretaceous age. The recognition of a much older age than previously reported of the ZOC warrants a re-examination of its actual distribution and genesis. Correlating with other similarly-aged ophiolites, we suggest defining a western Mesozoic ophiolite belt, largely extending from the west-central portion of the archipelago to the northeastern tip of Luzon island. Tentatively, we attribute the Mesozoic ophiolitic and associated rocks in western Luzon to an arc-continent collision involving the Philippine Mobile Belt and the Palawan Microcontinental Block. In addition, differences in the clastic compositions of the Cenozoic sedimentary formations provide material not only for deciphering the ZOC's unroofing history but also for constraining the timing of province linkage. The intermittent appearance of lithic fragments and detrital minerals from the ophiolite in the units of the Middle Miocene Candelaria Limestone and the Late Miocene to Early Pliocene Sta. Cruz Formation indicates significant but geographically variable contributions from the ophiolite complex. In the northern Zambales Range, the Sta. Cruz Formation caps the Coto Block and the Acoje Block of the ZOC

  1. Visualizing the future: technology competency development in clinical medicine, and implications for medical education.

    Science.gov (United States)

    Srinivasan, Malathi; Keenan, Craig R; Yager, Joel

    2006-01-01

    In this article, the authors ask three questions. First, what will physicians need to know in order to be effective in the future? Second, what role will technology play in achieving that high level of effectiveness? Third, what specific skill sets will physicians need to master in order to become effective? Through three case vignettes describing past, present, and potential future medical practices, the authors identify trends in major medical, technological and cultural shifts that will shape medical education and practice. From these cases, the authors generate a series of technology-related competencies and skill sets that physicians will need to remain leaders in the delivery of medical care. Physicians will choose how they will be end-users of technology, technology developers, and/or the interface between users and developers. These choices will guide the types of skills each physician will need to acquire. Finally, the authors explore the implications of these trends for medical educators, including the competencies that will be required of educators as they develop the medical curriculum. Examining historical and social trends, including how users adopt current and emerging technologies, allows us to anticipate changes in the practice of medicine. By considering market pressures, global trends and emerging technologies, medical educators and practicing physicians may prepare themselves for the changes likely to occur in the medical curriculum and in the marketplace.

  2. A significant longshore transport divergence zone at the Northeastern Brazilian coast: implications on coastal Quaternary evolution

    Directory of Open Access Journals (Sweden)

    ABÍLIO C.S.P. BITTENCOURT

    2002-09-01

    Full Text Available By using the mean directions of the wave-fronts approaching the Brazilian northeastern coastal stretch comprised between the localities of Real river (Sergipe State and Galinhos (Rio Grande do Norte State - coincident with those of the main winds occurring in the area - and their periods, we have defined a wave climate model based on the construction of refraction diagrams. The resulting model of sediment transport, as obtained by numerical modelling from the refraction diagrams, taking into consideration the angle of approach and waves heights along the 10-m isobath, was capable of reproducing the patterns of sediment dispersion provided by geomorphic indicators of the longshore drift. All this coastal region, approximately 900 km in length, is characterized by a significant divergence zone in the direction of net longshore drift of sediments, the potential intensity of which increases considerably in value, in almost its entire length, continuously toward downdrift, which might explain the greater or lesser long term susceptibility to erosion, during the Quaternary, along the coastal stretch studied.Utilizando-se as direções médias das principais frentes-de-onda que se aproximam do trecho costeiro do nordeste brasileiro compreendido entre as localidades de Rio Real (Sergipe e Galinhos (Rio Grande do Norte - coincidentes com aquelas dos principais ventos que ocorrem na área - e de seus períodos, nós definimos um modelo de clima de ondas baseado na construção de diagramas de refração. O modelo resultante de transporte de sedimentos, obtido por modelagem numérica feita a partir dos diagramas de refração, considerando o ângulo de aproximação e a altura das ondas ao longo da isóbata de 10m, foi capaz de reproduzir os padrões de dispersão de sedimentos fornecidos pelos indicadores geomórficos de deriva litorânea. Toda essa região costeira, com cerca de 900km de extensão, caracteriza-se por se constituir em uma grande zona de

  3. Psychiatric Medication Intake in Suicide Victims: Gender Disparities and Implications for Suicide Prevention.

    Science.gov (United States)

    Paraschakis, Antonios; Michopoulos, Ioannis; Christodoulou, Christos; Koutsaftis, Filippos; Douzenis, Athanassios

    2016-11-01

    Frequency and gender differences of psychiatric medication intake in a sample of suicide victims from the Athens Greater Area were investigated with a particular focus on the implications for suicide prevention. Data were collected from the toxicological analyses of the suicide cases of the period November 2007-October 2009. Information was available for 262 individuals, 196 men (74.8%) and 66 women (25.2%); 109 of these (41.6%) were receiving psychiatric medication(s). Women were statistically more frequently under treatment: antidepressants (32.8% vs. 11.3%, p suicides. More thoughtful choice of psychiatric medication could possibly already prevent a number of female suicides. © 2016 American Academy of Forensic Sciences.

  4. [Medical tourism and its implications for patients and hospital services throughout the world].

    Science.gov (United States)

    Hansen, Kristine Sorgenfri

    2017-05-15

    This article provides a snapshot of global medical tourism and its positive and negative implications for healthcare around the world presented through selected examples. Medical tourism is an old phenomenon which has seen a rapid increase due to global technological advances thus enabling people to receive treatment anywhere in the world, often combined with a tropical vacation. Treatments are of a non-acute, voluntary nature and are driven largely by high prices and long waiting lists at the home countries and low prices and high service quality at the destination country.

  5. How groups co-ordinate their concepts and terminology: implications for medical informatics.

    Science.gov (United States)

    Garrod, S

    1998-11-01

    Conceptual and terminological systems are established and maintained by the communities who use them. This paper reports experiments which investigate the role of communication and interaction in the process. The experiments show that isolated pairs of communicators and virtual communities of interacting pairs naturally converge on their own conceptual and terminological systems when confronted with a common task. The results also indicate that the system converged on is optimal for that particular group engaged in that particular task. These findings are discussed in relation to the increasing use of tightly coordinated medical teams and its implications for getting them to adopt standardized medical terminologies.

  6. 75 FR 20854 - Medical Device Use in the Home Environment: Implications for the Safe and Effective Use of...

    Science.gov (United States)

    2010-04-21

    ...] Medical Device Use in the Home Environment: Implications for the Safe and Effective Use of Medical Device... related to the safe and effective use of medical device technology in the home environment. The workshop... the home environment. FDA will solicit feedback on: 1. The agency's current working definition of...

  7. Predicting meaningful outcomes to medication and self-help treatments for binge-eating disorder in primary care: The significance of early rapid response.

    Science.gov (United States)

    Grilo, Carlos M; White, Marney A; Masheb, Robin M; Gueorguieva, Ralitza

    2015-04-01

    We examined rapid response among obese patients with binge-eating disorder (BED) in a randomized clinical trial testing antiobesity medication and self-help cognitive-behavioral therapy (shCBT), alone and in combination, in primary-care settings. One hundred four obese patients with BED were randomly assigned to 1 of 4 treatments: sibutramine, placebo, shCBT + sibutramine, or shCBT + placebo. Treatments were delivered by generalist primary-care physicians and the medications were given double-blind. Independent assessments were performed by trained and monitored doctoral research clinicians monthly throughout treatment, posttreatment (4 months), and at 6- and 12-month follow-ups (i.e., 16 months after randomization). Rapid response, defined as ≥65% reduction in binge eating by the fourth treatment week, was used to predict outcomes. Rapid response characterized 47% of patients, was unrelated to demographic and baseline clinical characteristics, and was significantly associated, prospectively, with remission from binge eating at posttreatment (51% vs. 9% for nonrapid responders), 6-month (53% vs. 23.6%), and 12-month (46.9% vs. 23.6%) follow-ups. Mixed-effects model analyses revealed that rapid response was significantly associated with greater decreases in binge-eating or eating-disorder psychopathology, depression, and percent weight loss. Our findings, based on a diverse obese patient group receiving medication and shCBT for BED in primary-care settings, indicate that patients who have a rapid response achieve good clinical outcomes through 12-month follow-ups after ending treatment. Rapid response represents a strong prognostic indicator of clinically meaningful outcomes, even in low-intensity medication and self-help interventions. Rapid response has important clinical implications for stepped-care treatment models for BED. clinicaltrials.gov: NCT00537810 (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  8. A multi-disciplinary approach to medication safety and the implication for nursing education and practice.

    Science.gov (United States)

    Adhikari, Radha; Tocher, Jennifer; Smith, Pam; Corcoran, Janet; MacArthur, Juliet

    2014-02-01

    pharmacological knowledge to junior nursing staff and pre-registration nursing students. This paper argues that the 'five rights' principle during medication administration is not enough for holistic medication safety and explains two reasons why there is a need for strengthened multi-disciplinary team-work to achieve greater patient safety. To accomplish this, nurses need to have sufficient knowledge of pharmacology and medication safety issues. These findings have important educational implications and point to the requirement for the incorporation of medication management and pharmacology in to the teaching curriculum for nursing students. There is also a call for continuing professional development opportunities for nurses working in clinical settings. © 2014.

  9. Third year medical students perceptions towards learning communication skills: implications for medical education.

    Science.gov (United States)

    Loureiro, Elizabete; Severo, Milton; Bettencourt, Paulo; Ferreira, Maria Amélia

    2011-12-01

    To analyze students' perceptions towards learning communication skills pre-and-post training in a Communication and Clinical Skills Course (CCSC) at a Portuguese Medical School. Content analysis was used to describe and systematically analyze the content written by students (n=215 from a total of 229) in an open-ended survey. In addition, content analysis association rules were used to identify meaning units. Students' pre-training definitions of communication skills were not specific; their post-training definitions were more precise and elaborated. Students perceived communications skills in Medicine as important (61%), but recommended that teaching methodologies (52%) be restructured. There appeared to be no connection between criticism of teaching skills performance and perceptions of the other aspects of the course. Students' experiences at CCSC are associated with their perceptions of communications skills learning. Content analysis associations indicated that these perceptions are influenced by context. Improvement of curricula, teaching and assessment methods, and investment in faculty development are likely to foster positive perceptions towards learning communication skills in these students. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  10. A study to determine whether targeted education significantly improves the perception of human torture in medical students in India.

    Science.gov (United States)

    Husain, Munawwar; Ghaffar, Usama B; Usmani, Jawed Ahmad; Rivzi, Shameem Jahan

    2010-08-01

    This study was undertaken to find out the knowledge of torture in MBBS students. A fair comparison was done by selecting two groups of medical students; one, to whom torture was not taught ie, pretaught group (PrTG, n = 125), and second, to whom torture was taught in classroom ie, post-taught group (PoTG, n = 110) in more than one sessions. The topic on torture was taught under many headings maximising the effort to cover as much as possible; namely, definition, geographical distribution, types of torture (physical, psychological and sexual), post-torture sequelae, sociopolitical environment prevailing in the country, doctors' involvement in torture, rehabilitation of torture victims and the UNO's role in containment of torture. In all a questionnaire was designed having MCQ types on these aspects. It was found that significant level of difference in perception and knowledge about torture existed amongst the groups, and this was further accentuated in medical and non-medical intratopics. 'P' value of each question was computed separately. It was found that the study was statistically significant and reestablished the need of fortifying the gossameric firmament of education specific to torture.

  11. Estimation of population doses from diagnostic medical examinations in Japan, 1974. II. Estimation of genetically significant dose

    Energy Technology Data Exchange (ETDEWEB)

    Hashizume, T; Maruyama, T; Kumamoto, Y [National Inst. of Radiological Sciences, Chiba (Japan)

    1976-03-01

    The genetically significant dose from radiographic and fluoroscopic examination in Japan has been estimated based on a 1974 nation wide survey of randomly sampled hospitals and clinics. The gonad dose during x-ray diagnosis was determined with an ionization chamber placed at the positions of ovary and testis in a Rando phantom. The instrumented phantom was irradiated with medical diagnostic x-rays on the basis of the exposure data on the patients selected in the nation wide survey. In the calculation of the genetically significant dose, the child expectancy of the patients that undergo each particular type of examination was assumed to be same as that of the general population. The resultant genetically significant dose was 11.1 and 5.43 mrad per person per year for radiography and fluoroscopy, respectively. These values were compared with those of 1960 and 1969. Though the number of examinations per year shows a yearly increase, the genetically significant dose is gradually on the decrease. This may be due to technical improvements in medical radiological practices.

  12. The pathophysiology, medical management and dental implications of adult attention-deficit/hyperactivity disorder.

    Science.gov (United States)

    Friedlander, Arthur H; Yagiela, John A; Mahler, Michael E; Rubin, Robert

    2007-04-01

    Few published reports in the dental literature have focused on adult attention-deficit/hyperactivity disorder (ADHD) and its dental implications. The authors conducted a MEDLINE search for the period 2000 through 2005 using the terms "adult" and "attention-deficit" to define ADHD's pathology, medical treatment and dental implications. ADHD is a developmental condition that affects slightly more than 4 percent of the adult U.S. population. Its symptoms include inattention, hyperactivity and impulsivity that can cause personal, social, occupational and leisure-time dysfunction. Medications used to treat the disorder include stimulants, selective noradrenergic uptake inhibitors and tricyclic antidepressants. The oral health of people with ADHD may be compromised by inattention and impulsivity that impair home care regimens and can lead to cigarette addiction, which may cause oral cancer and damage the periodontium, and excessive ingestion of caffeinated sugar-laden soft drinks that promote dental caries. To safely care for this patient population, dentists must be familiar with the stimulant and nonstimulant medications used to treat adult ADHD, because these drugs can cause adverse orofacial and systemic reactions and interact adversely with dental therapeutic agents.

  13. Undocumented students pursuing medical education: The implications of deferred action for childhood arrivals (DACA).

    Science.gov (United States)

    Balderas-Medina Anaya, Yohualli; del Rosario, Mithi; Doyle, Lawrence Hy; Hayes-Bautista, David E

    2014-12-01

    There are about 1.8 million young immigrants in the United States who came or were brought to the country without documentation before the age of 16. These youth have been raised and educated in the United States and have aspirations and educational achievements similar to those of their native-born peers. However, their undocumented status has hindered their pursuit of higher education, especially in medical and other graduate health sciences. Under a new discretionary policy, Deferred Action for Childhood Arrivals (DACA), many of these young immigrants are eligible to receive permission to reside and work in the United States. DACA defers deportation of eligible, undocumented youth and grants lawful presence in the United States, work permits, Social Security numbers, and, in most states, driver's licenses. These privileges have diminished the barriers undocumented students traditionally have faced in obtaining higher education, specifically in pursuing medicine. With the advent of DACA, students are slowly matriculating into U.S. medical schools and residencies. However, this applicant pool remains largely untapped. In the face of a physician shortage and the implementation of the Affordable Care Act, an increase in matriculation of qualified undocumented students would be greatly beneficial. This Perspective is intended to begin discussion within the academic medicine community of the implications of DACA in reducing barriers for the selection and matriculation of undocumented medical students and residents. Moreover, this Perspective is a call to peers in the medical community to support undocumented students seeking access to medical school, residency, and other health professions.

  14. Significance of Ubiad1 for Epidermal Keratinocytes Involves More Than CoQ10 Synthesis: Implications for Skin Aging

    Directory of Open Access Journals (Sweden)

    Florian Labarrade

    2018-01-01

    Full Text Available The significance of Coenzyme Q10 (CoQ10 as an anti-oxidant barrier of the skin, as well as a key component in anti-aging strategies for skin care products, has been firmly established. Biosynthesis of CoQ10 in the mitochondria is well known, but there is only limited information on the non-mitochondrial synthesis of CoQ10 in the skin. Recent findings in zebrafish identified that a tumor suppressor, Ubiad1, is also a key enzyme in the non-mitochondrial synthesis of CoQ10. The purpose of this study was to investigate expression of Ubiad1 in human skin, and its implication in the skin’s cutaneous response to oxidative stress. We observed Ubiad1 localization in the epidermis, particularly a subcellular localization in the Golgi apparatus. Ubiad1 modulation by a pentapeptide was associated with an observed reduction in ROS/RNS stresses (−44%/−19% respectively, lipid peroxidation (−25% and preservation of membrane fluidity under stress conditions. Electron microscopy of keratinocytes revealed a significant degree of stimulation of the Golgi complex, as well as significantly improved mitochondrial morphology. Given the importance of CoQ10 in mitigating the visible signs of skin aging, our findings identify Ubiad1 as an essential component of the defensive barriers of the epidermis.

  15. The distribution of P-values in medical research articles suggested selective reporting associated with statistical significance.

    Science.gov (United States)

    Perneger, Thomas V; Combescure, Christophe

    2017-07-01

    Published P-values provide a window into the global enterprise of medical research. The aim of this study was to use the distribution of published P-values to estimate the relative frequencies of null and alternative hypotheses and to seek irregularities suggestive of publication bias. This cross-sectional study included P-values published in 120 medical research articles in 2016 (30 each from the BMJ, JAMA, Lancet, and New England Journal of Medicine). The observed distribution of P-values was compared with expected distributions under the null hypothesis (i.e., uniform between 0 and 1) and the alternative hypothesis (strictly decreasing from 0 to 1). P-values were categorized according to conventional levels of statistical significance and in one-percent intervals. Among 4,158 recorded P-values, 26.1% were highly significant (P values values equal to 1, and (3) about twice as many P-values less than 0.05 compared with those more than 0.05. The latter finding was seen in both randomized trials and observational studies, and in most types of analyses, excepting heterogeneity tests and interaction tests. Under plausible assumptions, we estimate that about half of the tested hypotheses were null and the other half were alternative. This analysis suggests that statistical tests published in medical journals are not a random sample of null and alternative hypotheses but that selective reporting is prevalent. In particular, significant results are about twice as likely to be reported as nonsignificant results. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Genetically significant dose assessments of occupationally exposed individuals involved in industrial and medical radiographic procedures in certain establishments in Nigeria

    International Nuclear Information System (INIS)

    Jibiri, N.N.; Oguntade, G. T.

    2007-01-01

    The main source of radiation doses received by humans from man-made sources of ionizing radiation in medicine and industry comes from X-rays. The genetic risks of ionizing radiation effects on an individual who is occupationally exposed largely depend on the magnitude of the radiation dose received, period of practice, work load and radio logical procedures involved. In this work, using the linear non-thresh old model, we have attempted to assess the level of genetic risk of occupationally exposed individuals in two medical and industrial establishments in Nigeria by estimating their genetically significant dose values. The estimation was based on continuous personnel radiation dose monitoring data for the individuals in each of the establishments over a three year period (1998-2001). The estimated genetically significant dose values in the years considered were 12 mSv for the medical, and 29 mSv for the industrial personnel. Appropriate radiation protection precautions should be taken by the personnel to adhere to standard operational practices in order to minimize the genetically significant dose resulting from radio logical practices

  17. Newly qualified doctors' views on the significance and accessibility of career advice during medical training in Saudi Arabia.

    Science.gov (United States)

    Mehmood, Syed Imran; Norcini, John J; Borleffs, Jan C C

    2013-01-01

    Career advice is an important instrument to help students with the proper specialty selection. The study aims (1) to explore the views of newly graduated doctors in Saudi Arabia about their experience with the current status of career support system during medical training and (2) to identify cross-cultural similarities and differences. A cross-sectional design study was conducted using a questionnaire to elicit the responses of participants from newly qualified doctors concerning the availability and significance of career advice. SPSS (version 11.0; Chicago, IL) was used to analyze the data and statistical tests, such as chi-square and unpaired t tests, were used to analyze the observations. A response rate of 94.7% was obtained. Among this group, 102 were males and 78 were females. Only 53% did receive career advice. The majority of men felt that career advice during medical studies was inadequate, while women were less negative (69% versus 32%; p = 0.0001). Furthermore, men were more disappointed about the possibilities for career advice after graduating than women (34% versus 13%, p = 0.0001). The results show that only half of newly graduated doctors had received any career advice during medical training. As the health care system cannot afford the potential waste of time and resources for doctors, career guidance should begin in undergraduate training so that the process of thinking about their future career starts longtime before they make their career choice.

  18. Enforcement actions: Significant actions resolved medical licensees. Quarterly progress report, January 1995--March 1995. Volume 14, No. 1, Part 2

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-05-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (January-March 1995) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to medical licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication.

  19. Enforcement actions: Significant actions resolved material licensees (non-medical). Quarterly progress report, October 1994--December 1994

    International Nuclear Information System (INIS)

    1995-02-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (October - December 1994) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to material licensees (non-medical) with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  20. Enforcement actions: Significant actions resolved, medical licensees. Quarterly progress report, July--September 1994: Volume 13, Number 3, Part 2

    International Nuclear Information System (INIS)

    1994-12-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (July--September 1994) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to medical licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  1. Enforcement actions: Significant actions resolved medical licensees. Quarterly progress report, January 1995--March 1995. Volume 14, No. 1, Part 2

    International Nuclear Information System (INIS)

    1995-05-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (January-March 1995) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to medical licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  2. Enforcement actions: Significant actions resolved material licensees (non-medical). Quarterly progress report, October 1994--December 1994

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-02-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (October - December 1994) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to material licensees (non-medical) with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication.

  3. Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia

    Science.gov (United States)

    2011-01-01

    Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism's growth for health systems, drawing on the cases of Thailand, Singapore and Malaysia, three regional hubs for medical tourism, via an extensive review of academic and grey literature. Variables for further analysis of the potential impact of medical tourism on health systems are also identified. The framework can provide a basis for empirical, in country studies weighing the benefits and disadvantages of medical tourism for health systems. The policy implications described are of particular relevance for policymakers and industry practitioners in other Southeast Asian countries with similar health systems where governments have expressed interest in facilitating the growth of the medical tourist industry. This article calls for a universal definition of medical tourism and medical tourists to be enunciated, as well as concerted data collection efforts, to be undertaken prior to any meaningful empirical analysis of medical tourism's impact on health systems. PMID:21539751

  4. Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia

    Directory of Open Access Journals (Sweden)

    Phua Kai Hong

    2011-05-01

    Full Text Available Abstract Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism's growth for health systems, drawing on the cases of Thailand, Singapore and Malaysia, three regional hubs for medical tourism, via an extensive review of academic and grey literature. Variables for further analysis of the potential impact of medical tourism on health systems are also identified. The framework can provide a basis for empirical, in country studies weighing the benefits and disadvantages of medical tourism for health systems. The policy implications described are of particular relevance for policymakers and industry practitioners in other Southeast Asian countries with similar health systems where governments have expressed interest in facilitating the growth of the medical tourist industry. This article calls for a universal definition of medical tourism and medical tourists to be enunciated, as well as concerted data collection efforts, to be undertaken prior to any meaningful empirical analysis of medical tourism's impact on health systems.

  5. Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia.

    Science.gov (United States)

    Pocock, Nicola S; Phua, Kai Hong

    2011-05-04

    Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism's growth for health systems, drawing on the cases of Thailand, Singapore and Malaysia, three regional hubs for medical tourism, via an extensive review of academic and grey literature. Variables for further analysis of the potential impact of medical tourism on health systems are also identified. The framework can provide a basis for empirical, in country studies weighing the benefits and disadvantages of medical tourism for health systems. The policy implications described are of particular relevance for policymakers and industry practitioners in other Southeast Asian countries with similar health systems where governments have expressed interest in facilitating the growth of the medical tourist industry. This article calls for a universal definition of medical tourism and medical tourists to be enunciated, as well as concerted data collection efforts, to be undertaken prior to any meaningful empirical analysis of medical tourism's impact on health systems.

  6. Research cardiac magnetic resonance imaging in end stage renal disease - incidence, significance and implications of unexpected incidental findings

    Energy Technology Data Exchange (ETDEWEB)

    Rutherford, Elaine; Weir-McCall, Jonathan R.; Houston, J.G.; Struthers, Allan D. [Ninewells Hospital, Division of Cardiovascular and Diabetes Medicine, Dundee (United Kingdom); Patel, Rajan K.; Jardine, Alan G.; Mark, Patrick B. [Institute of Cardiovascular and Medical Sciences, Glasgow (United Kingdom); Roditi, Giles [NHS Greater Glasgow and Clyde, Department of Radiology, Glasgow Royal Infirmary, Glasgow (United Kingdom)

    2017-01-15

    Left ventricular mass (LVM) at cardiac magnetic resonance imaging (CMR) is a frequent end point in clinical trials in nephrology. Trial participants with end stage renal disease (ESRD) may have a greater frequency of incidental findings (IF). We retrospectively investigated prevalence of IF in previous research CMR and reviewed their subsequent impact on participants. Between 2002 and 2006, 161 ESRD patients underwent CMR in a transplant assessment study. Images were used to assess LV mass and function. In the current study a radiologist reviewed the scans for IF. Review of patient records determined the subsequent clinical significance of IF. There were 150 IF in 95 study participants. Eighty-four (56 %) were new diagnoses. One hundred and two were non-cardiac. Fifteen were suspicious of malignancy. There was a clinically significant IF for 14.9 % of the participants. In six cases earlier identification of an IF may have improved quality of life or survival. Without radiology support clinically important IF may be missed on CMR. Patients undergoing CMR in trials should be counselled about the frequency and implications of IF. Patients with ESRD have a higher prevalence of IF than reported in other populations. Nephrology studies require mechanisms for radiologist reporting and strategies for dealing with IF. (orig.)

  7. Problem based learning in medical education: theory, rationale, process and implications for pakistan.

    Science.gov (United States)

    Baig, Lubna A

    2006-09-01

    Historically, lectures were the medium to transfer cognitive information to the learners in medical education. Apprenticeship training, labs, bedside teaching, tutorials etc. were used to impart psychomotor and affective skills. It was assumed that the learner will assimilate all this knowledge and will be competent to apply this learning in practical life. Problem-based learning (PBL) emerged due to problems in building the appropriate competencies in the medical graduates and is a relatively newer mode of transfer of knowledge. This paper will deal with problem-based learning which took the world with storm in the 80's and most institutions in the world started using different variants of PBL. This paper attempts to define and explore the theoretical basis and historical background of PBL. The paper will systematically review literature and argue about the advantages and disadvantages of PBL and the implications of its implementation in Pakistan.

  8. Positive implications from socially accountable, community-engaged medical education across two Philippines regions.

    Science.gov (United States)

    Woolley, Torres; Cristobal, Fortunato; Siega-Sur, Jusie; Ross, Simone; Neusy, Andre-Jacques; Halili, Servando; Reeve, Carole

    2018-02-01

    Hundreds of millions of people worldwide lack access to quality health services, largely because of geographic and socioeconomic maldistribution of qualified practitioners. This study describes differences between the practice locations of Philippines medical graduates from two 'socially accountable, community-engaged' health professional education (SAHPE) schools and the practice locations of graduates from two 'conventionally trained' medical schools located in the same respective geographic regions. Licensed medical graduates were currently practising in the Philippines and had been practising for at least 6 months. Graduates were from two Philippines SAHPE schools (Ateneo de Zamboanga University-School of Medicine (ADZU-SOM) on the Zamboanga Peninsula (n=212) and the University of the Philippines Manila-School of Health Sciences (SHS-Palo) in Eastern Visayas (n=71), and from two 'conventional' medical schools Methods: Current graduate practice locations in municipalities or cities were linked with their respective population size and socioeconomic income class, and geocoded using Geographical Information System software onto a geospatial map of the Philippines. Bivariate analysis compared the population size and socioeconomic class of communities where the SAHPE medical graduates practised to communities where 'conventional' medical school graduates practised. Thirty-one percent of ADZU-SOM medical graduates practised in communities play a significant role in graduates choosing to practice in rural and/or economically disadvantaged communities. Governments experiencing medical workforce maldistributions similar to those in the Philippines should consider SAHPE as a potentially cost-effective strategy in recruiting and retaining health graduates to underserved areas.

  9. Four motivations for charitable giving: implications for marketing strategy to attract monetary donations for medical research.

    Science.gov (United States)

    Dawson, S

    1988-06-01

    Medical research foundations can compete more effectively for charitable dollars by being aware of motivations for giving when designing marketing strategy. The study tests the extent to which the motives of reciprocity, income, career, and self-esteem predict monetary giving to medical research. The results indicate that reciprocity and income motives are significant predictors of giving, as are household assets and age. Interpretation of these results leads to several suggestions for marketing strategy.

  10. Medical Marijuana programs: implications for cannabis control policy--observations from Canada.

    Science.gov (United States)

    Fischer, Benedikt; Kuganesan, Sharan; Room, Robin

    2015-01-01

    While prohibition has been the dominant regime of cannabis control in most countries for decades, an increasing number of countries have been implementing cannabis control reforms recently, including decriminalization or even legalization frameworks. Canada has held out from this trend, although it has among the highest cannabis use rates in the world. Cannabis use is universally criminalized, and the current (conservative) federal government has vowed not to implement any softening reforms to cannabis control. As a result of several higher court decisions, the then federal government was forced to implement a 'medical marijuana access regulations' program in 2001 to allow severely ill patients therapeutic use and access to therapeutic cannabis while shielding them from prosecution. The program's regulations and approval processes were complex and subject to extensive criticism; initial uptake was low and most medical marijuana users continued their use and supply outside the program's auspices. This year, the government introduced new 'marijuana for medical purposes regulations', which allow physicians to 'authorize' medical marijuana use for virtually any health condition for which this is considered beneficial; supply is facilitated by licensed commercial producers. It is expected that some 500,000 users, and dozens of commercial producers will soon be approved under the program, arguably constituting - as with medical marijuana schemes elsewhere, e.g. in California--de facto 'legalization'. We discuss the question whether the evolving scope and realities of 'medical cannabis' provisions in Canada offer a 'sneaky side door' or a 'better third way' to cannabis control reform, and what the potential wider implications are of these developments. Copyright © 2014. Published by Elsevier B.V.

  11. The geochemical evolution of syncollisional magmatism and the implications for significant magmatic-hydrothermal lead-zinc mineralization (Gangdese, Tibet)

    Science.gov (United States)

    Zhou, Jinsheng; Yang, Zhusen; Hou, Zengqian; Liu, Yingchao; Zhao, Xiaoyan; Zhang, Xiong; Zhao, Miao; Ma, Wang

    2017-09-01

    In addition to well-known subduction processes, the collision of two continents also generates abundant ore deposits, as in the case of the Tibetan Plateau, which is the youngest and most spectacular collisional belt on Earth. During the building history of the Gangdese magmatic belt, several magmatic flare-up events developed, however, significant magmatic-hydrothermal lead-zinc mineralization dominantly accompanied the magmatism during the syncollisional period ( 65-41 Ma). Based on integrated geochemical and isotopic data, we provide insights into the genesis and evolution of syncollisional magmas, and their implications for significant magmatic-hydrothermal lead-zinc mineralization. The Sr-Nd isotopic compositions of most syncollisional igneous rocks (87Sr/86Sr = 0.7034-0.7123; εNd(t) = - 9.0 to + 1.8) indicate a mixing origin between mantle-derived basaltic magmas and ancient crustal melts, and fractional crystallization is a fundamental mechanism by which syncollisional magmas evolve towards intermediate to silicic compositions. Most lead-zinc mineralization-related plutons are high silica (76.14% wt.% SiO2 on average), high oxygen fugacity (average ΔFMQ + 2.5) granites with highly evolved chemical signatures [average Eun/Eun* = 0.33, high Rb/Sr (average = 3.9)], and they represent the final products from primary magmas. Due to the contribution of ancient crustal melts to the genesis of mineralization-related parent magmas, the spatial distribution of Pb-Zn deposits within the northern Gangdese magmatic belt is controlled by the lithospheric architecture. In compressional environments, magmas have low evacuation efficiency and long magma chamber lifespan, which is favorable for basaltic parents evolved to high silica granites through sufficient fractional crystallization. This scenario contributes to our understanding of the significant magmatic-hydrothermal lead-zinc mineralization that occurred in the syncollisional period.

  12. Significant Risk Factors for Postoperative Enlargement of Basal Ganglia Hematoma after Frameless Stereotactic Aspiration: Antiplatelet Medication and Concomitant IVH.

    Science.gov (United States)

    Son, Wonsoo; Park, Jaechan

    2017-09-01

    Frameless stereotactic aspiration of a hematoma can be the one of the treatment options for spontaneous intracerebral hemorrhage in the basal ganglia. Postoperative hematoma enlargement, however, can be a serious complication of intracranial surgery that frequently results in severe neurological deficit and even death. Therefore, it is important to identify the risk factors of postoperative hematoma growth. During a 13-year period, 101 patients underwent minimally invasive frameless stereotactic aspiration for basal ganglia hematoma. Patients were classified into two groups according to whether or not they had postoperative hematoma enlargement in a computed tomography scan. Baseline demographic data and several risk factors, such as hypertension, preoperative hematoma growth, antiplatelet medication, presence of concomitant intraventricular hemorrhage (IVH), were analysed via a univariate statistical study. Nine of 101 patients (8.9%) showed hematoma enlargement after frameless stereotactic aspiration. Among the various risk factors, concomitant IVH and antiplatelet medication were found to be significantly associated with postoperative enlargement of hematomas. In conclusion, our study revealed that aspirin use and concomitant IVH are factors associated with hematoma enlargement subsequent to frameless stereotactic aspiration for basal ganglia hematoma.

  13. Evaluation of medically significant bacteria in colonoscopes after 8 weeks of shelf life in open air storage.

    Science.gov (United States)

    Ingram, Jackie; Gaines, Peggy; Kite, Roberta; Morgan, Marcia; Spurling, Sheila; Winsett, Rebecca P

    2013-01-01

    The purpose of this study was to examine bacterial growth in colonoscopes in a series of graduated shelf times. There is no conclusive evidence on the length of time colonoscopes can be safely stored before requiring redisinfection. Standards for processing scopes after use are described and supported by the professional organizations of gastroenterology and infection control; however, shelf life varies from 3 to 5 days and most recommendations are based on clinical consensus. In this study, four colonoscopes were used in a clinical procedure, underwent automated high-level disinfection with 2.6% buffered glutaraldehyde, and cultured after 3, 5, 7, 14, 21, 28, 42, and 56 days of shelf time. Two investigators collected all the cultures after interrater reliability was established. Cultures were processed in the microbiology laboratory. No medically significant growth was detected at any of the culture points. At Day 14 and Day 42, one of four scopes grew fewer than two colony-forming units of a medically insignificant bacterium. Using professional standards for high-level disinfection growth was suppressed for up to 8 weeks. Further evidence to assess fungal or viral growth is needed to be able to make suggestions for colonoscope shelf life.

  14. An Analysis of Medication Errors at the Military Medical Center: Implications for a Systems Approach for Error Reduction

    National Research Council Canada - National Science Library

    Scheirman, Katherine

    2001-01-01

    An analysis was accomplished of all inpatient medication errors at a military academic medical center during the year 2000, based on the causes of medication errors as described by current research in the field...

  15. Professionalism in its time and place: some implications for medical education.

    Science.gov (United States)

    Wilkinson, Tim J; Moore, Maryleigh; Flynn, Eleanor M

    2012-07-29

    Professionalism is fundamental to good medical practice but is multifaceted so observing that a person is professional in some areas will not guarantee that person would be professional in others. Most definitions of professionalism include a commitment to self-monitor and to improve; some personal virtues; and effective relationships with colleagues, patients and people who are important to those patients. In addition, it is suggested that expectations of professionalism may alter depending on context, both of time and place. Societal expectations relating to professionalism are likely to change over time and our expectations of individuals may alter according to the stage of training. The environment (the workplace, one's colleagues, the work tasks) is also highly influential on the manifestation of professional behaviours. The medical profession's social contract in relation to professionalism will always need to be updated. The effect of time and place means that searching for innate or stable elements of professionalism, in order to predict subsequent behaviours, is therefore difficult. This has implications for the selection, education and assessment of medical students. The focus should be on how to build adaptability and resilience to contextual influences; to identify those elements of professionalism that can be learnt; and build systems of assessment that reflect professionalism's multifaceted and contextual aspects.

  16. A review of significant events analysed in general practice: implications for the quality and safety of patient care

    Directory of Open Access Journals (Sweden)

    Bradley Nick

    2009-09-01

    Full Text Available Abstract Background Significant event analysis (SEA is promoted as a team-based approach to enhancing patient safety through reflective learning. Evidence of SEA participation is required for appraisal and contractual purposes in UK general practice. A voluntary educational model in the west of Scotland enables general practitioners (GPs and doctors-in-training to submit SEA reports for feedback from trained peers. We reviewed reports to identify the range of safety issues analysed, learning needs raised and actions taken by GP teams. Method Content analysis of SEA reports submitted in an 18 month period between 2005 and 2007. Results 191 SEA reports were reviewed. 48 described patient harm (25.1%. A further 109 reports (57.1% outlined circumstances that had the potential to cause patient harm. Individual 'error' was cited as the most common reason for event occurrence (32.5%. Learning opportunities were identified in 182 reports (95.3% but were often non-specific professional issues not shared with the wider practice team. 154 SEA reports (80.1% described actions taken to improve practice systems or professional behaviour. However, non-medical staff were less likely to be involved in the changes resulting from event analyses describing patient harm (p Conclusion The study provides some evidence of the potential of SEA to improve healthcare quality and safety. If applied rigorously, GP teams and doctors in training can use the technique to investigate and learn from a wide variety of quality issues including those resulting in patient harm. This leads to reported change but it is unclear if such improvement is sustained.

  17. Dangerous anthropogenic interference, dangerous climatic change, and harmful climatic change. Non-trivial distinctions with significant policy implications

    International Nuclear Information System (INIS)

    Harvey, L.D.D.

    2007-01-01

    climate sensitivity and three alternative pdfs for the harm temperature threshold. The allowable radiative forcing ratio depends on the probability of significant harm that is tolerated, and can be translated into allowable CO2 concentrations given some assumption concerning the future change in total non-CO2 GHG radiative forcing. If future non-CO2 GHG forcing is reduced to half of the present non-CO2 GHG forcing, then the allowable CO2 concentration is 290-430 ppmv for a 10% risk tolerance (depending on the chosen pdfs) and 300-500 ppmv for a 25% risk tolerance (assuming a pre-industrial CO2 concentration of 280 ppmv). For future non-CO2 GHG forcing frozen at the present value, and for a 10% risk threshold, the allowable CO2 concentration is 257-384 ppmv. The implications of these results are that (1) emissions of GHGs need to be reduced as quickly as possible, not in order to comply with the UNFCCC, but in order to minimize the extent and duration of non-compliance; (2) we do not have the luxury of trading off reductions in emissions of non-CO2 GHGs against smaller reductions in CO2 emissions, and (3) preparations should begin soon for the creation of negative CO2 emissions through the sequestration of biomass carbon

  18. Policy implications of medical tourism development in destination countries: revisiting and revising an existing framework by examining the case of Jamaica.

    Science.gov (United States)

    Johnston, Rory; Crooks, Valorie A; Ormond, Meghann

    2015-07-04

    Medical tourism is now targeted by many hospitals and governments worldwide for further growth and investment. Southeast Asia provides what is perhaps the best documented example of medical tourism development and promotion on a regional scale, but interest in the practice is growing in locations where it is not yet established. Numerous governments and private hospitals in the Caribbean have recently identified medical tourism as a priority for economic development. We explore here the projects, activities, and outlooks surrounding medical tourism and their anticipated economic and health sector policy implications in the Caribbean country of Jamaica. Specifically, we apply Pocock and Phua's previously-published conceptual framework of policy implications raised by medical tourism to explore its relevance in this new context and to identify additional considerations raised by the Jamaican context. Employing case study methodology, we conducted six weeks of qualitative fieldwork in Jamaica between October 2012 and July 2013. Semi-structured interviews with health, tourism, and trade sector stakeholders, on-site visits to health and tourism infrastructure, and reflexive journaling were all used to collect a comprehensive dataset of how medical tourism in Jamaica is being developed. Our analytic strategy involved organizing our data within Pocock and Phua's framework to identify overlapping and divergent issues. Many of the issues identified in Pocock and Phua's policy implications framework are echoed in the planning and development of medical tourism in Jamaica. However, a number of additional implications, such as the involvement of international development agencies in facilitating interest in the sector, cyclical mobility of international health human resources, and the significance of health insurance portability in driving the growth of international hospital accreditation, arise from this new context and further enrich the original framework. The framework

  19. Implications of prescription drug monitoring and medical cannabis legislation on opioid overdose mortality.

    Science.gov (United States)

    Phillips, Elyse; Gazmararian, Julie

    To determine whether specific state legislation has an effect on opioid overdose mortality rates compared to states without those types of legislation. Ecological study estimating opioid-related mortality in states with and without a prescription drug monitoring program (PDMP) and/or medical cannabis legislation. Opioid-related mortality rates for 50 states and Washington DC from 2011 to 2014 were obtained from CDC WONDER. PDMP data were obtained from the National Alliance for Model State Drug Laws, and data on medical cannabis legislation from the National Organization for the Reform of Marijuana Laws. The relationship between PDMPs with mandatory access provisions, medical cannabis legislation, and opioid-related mortality rates. Multivariate repeated measures analysis performed with software and services. Medical cannabis laws were associated with an increase of 21.7 percent in mean age-adjusted opioid-related mortality (p cannabis (p = 0.049) and 5.8 percent for states with a PDMP (p = 0.005). Interaction between both types of legislation produced a borderline significant decrease of 10.1 percent (p = 0.055). For every year states had both types of legislation, interaction resulted in a 0.6 percent decrease in rate (p = 0.013). When combined with the availability of medical cannabis as an alternative analgesic therapy, PDMPs may be more effective at decreasing opioid-related mortality.

  20. [The significance of the experience in organizing medical support for the troops during the war years for the development of the modern military medical infrastructure].

    Science.gov (United States)

    Pogodin, Iu I; Gurov, A N

    1995-05-01

    In the present period when combat activities are being carried out at the territory of Russia, namely in Chechnya, it is very important to solve the problem of the improvement of the infrastructure of medical service as a basis of territorial system of medical support of troops. That's why we are looking at the experience of medical support of troops in the period of the Great Patriotic war in order to determine the basic characteristic features of military medical infrastructure (MMI) of that time. Using the experience of medical support in the period of the Great Patriotic war it is necessary to draw the main attention on studying the medico-geographical aspects of the Armed Forces deployment over the whole territory of the country, state of health service system (taking into account its reformation), influence of natural, socio-economic and ecological factors of different regions upon the health of servicemen, organization of medical support of troops, proliferation of infectious and parasitic diseases, local resources and availability of medication materials, medical supplies, equipment and technique, as well as other indices which must be taken into consideration in routine situations or during disaster relief. All this information is very valuable for the process of the formation of an adequate MMF in the zone of responsibility of medical support of troops.

  1. Analysis of the medical use of marijuana and its societal implications.

    Science.gov (United States)

    Taylor, H G

    1998-01-01

    To review the pharmacology, therapeutics, adverse effects, and societal implications of the medical use of marijuana. MEDLINE and manual searches of English-language marijuana literature, supplemented with interviews of scientists currently conducting cannabinoid research. Search terms included pain OR palliative care AND cannabis or ALL marijuana; cachexia OR appetite OR appetite stimulants; muscle spasticity OR spasm; immune system and cannabis; nausea and vomiting and cancer and cannabis. MEDLINE search terms: cannabis OR marijuana smoking OR marijuana abuse; all glaucoma; multiple sclerosis AND cannabis OR marijuana smoking OR marijuana abuse. Studies on pharmacology, risks, and medical potential of marijuana. Not applicable. The most prominent effects of marijuana are mediated by receptors in the brain. Acute intoxication is characterized by euphoria, loss of short-term memory, stimulation of the senses, and impaired linear thinking. Depersonalization and panic attacks are adverse effects. Increased heart rate and reddened conjunctivae are common physical effects. Chronic, high doses may cause subtle impairment of cognitive abilities that are appear to be long-term, but of unknown duration. Marijuana may be a risk factor for individuals with underlying mental illness. It causes dependence, but compared with cocaine, alcohol, heroin, and nicotine, marijuana has little addictive power and produces only mild withdrawal symptoms. Marijuana shows clinical promise for glaucoma, nausea and vomiting, analgesia, spasticity, multiple sclerosis, and AIDS wasting syndrome. As a recreational drug, marijuana poses dangers, particularly to social and emotional development during adolescence and young adulthood. As a medical drug, marijuana should be available for patients who do not adequately respond to currently available therapies.

  2. Factors that affect general practice as a choice of medical speciality: implications for policy development.

    Science.gov (United States)

    Vohra, Amit; Ladyshewsky, Richard; Trumble, Stephen

    2017-11-28

    Objective This article critically appraises the range of personal, professional and social factors that affect the choice of speciality across medical students, prevocational doctors, general practice registrars and general practitioners. Methods This qualitative study applied constructs from the fields of decision theory and career theory to better understand the complex nature of choosing a speciality. In all, 47 in-depth interviews were conducted with participants at different stages of their career cycle. The data was codified and analysed using NVivo to identify key factors that influenced speciality choice. Results The research identified 77 individual findings influencing general practice as a choice of medical speciality. These were distilled into a matrix to show that factors such as money, prestige and peer interaction did not have a compelling effect, whereas clinical and academic role models, flexibility, work-life balance, scope of practice, connection with patients, training environment and practical opportunities did. Conclusion The findings indicate that the decision in relation to the choice of medical speciality is a complex cognitive process that is undertaken within a personal, social and professional context particular to each individual. What is known about the topic? Current literature aims to quantify changes in attitudes towards choice of speciality or the effect of particular variables in isolation while ignoring the complexity of this decision process and how the numerous variables compare with each other. What does this paper add? The present study is the first intergenerational research on this topic in the Australian context and the paper dismisses the role of prestige and remuneration as key drivers of choice in picking general practice as a speciality, noting that money is merely a 'hygiene factor'. What are the implications for policy makers? A policy framework outlining 10 key principles is presented to assist policy makers seeking

  3. Memory accessibility and medical decision-making for significant others: The role of socially-shared retrieval induced forgetting

    OpenAIRE

    Dora M Coman; Alin eComan; William eHirst

    2013-01-01

    Medical decisions will often entail a broad search for relevant information. No sources alone may offer a complete picture, and many may be selective in their presentation. This selectivity may induce forgetting for previously learned material, thereby adversely affecting medical decision-making. In the study phase of two experiments, participants learned information about a fictitious disease and advantages and disadvantages of four treatment options. In the subsequent practice phase, the...

  4. Are we ready for BRCA-1 screening? The medical, ethical, and legal implications

    International Nuclear Information System (INIS)

    Pierce, Lori J.

    1996-01-01

    Inherited breast cancers account for approximately 5 to 10% of all breast malignancies. One gene, BRCA-1, is believed to account for 40-45% of hereditary breast cancers. Women who carry a BRCA-1 mutation has a 85-90% life-time risk of developing breast cancer and a 45-50% risk of developing ovarian cancer. Using linkage analyses of families with early onset breast cancer, bilateral breast cancer, and/or ovarian cancer, BRCA-1 was localized to chromosome 17q21. BRCA-1 has now been isolated and cloned. With the discovery of this inherited mutation, issues of genetic screening are facing women and their health care providers. Currently, testing for the presence of a BRCA-1 mutation is confined to members of high-risk families participating in research protocols, however, commercially available diagnostic assays are being developed for wide-spread screening. Screening for BRCA-1 is likely an inevitable reality. Therefore, panel members will discuss the implications of genetic screening specifically as they relate to the BRCA-1 gene. In particular, we will focus upon the genetic counseling that should be offered prior to the decision to proceed with testing, as well as the clinical and social implications of a positive test for a BRCA-1 mutation. Privacy issues for patients who pursue testing such s what should and should not be written in the medical records will be discussed, and the status of legislative measures designed to minimize insurance discrimination for those who test positive will be presented. Finally, options for management of women who have inherited a BRCA-1 mutation will be discussed, including the controversial role of radiotherapy for women diagnosed with breast cancer

  5. Medical implications of obesity in horses--lessons for human obesity.

    Science.gov (United States)

    Johnson, Philip J; Wiedmeyer, Charles E; Messer, Nat T; Ganjam, Venkataseshu K

    2009-01-01

    There is growing recognition that obesity is common and represents a significant detriment to the health of companion animals in a manner similar to that by which it is affecting the human population. As is the case for other species, obesity appears to promote insulin resistance in horses and it is through this pathophysiological process that many of the adverse medical consequences of obesity are being characterized. Equine medical conditions that have been described in the context of obesity and insulin resistance differ from those in humans. Chronic human conditions that have been attributed to obesity and insulin resistance, such as atherosclerosis and diabetes mellitus, are rarely described in obese horses. Significant current interest is centered on the recognition that insulin resistance plays a role in the pathogenesis of laminitis, a potentially severe and debilitating cause of lameness in the equine species. Other equine medical conditions that are more likely in obese, insulin-resistant individuals include hyperlipemia (hepatic lipidosis) and developmental orthopedic disease (osteochondrosis). Pituitary pars intermedia dysfunction (equine Cushing's syndrome) represents another common endocrinopathic condition of older horses associated with insulin resistance. This review presents an introductory overview of the present understanding of obesity and insulin resistance and how these conditions may be associated with disease conditions in horses. © Diabetes Technology Society

  6. Medical Implications of Obesity in Horses—Lessons for Human Obesity

    Science.gov (United States)

    Johnson, Philip J.; Wiedmeyer, Charles E.; Messer, Nat T.; Ganjam, Venkataseshu K.

    2009-01-01

    There is growing recognition that obesity is common and represents a significant detriment to the health of companion animals in a manner similar to that by which it is affecting the human population. As is the case for other species, obesity appears to promote insulin resistance in horses and it is through this pathophysiological process that many of the adverse medical consequences of obesity are being characterized. Equine medical conditions that have been described in the context of obesity and insulin resistance differ from those in humans. Chronic human conditions that have been attributed to obesity and insulin resistance, such as atherosclerosis and diabetes mellitus, are rarely described in obese horses. Significant current interest is centered on the recognition that insulin resistance plays a role in the pathogenesis of laminitis, a potentially severe and debilitating cause of lameness in the equine species. Other equine medical conditions that are more likely in obese, insulin-resistant individuals include hyperlipemia (hepatic lipidosis) and developmental orthopedic disease (osteochondrosis). Pituitary pars intermedia dysfunction (equine Cushing's syndrome) represents another common endocrinopathic condition of older horses associated with insulin resistance. This review presents an introductory overview of the present understanding of obesity and insulin resistance and how these conditions may be associated with disease conditions in horses. PMID:20046661

  7. Discrimination and Delayed Health Care Among Transgender Women and Men: Implications for Improving Medical Education and Health Care Delivery.

    Science.gov (United States)

    Jaffee, Kim D; Shires, Deirdre A; Stroumsa, Daphna

    2016-11-01

    The transgender community experiences health care discrimination and approximately 1 in 4 transgender people were denied equal treatment in health care settings. Discrimination is one of the many factors significantly associated with health care utilization and delayed care. We assessed factors associated with delayed medical care due to discrimination among transgender patients, and evaluated the relationship between perceived provider knowledge and delayed care using Anderson's behavioral model of health services utilization. Multivariable logistic regression analysis was used to test whether predisposing, enabling, and health system factors were associated with delaying needed care for transgender women and transgender men. A sample of 3486 transgender participants who took part in the National Transgender Discrimination Survey in 2008 and 2009. Predisposing, enabling, and health system environment factors, and delayed needed health care. Overall, 30.8% of transgender participants delayed or did not seek needed health care due to discrimination. Respondents who had to teach health care providers about transgender people were 4 times more likely to delay needed health care due to discrimination. Transgender patients who need to teach their providers about transgender people are significantly more likely to postpone or not seek needed care. Systemic changes in provider education and training, along with health care system adaptations to ensure appropriate, safe, and respectful care, are necessary to close the knowledge and treatment gaps and prevent delayed care with its ensuing long-term health implications.

  8. Special Forces Medical Sergeants' perceptions and beliefs regarding their current medical sustainment program: implications for the field.

    Science.gov (United States)

    Wilson, Ramey L; DeZee, Kent J

    2014-01-01

    Special Forces Medical Sergeants (SFMS) are trained to provide trauma and medical care in support of military operations and diplomatic missions throughout the world with indirect physician oversight. This study assessed their perceptions of the current program designed to sustain their medical skills. An Internet-based survey was developed using the constructs of the Theory of Reasoned Action/Planned Behavior and validated through survey best practices. Of the 334 respondents, 92.8% had deployed at least once as an SFMS. Respondents reported spending 4 hours per week sustaining their medical skills and were highly confident that they could perform their duties on a no-notice deployment. On a 5-point, Likert-type response scale, SFMS felt that only slight change is needed to the Special Operations Medical Skills Sustainment Course (mean: 2.17; standard deviation [SD]: 1.05), while moderate change is needed to the Medical Proficiency Training (mean: 2.82; SD: 1.21) and nontrauma modules (mean: 3.02; SD: 1.22). Respondents desire a medical sustainment program that is provided by subject matter experts, involves actual patient care, incorporates new technology, uses hands-on simulation, and is always available. SFMS are challenged to sustain their medical skills in the current operational environment, and barriers to medical training should be minimized to facilitate sustainment training. Changes to the current medical sustainment program should incorporate operator-level perspectives to ensure acceptability and utility but must be balanced with organizational realities. Improving the medical sustainment program will prepare SFMS for the challenges of future missions. 2014.

  9. Memory accessibility and medical decision-making for significant others: The role of socially-shared retrieval induced forgetting

    Directory of Open Access Journals (Sweden)

    Dora M Coman

    2013-06-01

    Full Text Available Medical decisions will often entail a broad search for relevant information. No sources alone may offer a complete picture, and many may be selective in their presentation. This selectivity may induce forgetting for previously learned material, thereby adversely affecting medical decision-making. In the study phase of two experiments, participants learned information about a fictitious disease and advantages and disadvantages of four treatment options. In the subsequent practice phase, they read a pamphlet selectively presenting either relevant (Experiment 1 or irrelevant (Experiment 2 advantages or disadvantages. A final cued recall followed and, in Experiment 2, a decision as to the best treatment for a patient. Not only did reading the pamphlet induce forgetting for related and unmentioned information, the induced forgetting adversely affected decision-making. The research provides a cautionary note about the risks of searching through selectively presented information when making a medical decision.

  10. Self-efficacy and health behaviour: Some implications for medical anthropology

    Directory of Open Access Journals (Sweden)

    Zlatanović Ljubiša

    2016-01-01

    Full Text Available The study of personality characteristics and behaviours related to human health has become a key area of research within contemporary health psychology. Personality variable that has attracted a growing interest of health psychologists is the concept of self-efficacy developed by Albert Bandura within his highly influential social-cognitive or social learning theory of human behaviour. Defined generally as the individual's belief that one will be able to carry out one's plans and intentions successfully or to perform certain behaviours necessary to attain desired goals or anticipated outcomes, self-efficacy is one of the key factors in the exercise of personal control, including a control over the state of one's own health. Starting from this theoretical framework, the main purpose of this article is to provide at first a concise overview of the theory of self-efficacy, and then to consider its relationship with the various forms or patterns of behaviours related to health, as well as to suggest some possible implications of this theory for medical anthropology - especially for its applied areas that are focused on the health education, health promotion, and health protection.

  11. Newly qualified doctors' views on the significance and accessibility of career advice during medical training in Saudi Arabia

    NARCIS (Netherlands)

    Mehmood, Syed Imran; Norcini, John J.; Borleffs, Jan C. C.

    2013-01-01

    Background: Career advice is an important instrument to help students with the proper specialty selection. The study aims (1) to explore the views of newly graduated doctors in Saudi Arabia about their experience with the current status of career support system during medical training and (2) to

  12. A randomized study of multimedia informational aids for research on medical practices: implications for informed consent

    Science.gov (United States)

    Kraft, Stephanie A; Constantine, Melissa; Magnus, David; Porter, Kathryn M.; Lee, Sandra Soo-Jin; Green, Michael; Kass, Nancy E; Wilfond, Benjamin S.; Cho, Mildred K

    2016-01-01

    Background/aims Participant understanding is a key element of informed consent for enrollment in research. However, participants often do not understand the nature, risks, benefits, or design of the studies in which they take part. Research on medical practices, which studies standard interventions rather than new treatments, has the potential to be especially confusing to participants because it is embedded within usual clinical care. Our objective in this randomized study was to compare the ability of a range of multimedia informational aids to improve participant understanding in the context of research on medical practices. Methods We administered a Web-based survey to members of a proprietary online panel sample selected to match national U.S. demographics. Respondents were randomized to one of five arms: four content-equivalent informational aids (animated videos, slideshows with voiceover, comics, and text), and one no-intervention control. We measured knowledge of research on medical practices using a summary knowledge score from 10 questions based on the content of the informational aids. We used ANOVA and paired t-tests to compare knowledge scores between arms. Results There were 1500 completed surveys (300 in each arm). Mean knowledge scores were highest for the slideshows with voiceover (65.7%), followed by the animated videos (62.7%), comics (60.7%), text (57.2%), and control (50.3%). Differences between arms were statistically significant except between the slideshows with voiceover and animated videos and between the animated videos and comics. Informational aids that included an audio component (animated videos and slideshows with voiceover) had higher knowledge scores than those without an audio component (64.2% versus 59.0%, peffectively than text alone. However, the relatively low knowledge scores suggest that targeted informational aids may be needed to teach some particularly challenging concepts. Nonetheless, our results demonstrate the

  13. Exploring UK medical and social work students' legal literacy: comparisons, contrasts and implications.

    Science.gov (United States)

    Preston-Shoot, Michael; McKimm, Judy

    2013-05-01

    To ensure acceptable practice standards both doctors and social workers should draw on relevant legal rules when reaching professional judgements concerning, for instance, children requiring protection, people with severe mental distress and adults at risk, information sharing, consent to intervention and service user involvement in their care and treatment. Many practitioners use the law to maintain high standards of professionalism. However, research has uncovered limited awareness of legal rules and poor standards of health and social care. Academic benchmarks and practice requirements for health and social care professions centrally position legal knowledge for secure decision-making. Model curricula exist. However, the outcomes of the taught curriculum on students' confidence in their legal knowledge and skills have been relatively overlooked. This article introduces the concept of legal literacy, a distillation of knowledge, understanding, skills and values that enables practitioners to connect relevant legal rules with their professional practice, to appreciate the roles and duties of other practitioners and to communicate effectively across organisational boundaries. It presents the outcomes for a 2006-2009 study of 1154 UK medical and 638 social work students of their law learning for practice, response rates of 46% and 68%. Significant differences were found between medical and social work students' attitudes towards the law, and in their self-ratings of legal knowledge and skills. Confidence levels were low and anxiety high, especially among medical students, although law teaching had some positive outcomes on knowledge and skill development. Social work and medical students associated different themes with the law, the latter especially foregrounding ethics, negligence and liability, which could affect inter-professional working. Students are not fully prepared for legally literate practice, with a consequent need to review the time allocated for, and

  14. Metformin: an old medication of new fashion: evolving new molecular mechanisms and clinical implications in polycystic ovary syndrome.

    Science.gov (United States)

    Diamanti-Kandarakis, Evanthia; Christakou, Charikleia D; Kandaraki, Eleni; Economou, Frangiskos N

    2010-02-01

    Polycystic ovary syndrome (PCOS) is now recognized to be the most common endocrinopathy in women of reproductive age with a prevalence of 6.6-6.8%. PCOS, a syndrome of unknown etiology, was initially regarded as a reproductive disorder. However, in the last 15 years the role of insulin resistance (IR) has been identified as a significant contributor to the pathogenesis of PCOS, and the metabolic and cardiovascular sequelae of the syndrome have been increasingly appreciated. The coexistence and interaction of reproductive and cardiometabolic abnormalities in the context of PCOS have created a need for a modified therapeutic management of affected women. Insulin sensitizers, particularly metformin, have been introduced as a pharmaceutical option targeting not only IR, but several other aspects of the syndrome, including reproductive abnormalities. The landscape of the multifaceted actions of metformin evolves to broaden the therapeutic implications of this old drug in a new fashion for patients with PCOS. Most recently, the spectrum of metformin's targets has been expanded, and molecular studies have explored the tissue-specific mechanisms of metformin in the liver, the muscle, the endothelium, and the ovary. The use of metformin in pregnant women with PCOS comprises another scarcely explored, but promising area of research. This review attempts to cover the spectrum of metformin's cellular actions in different tissues and to summarize the current literature regarding the potential medical value of this medication in PCOS. Even if many of these actions are individually modest, they seem to be collectively sufficient to confer therapeutic benefits not only in cardiometabolic aspects but also in reproductive aspects of PCOS.

  15. Genetic structure of a unique admixed population: implications for medical research.

    Science.gov (United States)

    Patterson, Nick; Petersen, Desiree C; van der Ross, Richard E; Sudoyo, Herawati; Glashoff, Richard H; Marzuki, Sangkot; Reich, David; Hayes, Vanessa M

    2010-02-01

    Coloured individuals and made comparisons with historically predicted founder populations. We show that there is substantial genetic contribution from at least four distinct population groups: Europeans, South Asians, Indonesians and a population genetically close to the isiXhosa sub-Saharan Bantu. This is in good accord with the historical record. We briefly examine the implications of determining the genetic diversity of this population, not only for furthering understanding of human evolution out of Africa, but also for genome-wide association studies using admixture mapping. In conclusion, we define the genetic structure of a uniquely admixed population that holds great potential to advance genetic-based medical research.

  16. Portfolio careers for medical graduates: implications for postgraduate training and workforce planning.

    Science.gov (United States)

    Eyre, Harris A; Mitchell, Rob D; Milford, Will; Vaswani, Nitin; Moylan, Steven

    2014-06-01

    Portfolio careers in medicine can be defined as significant involvement in one or more portfolios of activity beyond a practitioner's primary clinical role, either concurrently or in sequence. Portfolio occupations may include medical education, research, administration, legal medicine, the arts, engineering, business and consulting, leadership, politics and entrepreneurship. Despite significant interest among junior doctors, portfolios are poorly integrated with prevocational and speciality training programs in Australia. The present paper seeks to explore this issue. More formal systems for portfolio careers in Australia have the potential to increase job satisfaction, flexibility and retention, as well as diversify trainee skill sets. Although there are numerous benefits from involvement in portfolio careers, there are also risks to the trainee, employing health service and workforce modelling. Formalising pathways to portfolio careers relies on assessing stakeholder interest, enhancing flexibility in training programs, developing support programs, mentorship and coaching schemes and improving support structures in health services.

  17. Surgical training, duty-hour restrictions, and implications for meeting the Accreditation Council for Graduate Medical Education core competencies: views of surgical interns compared with program directors.

    Science.gov (United States)

    Antiel, Ryan M; Van Arendonk, Kyle J; Reed, Darcy A; Terhune, Kyla P; Tarpley, John L; Porterfield, John R; Hall, Daniel E; Joyce, David L; Wightman, Sean C; Horvath, Karen D; Heller, Stephanie F; Farley, David R

    2012-06-01

    To describe the perspectives of surgical interns regarding the implications of the new Accreditation Council for Graduate Medical Education (ACGME) duty-hour regulations for their training. We compared responses of interns and surgery program directors on a survey about the proposed ACGME mandates. Eleven general surgery residency programs. Two hundred fifteen interns who were administered the survey during the summer of 2011 and a previously surveyed national sample of 134 surgery program directors. Perceptions of the implications of the new duty-hour restrictions on various aspects of surgical training, including the 6 ACGME core competencies of graduate medical education, measured using 3-point scales (increase, no change, or decrease). Of 215 eligible surgical interns, 179 (83.3%) completed the survey. Most interns believed that the new duty-hour regulations will decrease continuity with patients (80.3%), time spent operating (67.4%), and coordination of patient care (57.6%), while approximately half believed that the changes will decrease their acquisition of medical knowledge (48.0%), development of surgical skills (52.8%), and overall educational experience (51.1%). Most believed that the changes will improve or will not alter other aspects of training, and 61.5% believed that the new standards will decrease resident fatigue. Surgical interns were significantly less pessimistic than surgery program directors regarding the implications of the new duty-hour restrictions on all aspects of surgical training (P training under the new paradigm of duty-hour restrictions have significant concerns about the effect of these regulations on the quality of their training.

  18. Medical Implications of Space Radiation Exposure Due to Low-Altitude Polar Orbits.

    Science.gov (United States)

    Chancellor, Jeffery C; Auñon-Chancellor, Serena M; Charles, John

    2018-01-01

    Space radiation research has progressed rapidly in recent years, but there remain large uncertainties in predicting and extrapolating biological responses to humans. Exposure to cosmic radiation and solar particle events (SPEs) may pose a critical health risk to future spaceflight crews and can have a serious impact on all biomedical aspects of space exploration. The relatively minimal shielding of the cancelled 1960s Manned Orbiting Laboratory (MOL) program's space vehicle and the high inclination polar orbits would have left the crew susceptible to high exposures of cosmic radiation and high dose-rate SPEs that are mostly unpredictable in frequency and intensity. In this study, we have modeled the nominal and off-nominal radiation environment that a MOL-like spacecraft vehicle would be exposed to during a 30-d mission using high performance, multicore computers. Projected doses from a historically large SPE (e.g., the August 1972 solar event) have been analyzed in the context of the MOL orbit profile, providing an opportunity to study its impact to crew health and subsequent contingencies. It is reasonable to presume that future commercial, government, and military spaceflight missions in low-Earth orbit (LEO) will have vehicles with similar shielding and orbital profiles. Studying the impact of cosmic radiation to the mission's operational integrity and the health of MOL crewmembers provides an excellent surrogate and case-study for future commercial and military spaceflight missions.Chancellor JC, Auñon-Chancellor SM, Charles J. Medical implications of space radiation exposure due to low-altitude polar orbits. Aerosp Med Hum Perform. 2018; 89(1):3-8.

  19. Laser Radiation Pressure Accelerator for Quasi-Monoenergetic Proton Generation and Its Medical Implications

    Science.gov (United States)

    Liu, C. S.; Shao, X.; Liu, T. C.; Su, J. J.; He, M. Q.; Eliasson, B.; Tripathi, V. K.; Dudnikova, G.; Sagdeev, R. Z.; Wilks, S.; Chen, C. D.; Sheng, Z. M.

    Laser radiation pressure acceleration (RPA) of ultrathin foils of subwavelength thickness provides an efficient means of quasi-monoenergetic proton generation. With an optimal foil thickness, the ponderomotive force of the intense short-pulse laser beam pushes the electrons to the edge of the foil, while balancing the electric field due to charge separation. The electron and proton layers form a self-organized plasma double layer and are accelerated by the radiation pressure of the laser, the so-called light sail. However, the Rayleigh-Taylor instability can limit the acceleration and broaden the energy of the proton beam. Two-dimensional particle-in-cell (PIC) simulations have shown that the formation of finger-like structures due to the nonlinear evolution of the Rayleigh-Taylor instability limits the acceleration and leads to a leakage of radiation through the target by self-induced transparency. We here review the physics of quasi-monoenergetic proton generation by RPA and recent advances in the studies of energy scaling of RPA, and discuss the RPA of multi-ion and gas targets. The scheme for generating quasi-monoenergetic protons with RPA has the potential of leading to table-top accelerators as sources for producing monoenergetic 50-250 MeV protons. We also discuss potential medical implications, such as particle therapy for cancer treatment, using quasi-monoenergetic proton beams generated from RPA. Compact monoenergetic ion sources also have applications in many other areas such as high-energy particle physics, space electronics radiation testing, and fast ignition in laser fusion.

  20. Evaluating the medication process in the context of CPOE use: the significance of working around the system.

    Science.gov (United States)

    Niazkhani, Zahra; Pirnejad, Habibollah; van der Sijs, Heleen; Aarts, Jos

    2011-07-01

    To evaluate the problems experienced after implementing a computerized physician order entry (CPOE) system, their possible root causes, and the responses of providers in order to incorporate the system into daily workflow. A qualitative study in the medication-use process after implementation of a CPOE system in an academic hospital in The Netherlands. Data included 21 interviews with clinical end-users, paper-based and system-generated documents used daily in the process, and educational materials used to train users. The problems in the medication-use process included cognitive overload on physicians and nurses, unmet information needs, miscommunication of orders and ideas, problematic coordination of interrelated tasks between co-working professionals, a potentially faulty administration phase, and suboptimal monitoring of the medication plans. These problems were mainly rooted in the lack of mobile computer devices, the uneasy integration of coexisting electronic and paper-based systems, suboptimal usability of the system, and certain organizational factors with regard to procuring drugs affecting the technology use. Various types of workarounds were used to address the difficulties, including phone calls, taking multiple paper notes, issuing paper-based and verbal orders, double-checking, using other patients' procured drugs or another department's drug supply, and modifying and annotating the printed orders. This study shows how providers are actively involved in working around the interruptions in workflow by bypassing the technology or adapting the work processes. Although certain workarounds help to maintain smooth workflow and/or to ensure patient safety, others may burden providers by necessitating extra time and effort and/or endangering patient safety. It is important that workarounds having a negative nature are recognized and discussed in order to find solutions to mitigate their effects. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  1. The "medication interest model": an integrative clinical interviewing approach for improving medication adherence-part 2: implications for teaching and research.

    Science.gov (United States)

    Shea, Shawn Christopher

    2009-01-01

    Over the past several decades, exciting advances have been made in the art and science of teaching clinical interviewing, which are supported by an ever-growing evidence base documenting their effectiveness. In this second article in a 2-part series, the training and research implications of an innovative approach to improving medication adherence based on these educational advances--the medication interest model (MIM)--are described. The objective is to provide an "insider's view" of how to creatively teach the MIM to case managers, as well as design state-of-the-art courses and research platforms dedicated to improving medication adherence through improved clinical interviewing skills in both nursing and medical student education. The teaching and research design concepts are applicable to all primary care settings as well as specialty areas from endocrinology and cardiology to psychiatry. Evidence-based advances in the teaching of clinical interviewing skills such as response-mode research, facilic supervision, microtraining, and macrotraining lend a distinctive quality and integrative power to the MIM. The model delineates several new platforms for training and research regarding the enhancement of medication adherence including an approach for collecting individual interviewing techniques into manageable "learning modules" amenable to competency evaluation and potential certification.

  2. A randomized study of multimedia informational aids for research on medical practices: Implications for informed consent.

    Science.gov (United States)

    Kraft, Stephanie A; Constantine, Melissa; Magnus, David; Porter, Kathryn M; Lee, Sandra Soo-Jin; Green, Michael; Kass, Nancy E; Wilfond, Benjamin S; Cho, Mildred K

    2017-02-01

    Participant understanding is a key element of informed consent for enrollment in research. However, participants often do not understand the nature, risks, benefits, or design of the studies in which they take part. Research on medical practices, which studies standard interventions rather than new treatments, has the potential to be especially confusing to participants because it is embedded within usual clinical care. Our objective in this randomized study was to compare the ability of a range of multimedia informational aids to improve participant understanding in the context of research on medical practices. We administered a web-based survey to members of a proprietary online panel sample selected to match national US demographics. Respondents were randomized to one of five arms: four content-equivalent informational aids (animated videos, slideshows with voice-over, comics, and text) and one no-intervention control. We measured knowledge of research on medical practices using a summary knowledge score from 10 questions based on the content of the informational aids. We used analysis of variance and paired t-tests to compare knowledge scores between arms. There were 1500 completed surveys (300 in each arm). Mean knowledge scores were highest for the slideshows with voice-over (65.7%), followed by the animated videos (62.7%), comics (60.7%), text (57.2%), and control (50.3%). Differences between arms were statistically significant except between the slideshows with voice-over and animated videos and between the animated videos and comics. Informational aids that included an audio component (animated videos and slideshows with voice-over) had higher knowledge scores than those without an audio component (64.2% vs 59.0%, p informational aids with a character-driven story component (animated videos and comics) and those without. Our results show that simple multimedia aids that use a dual-channel approach, such as voice-over with visual reinforcement, can

  3. Who is more skilful? Doping and its implication on the validity, morality and significance of the sporting test

    DEFF Research Database (Denmark)

    Christiansen, Ask Vest; Møller, Rasmus Bysted

    2016-01-01

    In this article, we explore if and in what ways doping can be regarded as a challenge to the validity, morality and significance of the sporting test. We start out by examining Kalevi Heinilä’s analysis of the logic of elite sport, which shows how the ‘spiral of competition’ leads to the use...... of ‘dubious means’. As a supplement to Heinilä, we revisit American sports historian John Hoberman’s writings on sport and technology. Then we discuss what function equality and fairness have in sport and what separates legitimate form illegitimate ways of enhancing performance. We proceed by discussing...... the line of argumentation set forth by philosopher Torbjörn Tännsjö on how our admiration of sporting superiority based on natural talent or ‘birth luck’ is immoral. We analyse his argument in favour of eliminating the significance of meritless luck in sport by lifting the ban on doping and argue that its...

  4. Psychometrics of Multiple Choice Questions with Non-Functioning Distracters: Implications to Medical Education.

    Science.gov (United States)

    Deepak, Kishore K; Al-Umran, Khalid Umran; AI-Sheikh, Mona H; Dkoli, B V; Al-Rubaish, Abdullah

    2015-01-01

    The functionality of distracters in a multiple choice question plays a very important role. We examined the frequency and impact of functioning and non-functioning distracters on psychometric properties of 5-option items in clinical disciplines. We analyzed item statistics of 1115 multiple choice questions from 15 summative assessments of undergraduate medical students and classified the items into five groups by their number of non-functioning distracters. We analyzed the effect of varying degree of non-functionality ranging from 0 to 4, on test reliability, difficulty index, discrimination index and point biserial correlation. The non-functionality of distracters inversely affected the test reliability and quality of items in a predictable manner. The non-functioning distracters made the items easier and lowered the discrimination index significantly. Three non-functional distracters in a 5-option MCQ significantly affected all psychometric properties (p psychometrically as effective as 5-option items. Our study reveals that a multiple choice question with 3 functional options provides lower most limit of item format that has adequate psychometric property. The test containing items with less number of functioning options have significantly lower reliability. The distracter function analysis and revision of nonfunctioning distracters can serve as important methods to improve the psychometrics and reliability of assessment.

  5. Significance of thymosin β4 and implication of PINCH-1-ILK-α-parvin (PIP complex in human dilated cardiomyopathy.

    Directory of Open Access Journals (Sweden)

    Nikolai Sopko

    Full Text Available Myocardial remodeling is a major contributor in the development of heart failure (HF after myocardial infarction (MI. Integrin-linked kinase (ILK, LIM-only adaptor PINCH-1, and α-parvin are essential components of focal adhesions (FAs, which are highly expressed in the heart. ILK binds tightly to PINCH-1 and α-parvin, which regulates FA assembly and promotes cell survival via the activation of the kinase Akt. Mice lacking ILK, PINCH or α-parvin have been shown to develop severe defects in the heart, suggesting that these proteins play a critical role in heart function. Utilizing failing human heart tissues (dilated cardiomyopathy, DCM, we found a 2.27-fold (p<0.001 enhanced expression of PINCH, 4 fold for α-parvin, and 10.5 fold (p<0.001 for ILK as compared to non-failing (NF counterparts. No significant enhancements were found for the PINCH isoform PINCH-2 and parvin isoform β-parvin. Using a co-immunoprecipitation method, we also found that the PINCH-1-ILK-α-parvin (PIP complex and Akt activation were significantly up-regulated. These observations were further corroborated with the mouse myocardial infarction (MI and transaortic constriction (TAC model. Thymosin beta4 (Tβ4, an effective cell penetrating peptide for treating MI, was found to further enhance the level of PIP components and Akt activation, while substantially suppressing NF-κB activation and collagen expression--the hallmarks of cardiac fibrosis. In the presence of an Akt inhibitor, wortmannin, we show that Tβ4 had a decreased effect in protecting the heart from MI. These data suggest that the PIP complex and activation of Akt play critical roles in HF development. Tβ4 treatment likely improves cardiac function by enhancing PIP mediated Akt activation and suppressing NF-κB activation and collagen-mediated fibrosis. These data provide significant insight into the role of the PIP-Akt pathway and its regulation by Tβ4 treatment in post-MI.

  6. From application to implication in medical anthropology: political, historical and narrative interpretations of the world of sickness and health.

    Science.gov (United States)

    Nunes, Mônica de Oliveira

    2014-01-01

    This article reviews some of the current writing on medical anthropology, and is guided by political orientation/implication in the choice of its study targets, its analysis and its construction of solutions for the problems investigated. Starting from the narratives of anthropologists, it goes on to show the historical and socio-political bases characteristic of the subject in their countries of origin or migration. Within a general overview of the three principal contemporary trends - critical medical anthropology, the anthropology of suffering and the anthropology of biopower - the focus is on theoretical and thematic choices to meet the demand for "politicization" of the anthropological debate in the field of health, on the basis of which an "implied" medical anthropology is advocated.

  7. Breast Cancer Epidemiology of the Working-Age Female Population Reveals Significant Implications for the South Korean Economy.

    Science.gov (United States)

    Park, Jeong Hyun; Lee, Se Kyung; Lee, Jeong Eon; Kim, Seok Won; Nam, Seok Jin; Kim, Ji-Yeon; Ahn, Jin-Seok; Park, Won; Yu, Jonghan; Park, Yeon Hee

    2018-03-01

    In this study, we aimed to evaluate the economic loss due to the diagnosis of breast cancer within the female South Korean working-age population. A population-based cost analysis was performed for cancer-related diagnoses between 1999 and 2014, using respective public government funded databases. Among the five most common cancers, breast cancer mortality was strongly associated with the growth in gross domestic product between 1999 and 2014 (R=0.98). In the female population, breast cancer represented the greatest productivity loss among all cancers, which was a consequence of the peak in the incidence of breast cancer during mid-working age in the working-age population, in addition to being the most common and fastest growing cancer among South Korean women. Our study shows that breast cancer not only represents a significant disease burden for individual patients, but also contributes a real, nonnegligible loss in productivity in the South Korean economy.

  8. Stepping reaction time and gait adaptability are significantly impaired in people with Parkinson's disease: Implications for fall risk.

    Science.gov (United States)

    Caetano, Maria Joana D; Lord, Stephen R; Allen, Natalie E; Brodie, Matthew A; Song, Jooeun; Paul, Serene S; Canning, Colleen G; Menant, Jasmine C

    2018-02-01

    Decline in the ability to take effective steps and to adapt gait, particularly under challenging conditions, may be important reasons why people with Parkinson's disease (PD) have an increased risk of falling. This study aimed to determine the extent of stepping and gait adaptability impairments in PD individuals as well as their associations with PD symptoms, cognitive function and previous falls. Thirty-three older people with PD and 33 controls were assessed in choice stepping reaction time, Stroop stepping and gait adaptability tests; measurements identified as fall risk factors in older adults. People with PD had similar mean choice stepping reaction times to healthy controls, but had significantly greater intra-individual variability. In the Stroop stepping test, the PD participants were more likely to make an error (48 vs 18%), took 715 ms longer to react (2312 vs 1517 ms) and had significantly greater response variability (536 vs 329 ms) than the healthy controls. People with PD also had more difficulties adapting their gait in response to targets (poorer stepping accuracy) and obstacles (increased number of steps) appearing at short notice on a walkway. Within the PD group, higher disease severity, reduced cognition and previous falls were associated with poorer stepping and gait adaptability performances. People with PD have reduced ability to adapt gait to unexpected targets and obstacles and exhibit poorer stepping responses, particularly in a test condition involving conflict resolution. Such impaired stepping responses in Parkinson's disease are associated with disease severity, cognitive impairment and falls. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Accumulation of genistein and daidzein, soybean isoflavones implicated in promoting human health, is significantly elevated by irrigation.

    Science.gov (United States)

    Bennett, John O; Yu, Oliver; Heatherly, Larry G; Krishnan, Hari B

    2004-12-15

    To circumvent drought conditions persisting during seed fill in the mid-south U.S. soybean production region, researchers have developed the early soybean (Glycine max [L.] Merr.) production system (ESPS), which entails early planting of short-season varieties. Because soybean supplies a preponderance of the world's protein and oil and consumption of soy-based foods has been associated with multiple health benefits, the effects of this agronomic practice on seed quality traits such as protein, oil, and isoflavones should be investigated. Four cultivars of soybean, two from maturity group IV and two from maturity group V, were planted in April (ESPS) and May (traditional) in a two-year study at Stoneville, MS. Near-infrared analysis of soybean seed was utilized to determine the percentages of protein and oil. Dependent upon variety, the oil content of the early-planted crop was increased by 3-8%, whereas protein was not significantly changed. Visualization of protein extracts fractionated by sodium dodecyl sulfate-polyacrylamide electrophoresis and fluorescence two-dimensional difference gel electrophoresis revealed that early planting did not affect the relative accumulation of the major seed-storage proteins; thus, protein composition was equal to that of traditionally cultivated soybeans. Maturity group IV cultivars contained a higher percentage of oil and a lower percentage of protein than did the maturity group V cultivars, regardless of planting date. Gas chromatographic separation of fatty acids revealed that the percentages of saturated and unsaturated fatty acids were not significantly altered by planting date. Methanol extracts of seed harvested from different planting dates when analyzed by high-performance liquid chromatography showed striking differences in isoflavone content. Dependent upon the variety, total isoflavone content was increased as much as 1.3-fold in early-planted soybeans. Irrigation enhanced the isoflavone content of both early- and

  10. Food Classification Systems Based on Food Processing: Significance and Implications for Policies and Actions: A Systematic Literature Review and Assessment.

    Science.gov (United States)

    Moubarac, Jean-Claude; Parra, Diana C; Cannon, Geoffrey; Monteiro, Carlos A

    2014-06-01

    This paper is the first to make a systematic review and assessment of the literature that attempts methodically to incorporate food processing into classification of diets. The review identified 1276 papers, of which 110 were screened and 21 studied, derived from five classification systems. This paper analyses and assesses the five systems, one of which has been devised and developed by a research team that includes co-authors of this paper. The quality of the five systems is assessed and scored according to how specific, coherent, clear, comprehensive and workable they are. Their relevance to food, nutrition and health, and their use in various settings, is described. The paper shows that the significance of industrial food processing in shaping global food systems and supplies and thus dietary patterns worldwide, and its role in the pandemic of overweight and obesity, remains overlooked and underestimated. Once food processing is systematically incorporated into food classifications, they will be more useful in assessing and monitoring dietary patterns. Food classification systems that emphasize industrial food processing, and that define and distinguish relevant different types of processing, will improve understanding of how to prevent and control overweight, obesity and related chronic non-communicable diseases, and also malnutrition. They will also be a firmer basis for rational policies and effective actions designed to protect and improve public health at all levels from global to local.

  11. Coronary risk assessment by point-based vs. equation-based Framingham models: significant implications for clinical care.

    Science.gov (United States)

    Gordon, William J; Polansky, Jesse M; Boscardin, W John; Fung, Kathy Z; Steinman, Michael A

    2010-11-01

    US cholesterol guidelines use original and simplified versions of the Framingham model to estimate future coronary risk and thereby classify patients into risk groups with different treatment strategies. We sought to compare risk estimates and risk group classification generated by the original, complex Framingham model and the simplified, point-based version. We assessed 2,543 subjects age 20-79 from the 2001-2006 National Health and Nutrition Examination Surveys (NHANES) for whom Adult Treatment Panel III (ATP-III) guidelines recommend formal risk stratification. For each subject, we calculated the 10-year risk of major coronary events using the original and point-based Framingham models, and then compared differences in these risk estimates and whether these differences would place subjects into different ATP-III risk groups (20% risk). Using standard procedures, all analyses were adjusted for survey weights, clustering, and stratification to make our results nationally representative. Among 39 million eligible adults, the original Framingham model categorized 71% of subjects as having "moderate" risk (20%) risk. Estimates of coronary risk by the original and point-based models often differed substantially. The point-based system classified 15% of adults (5.7 million) into different risk groups than the original model, with 10% (3.9 million) misclassified into higher risk groups and 5% (1.8 million) into lower risk groups, for a net impact of classifying 2.1 million adults into higher risk groups. These risk group misclassifications would impact guideline-recommended drug treatment strategies for 25-46% of affected subjects. Patterns of misclassifications varied significantly by gender, age, and underlying CHD risk. Compared to the original Framingham model, the point-based version misclassifies millions of Americans into risk groups for which guidelines recommend different treatment strategies.

  12. Cytochrome c oxidase inhibition by calcium at physiological ionic composition of the medium: Implications for physiological significance of the effect.

    Science.gov (United States)

    Vygodina, Tatiana V; Mukhaleva, Elizaveta; Azarkina, Natalia V; Konstantinov, Alexander A

    2017-12-01

    Cytochrome c oxidase (CcO) from mammalian mitochondria binds Ca 2+ and Na + in a special cation binding site. Binding of Ca 2+ brings about partial inhibition of the enzyme while Na + competes with Ca 2+ for the binding site and protects the enzyme from the inhibition [Vygodina, T., Kirichenko, A. and Konstantinov, A.A. (2013). Direct Regulation of Cytochrome c oxidase by Calcium Ions. PLoS One 8(9): e74436]. In the original studies, the inhibition was found to depend significantly on the ionic composition of the buffer. Here we describe inhibition of CcO by Ca 2+ in media containing the main ionic components of cytoplasm (150mM KCl, 12mM NaCl and 1mM MgCl 2 ). Under these conditions, Ca 2+ inhibits CcO with effective K i of 20-26μM, that is an order of magnitude higher than determined earlier in the absence of Na + . At physiological value of ionic strength, the inhibition can be observed at any turnover number of CcO, rather than only at low TN (calcium matches closely the known value of "K m " for Ca 2+ -induced activation of the mitochondrial calcium uniporter. The inhibition of CcO by Ca 2+ is proposed to modulate mitochondrial Ca 2+ -uptake via the mitochondrial calcium uniporter, promote permeability transition pore opening and induce reduction of Mia40 in the mitochondrial intermembrane space. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. An Industry Perspective on Canadian Patients' Involvement in Medical Tourism: Implications for Public Health

    OpenAIRE

    Johnston, Rory; Crooks, Valorie A.; Adams, Krystyna; Kingsbury, Paul; Snyder, Jeremy

    2011-01-01

    Abstract Background The medical tourism industry, which assists patients with accessing non-emergency medical care abroad, has grown rapidly in recent years. A lack of reliable data about medical tourism makes it difficult to create policy, health system, and public health responses to address the associated risks and shortcomings, such as spread of infectious diseases, associated with this industry. This article addresses this knowledge gap by analyzing interviews conducted with Canadian med...

  14. Tension-type Headache With Medication Overuse: Pathophysiology and Clinical Implications

    OpenAIRE

    Monteith, Teshamae S.; Oshinsky, Michael L.

    2009-01-01

    Tension-type headache (TTH) is the most prevalent primary headache disorder. An important factor in the long-term prognosis of TTH is the overuse of acute medications used to treat headache. There are many reasons why patients with TTH overuse acute medications, including biobehavioral influences, dependency, and a lack of patient education. Chronic daily headache occurs in 4.1% of the general population, and chronic tension-type headache and medication overuse headache (MOH) occur in approxi...

  15. The impact of public hospital closure on medical and residency education: implications and recommendations.

    Science.gov (United States)

    Walker, Kara Odom; Calmes, Daphne; Hanna, Nancy; Baker, Richard

    2008-12-01

    Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices. To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents. Retrospective cohort study of medical students' and residents' and clinical placement into safety-net experiences after the closure of the primary teaching hospital. The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County. While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location.

  16. Life-Metaphors among Colombian Medical Students: Uncovering Core Values and Educational Implications

    Science.gov (United States)

    Hoffman, Edward; Acosta-Orozco, Catalina; Compton, William C.

    2015-01-01

    The present study utilized metaphor analysis to examine the core values of Colombian medical students. The entire 9th semester medical class of 60 students was invited to respond to a structured questionnaire. It asked participants to state their preferred life-metaphor, whether they had always preferred this metaphor since childhood or…

  17. Late-onset Tay-Sachs disease: adverse effects of medications and implications for treatment.

    Science.gov (United States)

    Shapiro, B E; Hatters-Friedman, S; Fernandes-Filho, J A; Anthony, K; Natowicz, M R

    2006-09-12

    The authors conducted a retrospective and brief prospective study of adverse effects of approximately 350 medications in 44 adults with late-onset Tay-Sachs disease (LOTS). Some medications were relatively safe, whereas others, particularly haloperidol, risperidone, and chlorpromazine, were associated with neurologic worsening.

  18. Economic Implications of Changes in Financing Medical Education. The Rand Paper Series P-5150.

    Science.gov (United States)

    Koehler, John E.; Williams, Albert P., Jr.

    To increase the supply of doctors, the government has become directly involved in physician education. Of the $673 million appropriated for health manpower programs in 1972, 55% was for medical schools. Legislation to date has emphasized expansion of medical education output in the aggregate, but increasing attention has been directed to the…

  19. Rural origin plus a rural clinical school placement is a significant predictor of medical students' intentions to practice rurally: a multi-university study.

    Science.gov (United States)

    Walker, Judith H; Dewitt, Dawn E; Pallant, Julie F; Cunningham, Christine E

    2012-01-01

    Health workforce shortages are a major problem in rural areas. Australian medical schools have implemented a number of rural education and training interventions aimed at increasing medical graduates' willingness to work in rural areas. These initiatives include recruiting students from rural backgrounds, delivering training in rural areas, and providing all students with some rural exposure during their medical training. However there is little evidence regarding the impact of rural exposure versus rural origin on workforce outcomes. The aim of this study is to identify and assess factors affecting preference for future rural practice among medical students participating in the Australian Rural Clinical Schools (RCS) Program. Questionnaires were distributed to 166 medical students who had completed their RCS term in 2006; 125 (75%) responded. Medical students were asked about their preferred location and specialty for future practice, their beliefs about rural work and life, and the impact of the RCS experience on their future rural training and practice preferences. Almost half the students (47%; n=58) self-reported a 'rural background'. Significantly, students from rural backgrounds were 10 times more likely to prefer to work in rural areas when compared with other students (ppreferring general practice, 80% (n=24) wished to do so rurally. Eighty-five per cent (n=105) of students agreed that their RCS experience increased their interest in rural training and practice with 62% (n=75) of students indicating a preference for rural internship/basic training after their RCS experience. A substantial percentage (86%; n=108) agreed they would consider rural practice after their RCS experience. This baseline study provides significant evidence to support rural medical recruitment and retention through education and training, with important insights into the factors affecting preference for future rural practice. By far the most significant predictor of rural practice

  20. Increased superior frontal gyrus activation during working memory processing in psychosis: Significant relation to cumulative antipsychotic medication and to negative symptoms.

    Science.gov (United States)

    Vogel, Tobias; Smieskova, Renata; Schmidt, André; Walter, Anna; Harrisberger, Fabienne; Eckert, Anne; Lang, Undine E; Riecher-Rössler, Anita; Graf, Marc; Borgwardt, Stefan

    2016-08-01

    Impairment in working memory (WM) is a core symptom in schizophrenia. However, little is known about how clinical features influence functional brain activity specific to WM processing during the development of first-episode psychosis (FEP) to schizophrenia (SZ). We compared functional WM-specific brain activity in FEP and SZ patients, including the effects of the duration of illness, psychopathological factors and antipsychotic medication. Cross-sectional study of male FEP (n=22) and SZ (n=20) patients performing an n-back task when undergoing functional magnetic resonance imaging (fMRI). Clinical features were collected by semi-structured interviews and medical records. The SZ group performed significantly worse than the FEP group in the 2-back condition. The SZ group also showed significantly higher activation in the left superior frontal gyrus in the 2-back versus 0-back condition (2-back>0-back). This frontal activation correlated positively with negative symptoms and with cumulative antipsychotic medication during the year before the fMRI examination. There were no significant correlations between activation and duration of illness. There was greater frontal neural activation in SZ than in FEP. This indicated differences in WM processing, and was significantly related to cumulative antipsychotic exposure and negative symptoms, but not to the duration of illness. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. Not afraid to blame: the neglected role of blame attribution in medical consumerism and some implications for health policy.

    Science.gov (United States)

    Rosenthal, Marsha; Schlesinger, Mark

    2002-01-01

    A crucial aspect of medical consumerism has been overlooked in past research and policymaking: how consumers decide whom to "blame" for bad outcomes. This study explores how, in a system increasingly dominated by managed care, these attributions affect consumers' attitudes and behavior. Using data from the experiences of people with serious mental illness, hypotheses are tested regarding the origins and consequences of blaming for medical consumerism. Blame was allocated to health plans in a manner similar, but not identical, to the way in which blame was allocated to health care professionals. Both allocations are shaped by enrollment in managed care, with blame allocation affecting consumers' subsequent willingness to talk about adverse events. Policy implications include the need for more finely tuned grievance procedures and better consumer education about managed care practices.

  2. The impact of socially-accountable, community-engaged medical education on graduates in the Central Philippines: Implications for the global rural medical workforce.

    Science.gov (United States)

    Siega-Sur, J L; Woolley, T; Ross, S J; Reeve, C; Neusy, A-J

    2017-10-01

    Developing and retaining a high quality medical workforce, especially within low-resource countries has been a world-wide challenge exacerbated by a lack of medical schools, the maldistribution of doctors towards urban practice, health system inequities, and training doctors in tertiary centers rather than in rural communities. To describe the impact of socially-accountable health professional education on graduates; specifically: their motivation towards community-based service, preparation for addressing local priority health issues, career choices, and practice location. Cross-sectional survey of graduates from two medical schools in the Philippines: the University of Manila-School of Health Sciences (SHS-Palo) and a medical school with a more conventional curriculum. SHS-Palo graduates had significantly (p < 0.05) more positive attitudes to community service. SHS-Palo graduates were also more likely to work in rural and remote areas (p < 0.001) either at district or provincial hospitals (p = 0.032) or in rural government health services (p < 0.001) as Municipal or Public Health Officers (p < 0.001). Graduates also stayed longer in both their first medical position (p = 0.028) and their current position (p < 0.001). SHS-Palo medical graduates fulfilled a key aim of their socially-accountable institution to develop a health professional workforce willing and able, and have a commitment to work in underserved rural communties.

  3. The Net Present Value and Other Economic Implications of a Medical Career.

    Science.gov (United States)

    Reinhardt, Uwe E

    2017-07-01

    College graduates' career choices are driven by a complex mixture of factors, one of which is economics. The author comments on the report by Marcu and colleagues in this issue, which focuses strictly on the economics of this decision. Specifically, Marcu and colleagues modeled career choices as long-term financial investments in human capital, which consists of the knowledge and clinical skills physicians gain in undergraduate and graduate medical education. They distill the numerous factors that shape the economics of career choice into a commonly used criterion for long-term financial investments of any kind-namely, the so-called net present value (NPV) of the investment. For them, that investment is the decision to pursue a medical career rather than the next best nonmedical, alternative career. This NPV calculation determines the increase or decrease in wealth, relative to that of the next best alternative career, that a college graduate is thought to experience as of the moment she or he enters medical school simply by choosing a medical career rather than the next best alternative. Marcu and colleagues use this human capital model to explore how different plans to finance a medical school education impact the NPV, all other parameters being equal. The author of this Commentary explains in layman's terms how the NPV is calculated and then raises a number of other issues concerning the economics of a medical career, including medical school tuition, residents' salaries, and investments in human capital as tax deductible.

  4. Identifying deficiencies in national and foreign medical team responses through expert opinion surveys: implications for education and training.

    Science.gov (United States)

    Djalali, Ahmadreza; Ingrassia, Pier Luigi; Corte, Francesco Della; Foletti, Marco; Gallardo, Alba Ripoll; Ragazzoni, Luca; Kaptan, Kubilay; Lupescu, Olivera; Arculeo, Chris; von Arnim, Gotz; Friedl, Tom; Ashkenazi, Michael; Heselmann, Deike; Hreckovski, Boris; Khorram-Manesh, Amir; Khorrram-Manesh, Amir; Komadina, Radko; Lechner, Kostanze; Patru, Cristina; Burkle, Frederick M; Fisher, Philipp

    2014-08-01

    Unacceptable practices in the delivery of international medical assistance are reported after every major international disaster; this raises concerns about the clinical competence and practice of some foreign medical teams (FMTs). The aim of this study is to explore and analyze the opinions of disaster management experts about potential deficiencies in the art and science of national and FMTs during disasters and the impact these opinions might have on competency-based education and training. This qualitative study was performed in 2013. A questionnaire-based evaluation of experts' opinions and experiences in responding to disasters was conducted. The selection of the experts was done using the purposeful sampling method, and the sample size was considered by data saturation. Content analysis was used to explore the implications of the data. This study shows that there is a lack of competency-based training for disaster responders. Developing and performing standardized training courses is influenced by shortcomings in budget, expertise, and standards. There is a lack of both coordination and integration among teams and their activities during disasters. The participants of this study emphasized problems concerning access to relevant resources during disasters. The major findings of this study suggest that teams often are not competent during the response phase because of education and training deficiencies. Foreign medical teams and medically related nongovernmental organizations (NGOs) do not always provide expected capabilities and services. Failures in leadership and in coordination among teams are also a problem. All deficiencies need to be applied to competency-based curricula.

  5. The globalization of healthcare: implications of medical tourism for the infectious disease clinician.

    Science.gov (United States)

    Chen, Lin H; Wilson, Mary E

    2013-12-01

    Travel abroad for healthcare has increased rapidly; interventions include organ transplant; cardiac surgery; reproductive care; and joint, cosmetic, and dental procedures. Individuals who receive medical care abroad are a vulnerable, sentinel population, who sample the local environment and can carry home unusual and resistant infections, documented in many reports. Medical tourists are at risk for hospital-associated and procedure-related infections as well as for locally endemic infections. Patients may not volunteer details about care abroad, so clinicians must inquire about medical procedures abroad as well as recent travel. Special infection control measures may be warranted. Healthcare abroad is associated with diverse financial, legal, ethical, and health-related issues. We focus on problems the infectious disease clinician may encounter and provide a framework for evaluating returned medical tourists with suspected infections. A better system is needed to ensure broad access to high-quality health services, continuity of care, and surveillance for complications.

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

    Science.gov (United States)

    Sharpe, V A

    1992-12-01

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

  7. Veterinary Homeopathy: The Implications of Its History for Unorthodox Veterinary Concepts and Veterinary Medical Education.

    Science.gov (United States)

    Coulter, Dwight B.

    1979-01-01

    The history of veterinary homeopathy, its future and implications are discussed. The need for investigation into the validity of both allopathic and homeopathic claims is stressed and it is suggested that maintenance of quality is the key factor in any approach. (BH)

  8. Comparability of outcome frameworks in medical education: Implications for framework development.

    Science.gov (United States)

    Hautz, Stefanie C; Hautz, Wolf E; Feufel, Markus A; Spies, Claudia D

    2015-01-01

    Given the increasing mobility of medical students and practitioners, there is a growing need for harmonization of medical education and qualifications. Although several initiatives have sought to compare national outcome frameworks, this task has proven a challenge. Drawing on an analysis of existing outcome frameworks, we identify factors that hinder comparability and suggest ways of facilitating comparability during framework development and revisions. We searched MedLine, EmBase and the Internet for outcome frameworks in medical education published by national or governmental organizations. We analyzed these frameworks for differences and similarities that influence comparability. Of 1816 search results, 13 outcome frameworks met our inclusion criteria. These frameworks differ in five core features: history and origins, formal structure, medical education system, target audience and key terms. Many frameworks reference other frameworks without acknowledging these differences. Importantly, the level of detail of the outcomes specified differs both within and between frameworks. The differences identified explain some of the challenges involved in comparing outcome frameworks and medical qualifications. We propose a two-level model distinguishing between "core" competencies and culture-specific "secondary" competencies. This approach could strike a balance between local specifics and cross-national comparability of outcome frameworks and medical education.

  9. Modeling determinants of medication attitudes and poor adherence in early nonaffective psychosis: implications for intervention.

    Science.gov (United States)

    Drake, Richard J; Nordentoft, Merete; Haddock, Gillian; Arango, Celso; Fleischhacker, W Wolfgang; Glenthøj, Birte; Leboyer, Marion; Leucht, Stefan; Leweke, Markus; McGuire, Phillip; Meyer-Lindenberg, Andreas; Rujescu, Dan; Sommer, Iris E; Kahn, René S; Lewis, Shon W

    2015-05-01

    We aimed to design a multimodal intervention to improve adherence following first episode psychosis, consistent with current evidence. Existing literature identified medication attitudes, insight, and characteristics of support as important determinants of adherence to medication: we examined medication attitudes, self-esteem, and insight in an early psychosis cohort better to understand their relationships. Existing longitudinal data from 309 patients with early Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nonaffective psychosis (83% first episode) were analyzed to test the hypothesis that medication attitudes, while meaningfully different from "insight," correlated with insight and self-esteem, and change in each influenced the others. Rosenberg Self-Esteem Scale, Birchwood Insight Scale, and Positive and Negative Syndrome Scale insight were assessed at presentation, after 6 weeks and 3 and 18 months. Drug Attitudes Inventory (DAI) and treatment satisfaction were rated from 6 weeks onward. Structural equation models of their relationships were compared. Insight measures' and DAI's predictive validity were compared against relapse, readmission, and remission. Analysis found five latent constructs best fitted the data: medication attitudes, self-esteem, accepting need for treatment, self-rated insight, and objective insight. All were related and each affected the others as it changed, except self-esteem and medication attitudes. Low self-reported insight at presentation predicted readmission. Good 6-week insight (unlike drug attitudes) predicted remission. Literature review and data modeling indicated that a multimodal intervention using motivational interviewing, online psychoeducation, and SMS text medication reminders to enhance adherence without damaging self-concept was feasible and appropriate. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For

  10. Making reasonable decisions: a qualitative study of medical decision making in the care of patients with a clinically significant haemoglobin disorder.

    Science.gov (United States)

    Crowther, Helen J; Kerridge, Ian

    2015-10-01

    Therapies utilized in patients with clinically significant haemoglobin disorders appear to vary between clinicians and units. This study aimed to investigate the processes of evidence implementation and medical decision making in the care of such patients in NSW, Australia. Using semi-structured interviews, 11 haematologists discussed their medical decision-making processes with particular attention paid to the use of published evidence. Transcripts were thematically analysed by a single investigator on a line-by-line basis. Decision making surrounding the care of patients with significant haemoglobin disorders varied and was deeply contextual. Three main determinants of clinical decision making were identified - factors relating to the patient and to their illness, factors specific to the clinician and the institution in which they were practising and factors related to the notion of evidence and to utility and role of evidence-based medicine in clinical practice. Clinicians pay considerable attention to medical decision making and evidence incorporation and attempt to tailor these to particular patient contexts. However, the patient context is often inferred and when discordant with the clinician's own contexture can lead to discomfort with decision recommendations. Clinicians strive to improve comfort through the use of experience and trustworthy evidence. © 2015 John Wiley & Sons, Ltd.

  11. Rape as a legal indication for abortion: implications and consequences of the medical examination requirement.

    Science.gov (United States)

    Teklehaimanot, K I; Smith, C Hord

    2004-01-01

    A number of countries adopt abortion laws recognizing rape as a legal ground for access to safe abortion service. As rape is a crime, these abortion laws carry with them criminal and health care elements that in turn result in the involvement of legal and medical expertise. The most common objective of the laws should be providing safe abortion services to women survivors of rape. Depending on purposes of a given abortion law, the laws usually require women to undergo a medical examination to qualify for a legal abortion. Some abortion laws are so vague as to result in uncertainties regarding the steps health personnel must follow in conducting medical examination. Another group of abortion laws do not leave room for regulation and remain too rigid to respond to changing socio-economic circumstances. Still others require medical examination as a prerequisite for abortion. As a result, a number of abortion laws remain on the books. The paper attempts to analyze legal and practical issues related to medical examination in rape cases.

  12. Factors that influence medical student selection of an emergency medicine residency program: implications for training programs.

    Science.gov (United States)

    Love, Jeffrey N; Howell, John M; Hegarty, Cullen B; McLaughlin, Steven A; Coates, Wendy C; Hopson, Laura R; Hern, Gene H; Rosen, Carlo L; Fisher, Jonathan; Santen, Sally A

    2012-04-01

    An understanding of student decision-making when selecting an emergency medicine (EM) training program is essential for program directors as they enter interview season. To build upon preexisting knowledge, a survey was created to identify and prioritize the factors influencing candidate decision-making of U.S. medical graduates. This was a cross-sectional, multi-institutional study that anonymously surveyed U.S. allopathic applicants to EM training programs. It took place in the 3-week period between the 2011 National Residency Matching Program (NRMP) rank list submission deadline and the announcement of match results. Of 1,525 invitations to participate, 870 candidates (57%) completed the survey. Overall, 96% of respondents stated that both geographic location and individual program characteristics were important to decision-making, with approximately equal numbers favoring location when compared to those who favored program characteristics. The most important factors in this regard were preference for a particular geographic location (74.9%, 95% confidence interval [CI] = 72% to 78%) and to be close to spouse, significant other, or family (59.7%, 95% CI = 56% to 63%). Factors pertaining to geographic location tend to be out of the control of the program leadership. The most important program factors include the interview experience (48.9%, 95% CI = 46% to 52%), personal experience with the residents (48.5%, 95% CI = 45% to 52%), and academic reputation (44.9%, 95% CI = 42% to 48%). Unlike location, individual program factors are often either directly or somewhat under the control of the program leadership. Several other factors were ranked as the most important factor a disproportionate number of times, including a rotation in that emergency department (ED), orientation (academic vs. community), and duration of training (3-year vs. 4-year programs). For a subset of applicants, these factors had particular importance in overall decision-making. The vast majority

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

    Science.gov (United States)

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

    2012-02-01

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

  14. Public policy and medical tourism: ethical implications for the Egyptian health care system.

    Science.gov (United States)

    Haley, Bob

    2011-01-01

    Egypt's medical tourism industry has been experiencing tremendous growth. However, Egypt continues to lack the necessary investment in its public health system to effectively care for its population. Current policy and the emergence of medical tourism have led to unequal health care access, resulting in high a prevalence of infectious diseases and lack of resources for its most vulnerable populations. As a new Egyptian government emerges, it is important for policymakers to understand the critical issues and ethical concerns of existing health policy. This understanding may be used to propose new policy that more effectively allocates to care for Egypt's population.

  15. Conceptualizing the Research Culture in Postgraduate Medical Education: Implications for Leading Culture Change.

    Science.gov (United States)

    O'Brien, Jennifer M

    2015-12-01

    By recognizing symbols of research culture in postgraduate medical education, educators and trainees can gain a deeper understanding of the existing culture and mechanisms for its transformation. First, I identify symbolic manifestations of the research culture through a case narrative of a single anesthesia residency program, and I offer a visual conceptualization of the research culture. In the second part, I theorize the application of Senge's (1994) disciplines of a learning organization and discuss leverage for enhancing research culture. This narrative account is offered to inform the work of enhancing the broader research culture in postgraduate medical education.

  16. Rework and workarounds in nurse medication administration process: implications for work processes and patient safety.

    Science.gov (United States)

    Halbesleben, Jonathon R B; Savage, Grant T; Wakefield, Douglas S; Wakefield, Bonnie J

    2010-01-01

    Health care organizations have redesigned existing and implemented new work processes intended to improve patient safety. As a consequence of these process changes, there are now intentionally designed "blocks" or barriers that limit how specific work actions, such as ordering and administering medication, are to be carried out. Health care professionals encountering these designed barriers can choose to either follow the new process, engage in workarounds to get past the block, or potentially repeat work (rework). Unfortunately, these workarounds and rework may lead to other safety concerns. The aim of this study was to examine rework and workarounds in hospital medication administration processes. Observations and semistructured interviews were conducted with 58 nurses from four hospital intensive care units focusing on the medication administration process. Using the constant comparative method, we analyzed the observation and interview data to develop themes regarding rework and workarounds. From this analysis, we developed an integrated process map of the medication administration process depicting blocks. A total of 12 blocks were reported by the participants. Based on the analysis, we categorized them as related to information exchange, information entry, and internal supply chain issues. Whereas information exchange and entry blocks tended to lead to rework, internal supply chain issues were more likely to lead to workarounds. A decentralized pharmacist on the unit may reduce work flow blocks (and, thus, workarounds and rework). Work process redesign may further address the problems of workarounds and rework.

  17. The Changing Health Care Landscape and Implications of Organizational Ethics on Modern Medical Practice

    NARCIS (Netherlands)

    Castlen, Joseph P; Cote, David J; Moojen, Wouter A.; Robe, Pierre A.; Balak, Naci; Brennum, Jannick; Ammirati, Mario; Mathiesen, Tiit; Broekman, Marike L.D.

    2017-01-01

    Introduction Medicine is rapidly changing, both in the level of collective medical knowledge and in how it is being delivered. The increased presence of administrators in hospitals helps to facilitate these changes and ease administrative workloads on physicians; however, tensions sometimes form

  18. Name Changes in Medically Important Fungi and Their Implications for Clinical Practice

    DEFF Research Database (Denmark)

    de Hoog, G. Sybren; Chaturvedi, Vishnu; Denning, David W.

    2015-01-01

    Recent changes in the Fungal Code of Nomenclature and developments in molecular phylogeny are about to lead to dramatic changes in the naming of medically important molds and yeasts. In this article, we present a widely supported and simple proposal to prevent unnecessary nomenclatural instability....

  19. Work/Life Balance Issues for Female Physicians and Implications for Medical Education

    Science.gov (United States)

    Corder, Paige Frances

    2016-01-01

    Work/life balance issues exist for all people who navigate both professional and personal responsibilities, regardless of profession, gender, marital status, or number of children. This research sought to better understand the specific work/life balance challenges faced by female physicians and how medical education can better prepare future…

  20. Choice of Future Career amongst Medical Students in Enugu, Nigeria: Implications for Anaesthesia

    Directory of Open Access Journals (Sweden)

    T C Onyeka

    2010-01-01

    Conclusion - This study has highlighted a very low level of interest for anaesthesia amongst Nigerian undergraduates. It also showed that ability to pursue other hobbies, availability of posts as well as academic and research opportunities are the main influencing factors in the choice of future specialty.We call for urgent measures be put in place tomake anaesthesia more attractive to young medical graduates

  1. Name changes in medically important fungi and their implications for clinical practice

    NARCIS (Netherlands)

    de Hoog, G Sybren; Chaturvedi, Vishnu; Denning, David W; Dyer, Paul S; Frisvad, Jens Christian; Geiser, David; Gräser, Yvonne; Guarro, Josep; Haase, Gerhard; Kwon-Chung, Kyung-Joo; Meis, Jacques F; Meyer, Wieland; Pitt, John I; Samson, Robert A; Taylor, John W; Tintelnot, Kathrin; Vitale, Roxana G; Walsh, Thomas J; Lackner, Michaela

    2014-01-01

    Recent changes in the Fungal Code of Nomenclature and developments in molecular phylogeny are about to lead to dramatic changes in the naming of medically important moulds and yeasts. In this article, we present a widely supported and simple proposal to prevent unnecessary nomenclatural instability.

  2. Medical implications of ultra marathon running: observations on a six day track race.

    OpenAIRE

    Hutson, M. A.

    1984-01-01

    Medical records were kept of the injuries and illnesses sustained by competitors in a six day running race held in Nottingham in August 1982. The overall rate of injuries sufficiently severe to affect running performance was 60 per cent. These injuries are itemised and discussed with particular reference to the problems raised by this ultra distance race.

  3. Identifying the Dominant Personality Profiles in Medical Students: Implications for Their Well-Being and Resilience.

    Science.gov (United States)

    Eley, Diann S; Leung, Janni; Hong, Barry A; Cloninger, Kevin M; Cloninger, C Robert

    2016-01-01

    There is a high prevalence of stress, depression, and burn-out in medical students. Medical students differ widely in personality traits, self-perceptions, and values that may have an impact on their well-being. This study aimed to investigate variability in their personality profiles in relation to their potential for well-being and resilience. Participants were 808 medical students from The University of Queensland. An online questionnaire collected socio-demographics and the Temperament and Character Inventory to assess personality traits. Latent profile analyses identified students' trait profiles. Two distinct personality profiles were identified. Profile 1 ("Resilient") characterized 60% of the sample and was distinguished by low Harm Avoidance combined with very high Persistence, Self-Directedness and Cooperativeness compared to Profile 2 ("Conscientious"). Both Profiles had average levels of Reward Dependence and Novelty Seeking and low levels of Self-Transcendence. Profiles did not differ by age, gender, or country of birth, but rural background students were more likely to have Profile 1. While both Profiles indicate mature and healthy personalities, the combination of traits in Profile 1 is more strongly indicative of well-being and resilience. Finding two distinct profiles of personality highlights the importance of considering combinations of traits and how they may interact with medical students' potential for well-being. Although both profiles of students show healthy personalities, many may lack the resilience to maintain well-being over years of medical training. Programs that develop character and personality self-awareness would enhance their well-being and prepare them to promote the health of their patients.

  4. Software-Related Recalls of Health Information Technology and Other Medical Devices: Implications for FDA Regulation of Digital Health.

    Science.gov (United States)

    Ronquillo, Jay G; Zuckerman, Diana M

    2017-09-01

    Policy Points: Medical software has become an increasingly critical component of health care, yet the regulation of these devices is inconsistent and controversial. No studies of medical devices and software assess the impact on patient safety of the FDA's current regulatory safeguards and new legislative changes to those standards. Our analysis quantifies the impact of software problems in regulated medical devices and indicates that current regulations are necessary but not sufficient for ensuring patient safety by identifying and eliminating dangerous defects in software currently on the market. New legislative changes will further deregulate health IT, reducing safeguards that facilitate the reporting and timely recall of flawed medical software that could harm patients. Medical software has become an increasingly critical component of health care, yet the regulatory landscape for digital health is inconsistent and controversial. To understand which policies might best protect patients, we examined the impact of the US Food and Drug Administration's (FDA's) regulatory safeguards on software-related technologies in recent years and the implications for newly passed legislative changes in regulatory policy. Using FDA databases, we identified all medical devices that were recalled from 2011 through 2015 primarily because of software defects. We counted all software-related recalls for each FDA risk category and evaluated each high-risk and moderate-risk recall of electronic medical records to determine the manufacturer, device classification, submission type, number of units, and product details. A total of 627 software devices (1.4 million units) were subject to recalls, with 12 of these devices (190,596 units) subject to the highest-risk recalls. Eleven of the devices recalled as high risk had entered the market through the FDA review process that does not require evidence of safety or effectiveness, and one device was completely exempt from regulatory review

  5. Evaluating the Impact of the Medical Education Partnership Initiative at the University of Zimbabwe College of Health Sciences Using the Most Significant Change Technique.

    Science.gov (United States)

    Connors, Susan C; Nyaude, Shemiah; Challender, Amelia; Aagaard, Eva; Velez, Christine; Hakim, James

    2017-09-01

    In medical education, evaluating outcomes from programs intended to transform attitudes or influence career trajectories using conventional methods of monitoring is often difficult. To address this problem, the authors adapted the most significant change (MSC) technique to gain a more comprehensive understanding of the impact of the Medical Education Partnership Initiative (MEPI) program at the University of Zimbabwe College of Health Sciences. In 2014-2015, the authors applied the MSC to systematically examine the personal significance and level of positive transformation that individuals attributed to their MEPI participation. Interviews were conducted with 28 participants nominated by program leaders. The authors coded results inductively for prevalent themes in participants' stories and prepared profiles with representative quotes to place the stories in context. Stakeholders selected 9 themes and 18 stories to illustrate the most significant changes. Six themes (or outcomes) were expected, as they aligned with MEPI goals-becoming a better teacher, becoming a better clinician, increased interest in teaching, increased interest in research, new career pathways (including commitment to practice in Zimbabwe), and improved research skills. Three themes were unexpected-increased confidence, expanded interprofessional networks, and improved interpersonal interactions. The authors found the MSC to be a useful and systematic evaluation approach for large, complex, and transformative initiatives like MEPI. The MSC seemed to encourage participant reflection, support values inquiry by program leaders, and provide insights into the personal and cultural impacts of MEPI. Additional trial applications of the MSC technique in academic medicine are warranted.

  6. Enforcement actions: Significant actions resolved, material licensees (non-medical). Quarterly progress report, July--September 1994: Volume 13, Number 3, Part 3

    International Nuclear Information System (INIS)

    1994-12-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (July--September 1994) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to material licensees (non-medical) with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated the managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  7. Enforcement actions: Significant actions resolved material licensees (non-medical). Volume 14, No. 1, Part 3, Quarterly progress report, January--March 1995

    International Nuclear Information System (INIS)

    1995-05-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (January--March 1995) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to Material Licensees (non-Medical) with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  8. Enforcement actions: Significant actions resolved material licensees (non-medical). Volume 14, No. 1, Part 3, Quarterly progress report, January--March 1995

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-05-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (January--March 1995) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to Material Licensees (non-Medical) with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication.

  9. Left ventricular remodelling in chronic primary mitral regurgitation: implications for medical therapy.

    Science.gov (United States)

    McCutcheon, Keir; Manga, Pravin

    Surgical repair or replacement of the mitral valve is currently the only recommended therapy for severe primary mitral regurgitation. The chronic elevation of wall stress caused by the resulting volume overload leads to structural remodelling of the muscular, vascular and extracellular matrix components of the myocardium. These changes are initially compensatory but in the long term have detrimental effects, which ultimately result in heart failure. Understanding the changes that occur in the myocardium due to volume overload at the molecular and cellular level may lead to medical interventions, which potentially could delay or prevent the adverse left ventricular remodelling associated with primary mitral regurgitation. The pathophysiological changes involved in left ventricular remodelling in response to chronic primary mitral regurgitation and the evidence for potential medical therapy, in particular beta-adrenergic blockers, are the focus of this review.

  10. Applying surveillance and screening to family psychosocial issues: implications for the medical home.

    Science.gov (United States)

    Garg, Arvin; Dworkin, Paul H

    2011-06-01

    Within the medical home, understanding the family and community context in which children live is critical to optimally promoting children's health and development. How to best identify psychosocial issues likely to have an impact on children's development is uncertain. Professional guidelines encourage pediatricians to incorporate family psychosocial screening within the context of primary care, yet few providers routinely screen for these issues. The authors propose applying the core principles of surveillance and screening, as applied to children's development and behavior, to also address family psychosocial issues during health supervision services. Integrating psychosocial surveillance and screening into the medical home requires changes in professional training, provider practice, and public policy. The potential of family psychosocial surveillance and screening to promote children's optimal development justifies such changes.

  11. Assessing the comparative effectiveness of newly marketed medications: methodological challenges and implications for drug development.

    Science.gov (United States)

    Schneeweiss, S; Gagne, J J; Glynn, R J; Ruhl, M; Rassen, J A

    2011-12-01

    Comparative-effectiveness research (CER) aims to produce actionable evidence regarding the effectiveness and safety of medical products and interventions as they are used outside of controlled research settings. Although CER evidence regarding medications is particularly needed shortly after market approval, key methodological challenges include (i) potential bias due to channeling of patients to the newly marketed medication because of various patient-, physician-, and system-related factors; (ii) rapid changes in the characteristics of the user population during the early phase of marketing; and (iii) lack of timely data and the often small number of users in the first few months of marketing. We propose a mix of approaches to generate comparative-effectiveness data in the early marketing period, including sequential cohort monitoring with secondary health-care data and propensity score (PS) balancing, as well as extended follow-up of phase III and phase IV trials, indirect comparisons of placebo-controlled trials, and modeling and simulation of virtual trials.

  12. Lack of language skills and knowledge of local culture in international medical graduates: Implications for the NHS.

    Science.gov (United States)

    Hamarneh, Ashraf

    2015-01-01

    International Medical Graduates (IMGs) form a coherent part of the National Health Service (NHS). Nearly 25% of the doctors working in the NHS are IMGs who obtained their primary medical degree from outside the EU. Moving to a different country that holds a different set of values and belief systems can be very challenging for IMGs, which in turn could have a significant effect on the service provided to NHS patients. This article will address the issue of effective communication skills within the IMG population and will explore the underlying issues behind this problem.

  13. An Evaluation of Shared Mental Models and Mutual Trust on General Medical Units: Implications for Collaboration, Teamwork, and Patient Safety.

    Science.gov (United States)

    McComb, Sara A; Lemaster, Matthew; Henneman, Elizabeth A; Hinchey, Kevin T

    2017-12-01

    This study examines nurse-physician teamwork and collaboration, a critical component in the delivery of safe patient care, on general medical units. To that end, we assess shared mental models and mutual trust, 2 coordinating mechanisms that help facilitate teamwork, among nurses and physicians working on general medical units. Data were collected from 37 nurses and 42 physicians at an urban teaching medical center in the Northeastern United States. Shared mental model questionnaire items were iteratively developed with experts' input to ensure content validity. Mutual trust items were adapted from an existing scale; items were reliable. Data were analyzed using χ and independent 2-tailed t tests. Physicians and nurses reported significant differences in their perceptions of the professional responsible for a variety of roles (e.g., advocating for the patient [P = 0.0007], identifying a near miss/error [P = 0.003]). Medication reconciliation is only role for which nurses perceive less responsibility than physicians perceive nurses have. Regarding mutual trust, both groups reported significantly more trust within their own professions; both groups reported similar levels of trust in physicians, with physicians reporting significantly less trust in their nursing colleagues than nurses perceive (P work is needed. To that end, we propose increasing knowledge about their respective roles, providing opportunities for nurse and physician collaboration through rounding or committee work and enhancing the preparedness and professionalism of interactions.

  14. Medical narratives and patient analogs: the ethical implications of electronic patient records.

    Science.gov (United States)

    Kluge, E H

    1999-12-01

    An electronic patient record consists of electronically stored data about a specific patient. It therefore constitutes a data-space. The data may be combined into a patient profile which is relative to a particular specialty as well as phenomenologically unique to the specific professional who constructs the profile. Further, a diagnosis may be interpreted as a path taken by a health care professional with a certain specialty through the data-space relative to the patient profile constructed by that professional. This way of looking at electronic patient records entails certain ethical implications about privacy and accessibility. However, it also permits the construction of artificial intelligence and competence algorithms for health care professionals relative to their specialties.

  15. Medical complications of intra-hospital patient transports: implications for architectural design and research.

    Science.gov (United States)

    Ulrich, Roger S; Zhu, Xuemei

    2007-01-01

    Literature on healthcare architecture and evidence-based design has rarely considered explicitly that patient outcomes may be worsened by intra-hospital transport (IHT), which is defined as transport of patients within the hospital. The article focuses on the effects of IHTs on patient complications and outcomes, and the implications of such impacts for designing safer, better hospitals. A review of 22 scientific studies indicates that IHTs are subject to a wide range of complications, many of which occur frequently and have distinctly detrimental effects on patient stability and outcomes. The research suggests that higher patient acuity and longer transport durations are associated with more frequent and serious IHT-related complications and outcome effects. It appears no rigorous research has compared different hospital designs and layouts with respect to having possibly differential effects on transport-related complications and worsened outcomes. Nonetheless, certain design implications can be extracted from the existing research literature, including the importance of minimizing transport delays due to restricted space and congestion, and creating layouts that shorten IHT times for high-acuity patients. Limited evidence raises the possibility that elevator-dependent vertical building layouts may increase susceptibility to transport delays that worsen complications. The strong evidence indicating that IHTs trigger complications and worsen outcomes suggests a powerful justification for adopting acuity-adaptable rooms and care models that substantially reduce transports. A program of studies is outlined to address gaps in knowledge.Key WordsPatient transports, transports within hospitals, patient safety, evidence-based design, hospital design, healthcare architecture, intra-hospital transport complications, acuity-adaptable care, elevators, outcomes.

  16. Medical marijuana in pediatric oncology: A review of the evidence and implications for practice.

    Science.gov (United States)

    Ananth, Prasanna; Reed-Weston, Anne; Wolfe, Joanne

    2018-02-01

    Medical marijuana (MM) has become increasingly legal at the state level and accessible to children with serious illness. Pediatric patients with cancer may be particularly receptive to MM, given purported benefits in managing cancer-related symptoms. In this review, we examine the evidence for MM as a supportive care agent in pediatric oncology. We describe the current legal status of MM, mechanism of action, common formulations, and potential benefits versus risks for pediatric oncology patients. We offer suggestions for how providers might approach MM requests. Throughout, we comment on avenues for future investigation on this growing trend in supportive care. © 2017 Wiley Periodicals, Inc.

  17. Low-Cost Generic Program Use by Medicare Beneficiaries: Implications for Medication Exposure Misclassification in Administrative Claims Data.

    Science.gov (United States)

    Pauly, Nathan J; Talbert, Jeffery C; Brown, Joshua

    2016-06-01

    rounds of data collection during their panel period. MEPS captures medication utilization by surveying individuals on current and previous medication use and verifies this information at the pharmacy level, so prescription fills can be observed irrespective of payment by an insurer or a filed claim. Pharmaceutical utilization was assessed at the individual level for each year of the study period, and LCGP use was recorded as a binary variable for each individual. An LCGP medication fill was identified if the total cost of the drug was paid out of pocket and matched the cost of medications listed on LCGP formularies available from major pharmacy retailers during these years. Cohort demographics and characteristics of interest included age, gender, race, employment status, marital status, family income level, education level, residence in a metropolitan statistical area, geographic region, prescription drug coverage, Medicare type, comorbidities, number of unique medications used, and number of medication fills. Comparisons were made between users and nonusers using chi-square and t-tests. Multivariable logistic regression was used to identify factors associated with LCGP use. From the most recent MEPS panel, 1,861 individuals were included in the study cohort, of which 53.5% were observed to be LCGP users. The 995 LCGP users in this cohort represented over 20 million Medicare beneficiaries who used LCGPs from 2011 to 2012. Significant differences between LCGP users and nonusers existed in terms of race, educational attainment, comorbidity burden, type of Medicare insurance, number of unique medications used, and number of medication fills. Each additional unique medication filled increased the odds of LCGP use by 12% (95% CI = 1.09-1.14). Individuals with insurance in addition to Medicare (i.e., Tricare/Veteran's Affairs or Medicaid) had less than half the odds of using LCGPs compared with those with Medicare or Medicare managed care insurance coverage only. The

  18. The Changing Health Care Landscape and Implications of Organizational Ethics on Modern Medical Practice.

    Science.gov (United States)

    Castlen, Joseph P; Cote, David J; Moojen, Wouter A; Robe, Pierre A; Balak, Naci; Brennum, Jannick; Ammirati, Mario; Mathiesen, Tiit; Broekman, Marike L D

    2017-06-01

    Medicine is rapidly changing, both in the level of collective medical knowledge and in how it is being delivered. The increased presence of administrators in hospitals helps to facilitate these changes and ease administrative workloads on physicians; however, tensions sometimes form between physicians and administrators. This situation is based on perceptions from both sides that physicians obstruct cost-saving measures and administrators put profits before patients. In reality, increasing patient populations and changes in health care are necessitating action by hospitals to prevent excessive spending as health care systems become larger and more difficult to manage. Recognizing the cause of changes in health care, which do not always originate with physicians and administrators, along with implementing changes in hospitals such as increased physician leadership, could help to ease tensions and promote a more collaborative atmosphere. Ethically, there is a need to preserve physician autonomy, which is a tenet of medical professionalism, and a need to rein in spending costs and ensure that patients receive the best possible care. Physicians and administrators both need to have a well-developed personal ethic to achieve these goals. Physicians need be allowed to retain relative autonomy over their practices as they support and participate in administrator-led efforts toward distributive justice. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Prospects of nanoparticle-DNA binding and its implications in medical biotechnology.

    Science.gov (United States)

    An, Hongjie; Jin, Bo

    2012-01-01

    Bio-nanotechnology is a new interdisciplinary R&D area that integrates engineering and physical science with biology through the development of multifunctional devices and systems, focusing biology inspired processes or their applications, in particular in medical biotechnology. DNA based nanotechnology, in many ways, has been one of the most intensively studied fields in recent years that involves the use and the creation of bio-inspired materials and their technologies for highly selective biosensing, nanoarchitecture engineering and nanoelectronics. Increasing researches have been offered to a fundamental understanding how the interactions between the nanoparticles and DNA molecules could alter DNA molecular structure and its biochemical activities. This minor review describes the mechanisms of the nanoparticle-DNA binding and molecular interactions. We present recent discoveries and research progresses how the nanoparticle-DNA binding could vary DNA molecular structure, DNA detection, and gene therapy. We report a few case studies associated with the application of the nanoparticle-DNA binding devices in medical detection and biotechnology. The potential impacts of the nanoparticles via DNA binding on toxicity of the microorganisms are briefly discussed. The nanoparticle-DNA interactions and their impact on molecular and microbial functionalities have only drown attention in recent a few years. The information presented in this review can provide useful references for further studies on biomedical science and technology. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Periodontal Systemic Connections-Novel Associations-A Review of the Evidence with Implications for Medical Practitioners.

    Science.gov (United States)

    Kalakonda, Butchibabu; Koppolu, Pradeep; Baroudi, Kusai; Mishra, Ashank

    2016-04-01

    Periodontal diseases, considered as inflammatory diseases have proved to have a spectrum of systemic implications. Earliest research has associated periodontal disease with common systemic aliments such as hypertension, diabetes, osteoporosis, rheumatoid arthritis to name a few. The evolution of advanced diagnostic aids let researchers make vast inroads in linking periodontal diseases to systemic diseases like Alzheimer's disease (AD) and even Schizophrenia. Our aim was to review and critically evaluate comprehensive literature and provide knowledge to medical practitioners on these associations so as to pave way for closer interactions between medical and dental practitioners in implementing better health care. Electronic databases such as PubMed, Google Scholar and Cochrane databases were used as source of the data for relevant studies published from 2005 up to 2015 with the following keywords, "'Periodontal disease", "systemic conditions", "periodontal disease and Alzheimer's", "Periodontal disease and Schizophrenia", "Periodontal disease and Psoriasis" and "Periodontal disease and erectile dysfunction". The evidence presented ascertains that a reasonable and modest association does exist between Periodontal disease and Alzheimer's, Schizophrenia, Erectile dysfunction, as well as Psoriasis and thus establishes periodontal disease as a potential risk factor.

  1. Do we need a critical care ultrasound certification program? Implications from an Australian medical-legal perspective.

    Science.gov (United States)

    Huang, Stephen J; McLean, Anthony S

    2010-01-01

    Medical practitioners have a duty to maintain a certain standard of care in providing their services. With critical care ultrasound gaining popularity in the ICU, it is envisaged that more intensivists will use the tool in managing their patients. Ultrasound, especially echocardiography, can be an 'easy to learn, difficult to manage' skill, and the competency in performing the procedure varies greatly. In view of this, several recommendations for competency statements have been published in recent years to advocate the need for a unified approach to training and certification. In this paper, we take a slightly different perspective, from an Australian medical-legal viewpoint, to argue for the need to implement a critical care ultrasound certification program. We examine various issues that can potentially lead to a breach of the standard of care, hence exposing the practitioners and/or the healthcare institutions to lawsuits in professional negligence or breach of contract. These issues, among others, include the failure to use ultrasound in appropriate situations, the failure of hospitals to ensure practitioners are properly trained in the skills, the failure of practitioners to perform an ultrasound study that is of a reasonable standard, and the failure of practitioners to keep themselves abreast of the latest developments in treatment and management. The implications of these issues and the importance of having a certification process are discussed.

  2. Culture, ritual, and errors of repudiation: some implications for the assessment of alternative medical traditions.

    Science.gov (United States)

    Trotter, G

    2000-07-01

    In this article, sources of error that are likely involved when alternative medical traditions are assessed from the standpoint of orthodox biomedicine are discussed. These sources include (1) biomedicine's implicit reductive materialism (manifested in its negative orientation toward placebo effects), (2) a related bias against ritual, and (3) cultural barriers to the construction of externally valid protocols. To overcome these biases, investigators must attend to ritualistic elements in alternative treatments and should recruit patients from appropriate cultural groups. Collaborative research may be the key. Benefits of collaborative research include (1) increased mutual respect and integration between culturally distinct groups and practices, (2) increased understanding and use of sophisticated techniques of empirical analysis among practitioners from the alternative traditions, (3) increased appropriation of the therapeutic benefits of ritual, and (4) enhanced overall benefit for patients of all cultural backgrounds.

  3. [Regional health and autonomy conferences (CRSAs): the implications for medical democracy at a regional level].

    Science.gov (United States)

    Devictor, Bernadette

    2010-01-01

    The HPST law seeks to reorganize the governance of healthcare at a regional level and to maintain the existence of regional health conferences, now known as regional health and autonomy conferences (CRSAs). The purpose of this article is to examine the new duties attributed to the CRSAs and to consider the various issues raised by their practice. The article also provides an analysis of the preconditions required for the successful implementation of medical democracy at a regional level, ie.: the involvement of the CRSAs in the assessment of regional healthcare policies, the mobilization of funds, the composition of the CRSAs (including the full range of healthcare areas), the importance of providing adequate support for territorial conferences, and the elaboration of a communicative space for fostering exchanges between CRSAs.

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

    Science.gov (United States)

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

    2014-05-01

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

  5. Patients with heart failure as co-designers of an educational website: implications for medical education.

    Science.gov (United States)

    Kristiansen, Anne Mette; Svanholm, Jette R; Schjødt, Inge; Mølgaard Jensen, Karsten; Silén, Charlotte; Karlgren, Klas

    2017-02-25

    To identify the learning needs of patients with heart failure between outpatients follow-up visits from their perspective and to ascertain what they emphasize as being important in the design of an educational website for them. We conducted a two-step qualitative study at Aarhus University Hospital, Denmark. Twenty patients with heart failure participated either in focus group interviews, diary writing, or video-recorded design sessions. Data on learning needs were collected in step 1 and analyses, therefore, helped develop the preliminary prototypes of a website. In step 2, patients worked on the prototypes in video-recorded design sessions, employing a think-aloud method. The interviews were transcribed and a content analysis was performed on the text and video data. Patients' learning needs were multifaceted, driven by anxiety, arising from, and often influenced by, such daily situations and contexts as the medical condition, medication, challenges in daily life, and where to get support and how to manage their self-care. They emphasized different ways of adapting the design to the patient group to enable interaction with peers and professionals and specific interface issues. This study provided insights into the different learning needs of patients with heart failure, how managing daily situations is the starting point for these needs and how emotions play a part in patients' learning. Moreover, it showed how patient co-designers proved to be useful for understanding how to design a website that supports patients' learning: insights, which may become important in designing online learning tools for patients.

  6. Implication of ultrasound bladder parameters on treatment response in patients with benign prostatic hyperplasia under medical management

    Directory of Open Access Journals (Sweden)

    Rajeev Thekumpadam Puthenveetil

    2015-10-01

    Conclusion: Ultrasound bladder parameters are useful tools for measuring the treatment response in BPH patients. Our study shows that RI and DWT significantly correlate with the treatment response in BPH patients. More importantly, pretreatment values of increased IPP and PUA determines the non-improvement of symptoms in BPH patients. Our study suggests the importance of transabdominal ultrasonography (KUB–P with Doppler for evaluating treatment responses to medical management.

  7. Professional approaches in clinical judgements among senior and junior doctors: implications for medical education

    Directory of Open Access Journals (Sweden)

    Pilhammar Ewa

    2009-05-01

    Full Text Available Abstract Background Clinical experience has traditionally been highly valued in medical education and clinical healthcare. On account of its multi-faceted nature, clinical experience is mostly difficult to articulate, and is mainly expressed in clinical situations as professional approaches. Due to retirement, hospitals in Scandinavia will soon face a substantial decrease in the number of senior specialist doctors, and it has been discussed whether healthcare will suffer an immense loss of experienced-based knowledge when this senior group leaves the organization. Both senior specialists and junior colleagues are often involved in clinical education, but the way in which these two groups vary in professional approaches and contributions to clinical education has not been so well described. Cognitive psychology has contributed to the understanding of how experience may influence professional approaches, but such studies have not included the effect of differences in position and responsibilities that junior and senior doctors hold in clinical healthcare. In the light of the discussion above, it is essential to describe the professional approaches of senior doctors in relation to those of their junior colleagues. This study therefore aims to describe and compare the professional approaches of junior and senior doctors when making clinical judgements. Methods Critical incident technique was used in interviews with nine senior doctors and nine junior doctors in internal medicine. The interviews were subjected to qualitative content analysis. Result Senior and junior doctors expressed a variety of professional approaches in clinical judgement as follows: use of theoretical knowledge, use of prior experience of cases and courses of events, use of ethical and moral values, meeting and communicating with the patient, focusing on available information, relying on their own ability, getting support and guidance from others and being directed by the

  8. General practice registrars' intentions for future practice: implications for rural medical workforce planning.

    Science.gov (United States)

    Harding, Catherine; Seal, Alexa; McGirr, Joe; Caton, Tim

    2016-11-01

    The models of practice that general practice registrars (GPRs) envisage undertaking will affect workforce supply. The aim of this research was to determine practice intentions of current GPRs in a regional general practice training program (Coast City Country General Practice Training). Questionnaires were circulated to 220 GPRs undertaking general practice placements to determine characteristics of ideal practice models and intentions for future practice. Responses were received for 99 participants (45%). Current GPRs intend to work an average of less than eight half-day sessions/week, with male participants intending to work more hours (t(91)=3.528, P=0.001). More than one-third of this regional cohort intends to practice in metropolitan centres. Proximity to family and friends was the most important factor influencing the choice of practice location. Men ranked remuneration for work as more important (t (88)=-4.280, Pmedical graduates intend to own their own practice compared with 52% of international medical graduates (χ 2 (1)=8.498, P=0.004). Future general practitioners (GPs) intend to work fewer hours than current GPs. Assumptions about lifestyle factors, practice models and possible professional roles should be carefully evaluated when developing strategies to recruit GPs and GPRs into rural practice.

  9. Reflections on the juridical implications of the medical use of radiations and radioisotope

    International Nuclear Information System (INIS)

    Campos, Ana Celia P.P.; Cuperschmid, Ethel Mizrahy; Campos, Tarcisio P. Ribeiro de

    2007-01-01

    The pacific use of radiation and radioisotopes for the society presents radiological risks, due its capacity to produce damage to environmental and human being, contrasting with its high economic and social benefits. In the face of the risk, juridical system leans over to reach the required regulations that implies in the balance between human and environmental security and the expected improvements of the medical nuclear techniques. The Brazilian Constitution of 1988 tries to provide the normalization for the application of the nuclear energy and its radioisotopes. However, target as a strategically technology and due to its expansion, its regulations still deserves analyses and reflections. The present paper starts from the Constitution presenting the references about the theme and analyzing it. It is addressed the principle of the objective civil responsibility making analyses on the use of radiations and radioisotope on the medicine. It addresses the role of federal autonomy related to the 'MCT - Ministerio de Ciencia e Tecnologia' with its accumulative functions in society, such as scientific and technologic development, education, and its own focalization. The recent opening of the monopoly for the production of radioisotopes for very short half-lives is also discussed. It makes a comparison between juridical aspects of Brazil with international system. The present article contributes to open same topics of discussions on the Brazilian juridical aspects involving radiations and radioisotopes application on medicine. (author)

  10. Reflections on the juridical implications of the medical use of radiations and radioisotope

    Energy Technology Data Exchange (ETDEWEB)

    Campos, Ana Celia P.P. [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Direito]. E-mails: anaceu2000@yahoo.com.br; Cuperschmid, Ethel Mizrahy [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Centro de Memoria da Medicina - CEMMOR]. E-mail: ethel.mizrahy@yahoo.com; Campos, Tarcisio P. Ribeiro de [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Programa de Pos-graduacao em Ciencias e Tecnicas Nucleares]. E-mail: campos@nuclear.ufmg.br

    2007-07-01

    The pacific use of radiation and radioisotopes for the society presents radiological risks, due its capacity to produce damage to environmental and human being, contrasting with its high economic and social benefits. In the face of the risk, juridical system leans over to reach the required regulations that implies in the balance between human and environmental security and the expected improvements of the medical nuclear techniques. The Brazilian Constitution of 1988 tries to provide the normalization for the application of the nuclear energy and its radioisotopes. However, target as a strategically technology and due to its expansion, its regulations still deserves analyses and reflections. The present paper starts from the Constitution presenting the references about the theme and analyzing it. It is addressed the principle of the objective civil responsibility making analyses on the use of radiations and radioisotope on the medicine. It addresses the role of federal autonomy related to the 'MCT - Ministerio de Ciencia e Tecnologia' with its accumulative functions in society, such as scientific and technologic development, education, and its own focalization. The recent opening of the monopoly for the production of radioisotopes for very short half-lives is also discussed. It makes a comparison between juridical aspects of Brazil with international system. The present article contributes to open same topics of discussions on the Brazilian juridical aspects involving radiations and radioisotopes application on medicine. (author)

  11. Identifying optimal postmarket surveillance strategies for medical and surgical devices: implications for policy, practice and research.

    Science.gov (United States)

    Gagliardi, Anna R; Umoquit, Muriah; Lehoux, Pascale; Ross, Sue; Ducey, Ariel; Urbach, David R

    2013-03-01

    Non-drug technologies offer many benefits, but have been associated with adverse events, prompting calls for improved postmarket surveillance. There is little empirical research to guide the development of such a system. The purpose of this study was to identify optimal postmarket surveillance strategies for medical and surgical devices. Qualitative methods were used for sampling, data collection and analysis. Stakeholders from Canada and the USA representing different roles and perspectives were first interviewed to identify examples and characteristics of different surveillance strategies. These stakeholders and others they recommended were then assembled at a 1-day nominal group meeting to discuss and prioritise the components of a postmarket device surveillance system, and research needed to achieve such a system. Consultations were held with 37 participants, and 47 participants attended the 1-day meeting. They recommended a multicomponent system including reporting by facilities, clinicians and patients, supported with some external surveillance for validation and real-time trials for high-risk devices. Many considerations were identified that constitute desirable characteristics of, and means by which to implement such a system. An overarching network was envisioned to broker linkages, establish a shared minimum dataset, and support communication and decision making. Numerous research questions were identified, which could be pursued in tandem with phased implementation of the system. These findings provide unique guidance for establishing a device safety network that is based on existing initiatives, and could be expanded and evaluated in a prospective, phased fashion as it was developed.

  12. Commentary: narrative lessons from a Nigerian novelist: implications for medical education and care.

    Science.gov (United States)

    Zarconi, Joseph

    2012-08-01

    In her TED Talk entitled "The danger of a single story," Nigerian novelist Chimamanda Adichie shares stories about her life that illustrate the natural human tendency to interpret the lives of others in the context of what she describes as narrowly constructed and often stereotypical "single stories." These single-story views often portray others as wholly different from those constructing the stories, thereby diminishing the possibilities for genuine human connection. Referencing Adichie's talk, the author describes the narrative dissonance that so often distances patients from their physicians. He illustrates the dangers to patients that can result from single-story caregiving by physicians, sharing an example from his own experience in which unnecessary harm came to his patient because of his own single-story thinking. The author argues that these single-story dangers must be openly and consciously addressed in the training of doctors to counteract the tendency for their clinical and educational experiences to inculcate single stories by which physicians come to interpret their patients. He offers suggestions as to why single-story thinking arises in clinical practice and how to mitigate these forces in medical education. The author concludes by contending that the education of physicians, and caring for the sick, should be aimed at preserving the dignity of those being served, and he argues for an "equal humanity" model of the patient-physician relationship that engages patients in all dimensions of their multiple stories.

  13. Medical pluralism among indigenous peoples in northeast India - implications for health policy.

    Science.gov (United States)

    Albert, Sandra; Nongrum, Melari; Webb, Emily L; Porter, John D H; Kharkongor, Glenn C

    2015-07-01

    The government of India is promoting and increasing investment in the traditional medicine systems of Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) in the northeast region of India. But there are few empirical data that support this policy decision. This study estimates the awareness and use of the different medical systems in rural Meghalaya, a state in north-east India with a predominantly ethnic tribal population. We conducted a cross-sectional multistage random sample household survey across all districts of Meghalaya. To enable appropriate estimates for the whole of rural Meghalaya, the data were weighted to allow for the probability of selection of households at each stage of the sampling process. Both local tribal medicine and biomedicine were widely accepted and used, but the majority (68.7%, 95% CI: 51.9-81.7) had not heard of AYUSH and even fewer had used it. Tribal medicine was used (79.1%, 95% CI 66.3-88.0), thought to be effective (87.5%, 95% CI: 74.2-94.1) and given in a variety of disorders, including both minor and major diseases. In the 3 months prior to the survey, 46.2% (95% CI: 30.5-62.8) had used tribal medicine. Only 10.5% (95% CI: 6.1-17.6) reported ever using any of the AYUSH systems. Our comparative estimates of the awareness and use of tribal medicine, different systems of AYUSH and of biomedicine among indigenous populations of India question the basis on which AYUSH is promoted in the northeast region of India and in the state of Meghalaya in particular. © 2015 John Wiley & Sons Ltd.

  14. Depictions of 'brain death' in the media: medical and ethical implications.

    Science.gov (United States)

    Daoust, Ariane; Racine, Eric

    2014-04-01

    Debates and controversies have shaped the understanding and the practices related to death determined by neurological criterion (DNC). Confusion about DNC in the public domain could undermine this notion. This confusion could further jeopardise confidence in rigorous death determination procedures, and raise questions about the integrity, sustainability, and legitimacy of modern organ donation practices. We examined the depictions of 'brain death' in major American and Canadian print media to gain insights into possible common sources of confusion about DNC and the relationship between expert and lay views on this crucial concept. We gathered 940 articles, available in electronic databases, published between 2005 and 2009 from high-circulation Canadian and American newspapers containing keywords 'brain dead' or 'brain death'. Articles were systematically examined for content (eg, definitions of brain death and criteria for determination of death) using the NVivo 8 software. Our results showed problematic aspects in American and Canadian media, with some salient differences. DNC was used colloquially in 39% (N=366) of the articles and its medical meaning infrequently defined (2.7%; N=14 in the USA and 3.6%; N=15 in Canada). The neurological criterion for determination of death was mentioned in less than 10% of the articles, and life support in about 20% of the articles. Organ donation issues related to DNC were raised more often in Canadian articles than in American articles (33.5% vs 21.2%; p<0.0001). Further discussion is needed to develop innovative strategies to bridge media representations of DNC with experts' views in connection with organ donation practices.

  15. 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

  16. The gender composition of the medical profession in Mexico: implications for employment patterns and physician labor supply.

    Science.gov (United States)

    Knaul, F; Frenk, J; Aguilar, A M

    2000-01-01

    The gender composition of the medical profession is changing rapidly in many parts of the world, including Mexico. We analyze cross-sectional and longitudinal data on sex differences in physician employment from household employment surveys. The results suggest that Mexico is a particularly interesting example of the feminization of physician employment. Female enrollment in medical school increased from 11% in 1970 to about 50% in 1998. The increased participation of women in medicine seems to be accompanied by differences in employment patterns that could generate significant reductions in the total supply of physician hours of service. Women physicians are unemployed at a much higher rate than men and hence account for half of underused physician human capital. The results suggest that improved educational opportunities do not translate automatically into equal employment opportunities.

  17. Alexithymia, Assertiveness and Psychosocial Functioning in HIV: Implications for Medication Adherence and Disease Severity.

    Science.gov (United States)

    McIntosh, Roger C; Ironson, Gail; Antoni, Michael; Fletcher, Mary Ann; Schneiderman, Neil

    2016-02-01

    Psychosocial function and adherence to antiretroviral regimen are key factors in human immunodeficiency virus (HIV) disease management. Alexithymia (AL) is a trait deficit in the ability to identify and describe feelings, emotions and bodily sensations. A structural equation model was used to test whether high levels of AL indirectly relate to greater non-adherent behavior and HIV disease severity via psychosocial dysfunction. Blood draws for HIV-1 viral load and CD4 T-lymphocyte, along with psychosocial surveys were collected from 439 HIV positive adults aged 18-73 years. The structural model supports significant paths from: (1) AL to non-active patient involvement, psychological distress, and lower social support, (2) psychological distress and non-active involvement to non-adherent behavior, and (3) non-adherence to greater HIV disease severity (CFI = .97, RMSEA = .04, SRMR = .05). A second model confirmed the intermediary effect of greater patient assertiveness on the path from AL to social support and non-active patient involvement (CFI = .94, RMSEA = .04, SRMR = .05). Altogether, AL is indirectly linked with HIV disease management through it's association with poor psychosocial function, however greater patient assertiveness buffers the negative impact of AL on relationship quality with healthcare providers and members of one's social support network.

  18. 论古代医德教育方法及其现代意义%The Ancient Medical Ethics Education Method and Its Modern Significance

    Institute of Scientific and Technical Information of China (English)

    艾华; 唐宇平; 刘钊; 郭辉; 谷晓红

    2013-01-01

    In order to explore and improve the method of medical ethics education,this paper reviewed the three categories of ancient medical ethics education method,namely the theory of medical discipline and edification,biographies' acknowledgement and leading role,teacher teaching students mode,aimed to provide basis and reference for modern medical ethics education,in order to improve the effectiveness of medical ethics education of medical colleges and to improve medical students medical ethics education level.%为了改进医德教育方法,通过对三大类古代医德教育方法的概述,医戒医论的灌输熏陶、医家传记的榜样表率、师徒相授的言传身教,为现代医德教育提供依据和参考,以提高医学院校医德教育的效果,促使医学生提高医德修养水平.

  19. Oral cancer--current knowledge, practices and implications for training among an Irish general medical practitioner cohort.

    LENUS (Irish Health Repository)

    Ni Riordain, Richeal

    2009-11-01

    This study investigated the current knowledge and practices of general medical practitioners (GMPs) in Ireland regarding the examination of the oral cavity and the detection of oral malignancy and the training they had received at both undergraduate and postgraduate level and since commencing in practice. A questionnaire survey of GMPs in Ireland was conducted. One hundred and fifty four (65.3%) of the practitioners reported regularly examining the oral mucosa of their patients. Almost half of these (n=68) further qualified this response by stating that they only examined the oral mucosa if the patient reported pain in this area or if the patient specifically requested an oral examination for some reason. Eighty one (34.3%) practitioners surveyed felt confident in their ability to detect oral malignancies with the remaining two thirds unsure of whether they would be able to detect oral cancer. There was a significant association between the undergraduate and postgraduate teaching on examination of the oral cavity and whether practitioners felt confident in their ability to detect oral cancer [chi(2)(1)=4.811, p<0.05]. A statistically significant association was also found between the undergraduate and postgraduate teaching on the diagnosis of oral malignant disease and whether practitioners felt confident in their ability to detect oral cancer [chi(2)(1)=6.194, p<0.05]. In conclusion the level of knowledge of Irish general medical practitioners needs to be addressed with appropriate initiatives both at undergraduate level and via CME.

  20. Significance and Implications of Patient-reported Xerostomia in Sjögren's Syndrome: Findings From the National Institutes of Health Cohort.

    Science.gov (United States)

    Billings, Monisha; Dye, Bruce A; Iafolla, Timothy; Baer, Alan N; Grisius, Margaret; Alevizos, Ilias

    2016-10-01

    Xerostomia is a chief complaint of patients with Sjögren's syndrome (SS). However, newer proposals for SS classification remove xerostomia and hyposalivation from the criteria list. Given these developments and the importance of patient-centered research outcomes, we sought to evaluate the utility of patient-reported xerostomia with implications for classification criteria, and clinical trials targeting SS treatment modalities. A nested case-control study was designed within The National Institute of Dental and Craniofacial Research/National Institutes of Health (NIDCR/NIH) SS Cohort - one of the largest SS cohorts in the US. Clinical characteristics of those with and without xerostomia in SS and other salivary gland dysfunctions were compared. Several analytical methods were employed, including multivariable logistic regression modeling. The NIDCR/NIH Sjögren's Syndrome Clinic has an open cohort with ongoing enrollment since 1984. This open cohort comprised of 2046 participants by August 27, 2015. Baseline data of 701 SS, 355 Sicca, and 247 ISS participants within the source cohort were analyzed. Xerostomia was highest among SS participants (87.4%, 95% CI: 84.8%-89.8%) compared to Sicca (72.4%, 95% CI: 67.4%-77.0%, pxerostomia were more likely to have SS than Sicca/ISS (OR=4.98, 95% CI: 3.78-6.56). The ability of xerostomia to screen for SS among those with salivary gland dysfunction was higher than screening for Sicca/ISS. Screening diagnostics of xerostomia were of greater utility compared to hyposalivation. After adjusting for confounding in multivariable modeling, SS participants with xerostomia were more likely to be White (Black/African Americans (OR: 0.40, 95% CI: 0.23-0.68, p-value=0.001) and Asians (OR: 0.49, 95% CI: 0.25-0.96, p-value=0.038) were less likely to have xerostomia compared to Whites), have dry eye symptoms for >3months (OR: 5.80, 95% CI: 3.62-9.28, p-value 2 (OR: 1.92, 95% CI: 1.20-3.09, p-value=0.007), and salivary gland swelling (OR: 49

  1. Medical tourism's impacts on health worker migration in the Caribbean: five examples and their implications for global justice

    OpenAIRE

    Snyder, Jeremy; Crooks, Valorie A.; Johnston, Rory; Adams, Krystyna; Whitmore, Rebecca

    2015-01-01

    Medical tourism is a practice where individuals cross international borders in order to access medical care. This practice can impact the global distribution of health workers by potentially reducing the emigration of health workers from destination countries for medical tourists and affecting the internal distribution of these workers. Little has been said, however, about the impacts of medical tourism on the immigration of health workers to medical tourism destinations. We discuss five patt...

  2. An Evaluation of the Significance of Work-Related Influence Factors on Fitness and the Development of Medical and Orthopaedic Conditions in Military Executives

    Directory of Open Access Journals (Sweden)

    Christoph Schulze

    2016-01-01

    Full Text Available Occupational health promotion is an effective tool to improve the state of health of employees. As part of occupational health promotion in the German Bundeswehr, top-ranking military executives are offered a medical examination and training programme. Health-related data is collected as a basis for training and lifestyle counselling. This data was subjected to a retrospective evaluation in order to identify occupational risk factors and their correlation with cardiovascular resilience, trunk strength, and the development of orthopaedic and internal disorders. A total of 122 military executives (all male, age 54.6±4.2 years answered a questionnaire aimed at evaluating private and occupational stress factors. The medical history was followed by a medical and orthopaedic examination involving a lactate performance test (treadmill or bicycle ergometry and an isometric trunk strength measurement. The data obtained was then statistically evaluated. For military executives, work-related travelling and commuting involve a high risk of medical and orthopaedic conditions. Regular exercise leads to improved fitness levels. In order to prevent medical problems, military executives working long hours should regularly take part in fitness and weight training under professional instructions.

  3. Comparison of the accuracy of cone beam computed tomography and medical computed tomography: implications for clinical diagnostics with guided surgery.

    Science.gov (United States)

    Abboud, Marcus; Calvo-Guirado, Jose Luis; Orentlicher, Gary; Wahl, Gerhard

    2013-01-01

    This study compared the accuracy of cone beam computed tomography (CBCT) and medical-grade CT in the context of evaluating the diagnostic value and accuracy of fiducial marker localization for reference marker-based guided surgery systems. Cadaver mandibles with attached radiopaque gutta-percha markers, as well as glass balls and composite cylinders of known dimensions, were measured manually with a highly accurate digital caliper. The objects were then scanned using a medical-grade CT scanner (Philips Brilliance 64) and five different CBCT scanners (Sirona Galileos, Morita 3D Accuitomo 80, Vatech PaX-Reve3D, 3M Imtech Iluma, and Planmeca ProMax 3D). The data were then imported into commercially available software, and measurements were made of the scanned markers and objects. CT and CBCT measurements were compared to each other and to the caliper measurements. The difference between the CBCT measurements and the caliper measurements was larger than the difference between the CT measurements and the caliper measurements. Measurements of the cadaver mandible and the geometric reference markers were highly accurate with CT. The average absolute errors of the human mandible measurements were 0.03 mm for CT and 0.23 mm for CBCT. The measurement errors of the geometric objects based on CT ranged between 0.00 and 0.12 mm, compared to an error range between 0.00 and 2.17 mm with the CBCT scanners. CT provided the most accurate images in this study, closely followed by one CBCT of the five tested. Although there were differences in the distance measurements of the hard tissue of the human mandible between CT and CBCT, these differences may not be of clinical significance for most diagnostic purposes. The fiducial marker localization error caused by some CBCT scanners may be a problem for guided surgery systems.

  4. Medical tourism's impacts on health worker migration in the Caribbean: five examples and their implications for global justice.

    Science.gov (United States)

    Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory; Adams, Krystyna; Whitmore, Rebecca

    2015-01-01

    Medical tourism is a practice where individuals cross international borders in order to access medical care. This practice can impact the global distribution of health workers by potentially reducing the emigration of health workers from destination countries for medical tourists and affecting the internal distribution of these workers. Little has been said, however, about the impacts of medical tourism on the immigration of health workers to medical tourism destinations. We discuss five patterns of medical tourism-driven health worker migration to medical tourism destinations: 1) long-term international migration; 2) long-term diasporic migration; 3) long-term migration and 'black sheep'; 4) short-term migration via time share; and 5) short-term migration via patient-provider dyad. These patterns of health worker migration have repercussions for global justice that include potential negative impacts on the following: 1) health worker training; 2) health worker distributions; 3) local provision of care; and 4) local economies. In order to address these potential negative impacts, policy makers in destination countries should work to ensure that changes in health worker training and licensure aimed at promoting the medical tourism sector are also supportive of the health needs of the domestic population. Policy makers in both source and destination countries should be aware of the effects of medical tourism on health worker flows both into and out of medical tourism destinations and work to ensure that the potential harms of these worker flows to both groups are mitigated.

  5. Medical tourism's impacts on health worker migration in the Caribbean: five examples and their implications for global justice

    Science.gov (United States)

    Snyder, Jeremy; Crooks, Valorie A.; Johnston, Rory; Adams, Krystyna; Whitmore, Rebecca

    2015-01-01

    Medical tourism is a practice where individuals cross international borders in order to access medical care. This practice can impact the global distribution of health workers by potentially reducing the emigration of health workers from destination countries for medical tourists and affecting the internal distribution of these workers. Little has been said, however, about the impacts of medical tourism on the immigration of health workers to medical tourism destinations. We discuss five patterns of medical tourism-driven health worker migration to medical tourism destinations: 1) long-term international migration; 2) long-term diasporic migration; 3) long-term migration and ‘black sheep’; 4) short-term migration via time share; and 5) short-term migration via patient-provider dyad. These patterns of health worker migration have repercussions for global justice that include potential negative impacts on the following: 1) health worker training; 2) health worker distributions; 3) local provision of care; and 4) local economies. In order to address these potential negative impacts, policy makers in destination countries should work to ensure that changes in health worker training and licensure aimed at promoting the medical tourism sector are also supportive of the health needs of the domestic population. Policy makers in both source and destination countries should be aware of the effects of medical tourism on health worker flows both into and out of medical tourism destinations and work to ensure that the potential harms of these worker flows to both groups are mitigated. PMID:25865122

  6. Medical tourism's impacts on health worker migration in the Caribbean: five examples and their implications for global justice

    Directory of Open Access Journals (Sweden)

    Jeremy Snyder

    2015-04-01

    Full Text Available Medical tourism is a practice where individuals cross international borders in order to access medical care. This practice can impact the global distribution of health workers by potentially reducing the emigration of health workers from destination countries for medical tourists and affecting the internal distribution of these workers. Little has been said, however, about the impacts of medical tourism on the immigration of health workers to medical tourism destinations. We discuss five patterns of medical tourism-driven health worker migration to medical tourism destinations: 1 long-term international migration; 2 long-term diasporic migration; 3 long-term migration and ‘black sheep’; 4 short-term migration via time share; and 5 short-term migration via patient-provider dyad. These patterns of health worker migration have repercussions for global justice that include potential negative impacts on the following: 1 health worker training; 2 health worker distributions; 3 local provision of care; and 4 local economies. In order to address these potential negative impacts, policy makers in destination countries should work to ensure that changes in health worker training and licensure aimed at promoting the medical tourism sector are also supportive of the health needs of the domestic population. Policy makers in both source and destination countries should be aware of the effects of medical tourism on health worker flows both into and out of medical tourism destinations and work to ensure that the potential harms of these worker flows to both groups are mitigated.

  7. astrophysical significance

    Directory of Open Access Journals (Sweden)

    Dartois E.

    2014-02-01

    Full Text Available Clathrate hydrates, ice inclusion compounds, are of major importance for the Earth’s permafrost regions and may control the stability of gases in many astrophysical bodies such as the planets, comets and possibly interstellar grains. Their physical behavior may provide a trapping mechanism to modify the absolute and relative composition of icy bodies that could be the source of late-time injection of gaseous species in planetary atmospheres or hot cores. In this study, we provide and discuss laboratory-recorded infrared signatures of clathrate hydrates in the near to mid-infrared and the implications for space-based astrophysical tele-detection in order to constrain their possible presence.

  8. Disagreements with implications: diverging discourses on the ethics of non-medical use of methylphenidate for performance enhancement

    OpenAIRE

    Forlini, Cynthia; Racine, Eric

    2009-01-01

    Abstract Background There is substantial evidence that methylphenidate (MPH; Ritalin), is being used by healthy university students for non-medical motives such as the improvement of concentration, alertness, and academic performance. The scope and potential consequences of the non-medical use of MPH upon healthcare and society bring about many points of view. Methods To gain insight into key ethical and social issues on the non-medical use of MPH, we examined discourses in the print media, b...

  9. Medicalizing versus psychologizing mental illness: what are the implications for help seeking and stigma? A general population study.

    Science.gov (United States)

    Pattyn, E; Verhaeghe, M; Sercu, C; Bracke, P

    2013-10-01

    This study contrasts the medicalized conceptualization of mental illness with psychologizing mental illness and examines what the consequences are of adhering to one model versus the other for help seeking and stigma. The survey "Stigma in a Global Context-Belgian Mental Health Study" (2009) conducted face-to-face interviews among a representative sample of the general Belgian population using the vignette technique to depict schizophrenia (N = 381). Causal attributions, labeling processes, and the disease view are addressed. Help seeking refers to open-ended help-seeking suggestions (general practitioner, psychiatrist, psychologist, family, friends, and self-care options). Stigma refers to social exclusion after treatment. The data are analyzed by means of logistic and linear regression models in SPSS Statistics 19. People who adhere to the biopsychosocial (versus psychosocial) model are more likely to recommend general medical care and people who apply the disease view are more likely to recommend specialized medical care. Regarding informal help, those who prefer the biopsychosocial model are less likely to recommend consulting friends than those who adhere to the psychosocial model. Respondents who apply a medical compared to a non-medical label are less inclined to recommend self-care. As concerns treatment stigma, respondents who apply a medical instead of a non-medical label are more likely to socially exclude someone who has been in psychiatric treatment. Medicalizing mental illness involves a package deal: biopsychosocial causal attributions and applying the disease view facilitate medical treatment recommendations, while labeling seems to trigger stigmatizing attitudes.

  10. Medical curriculum reform in Sun Yat-sen University: implications from the results of GMER evaluation in China.

    Science.gov (United States)

    Xiao, Haipeng; Xian, Liqing; Yu, Xueqing; Wang, Jianping

    2007-09-01

    Created by interlocking economies, a global language, the informatics revolution and rapid travel, globalization has penetrated all aspects of human life including science, environment, public health and medicine. Physicians are now members of a global community. The global physician should possess universal core essential competences required for medical practice throughout the world. The Institute for International Medical Education (IIME), created by the China Medical Board (CMB) of New York, has developed the " global minimal essential requirements" (GMER) that define the knowledge, skills, professional behavior and ethics that all physicians must have regardless of where they received their general medical education and training. The IIME initiated a pilot project in China in October, 2003, to evaluate the graduates of the 7- or 8-year track program of eight leading medical schools, including Medical School of Sun Yat-sen University. The results of GMER evaluation indicated strengths and areas for improvement of our school in relation to international standards, which greatly re-invigorate our enthusiasm on medical curriculum reform on the new 8-year track program in Medical School of Sun Yat-sen University. The modifications of our medical curriculum for the new 8-year track program based on the results of GMER evaluation are discussed in this paper.

  11. Veterans Health Administration's Disaster Emergency Medical Personnel System (DEMPS) Training Evaluation: Potential Implications for Disaster Health Care Volunteers.

    Science.gov (United States)

    Schmitz, Susan; Radcliff, Tiffany A; Chu, Karen; Smith, Robert E; Dobalian, Aram

    2018-02-20

    The US Veterans Health Administration's Disaster Emergency Medical Personnel System (DEMPS) is a team of employee disaster response volunteers who provide clinical and non-clinical staffing assistance when local systems are overwhelmed. This study evaluated attitudes and recommendations of the DEMPS program to understand the impact of multi-modal training on volunteer perceptions. DEMPS volunteers completed an electronic survey in 2012 (n=2120). Three training modes were evaluated: online, field exercise, and face-to-face. Measures included: "Training Satisfaction," "Attitudes about Training," "Continued Engagement in DEMPS." Data were analyzed using χ2 and logistic regression. Open-ended questions were evaluated in a manner consistent with grounded theory methodology. Most respondents participated in DEMPS training (80%). Volunteers with multi-modal training who completed all 3 modes (14%) were significantly more likely to have positive attitudes about training, plan to continue as volunteers, and would recommend DEMPS to others (P-valuevolunteer engagement. A blended learning environment using multi-modal training methods, could enhance satisfaction and attitudes and possibly encourage continued engagement in DEMPS or similar programs. DEMPS training program modifications in 2015 expanded this blended learning approach through new interactive online learning opportunities. (Disaster Med Public Health Preparedness. 2018; page 1 of 8).

  12. Allometric considerations when assessing aortic aneurysms in Turner syndrome: Implications for activity recommendations and medical decision-making.

    Science.gov (United States)

    Corbitt, Holly; Maslen, Cheryl; Prakash, Siddharth; Morris, Shaine A; Silberbach, Michael

    2018-02-01

    In Turner syndrome, the potential to form thoracic aortic aneurysms requires routine patient monitoring. However, the short stature that typically occurs complicates the assessment of severity and risk because the relationship of body size to aortic dimensions is different in Turner syndrome compared to the general population. Three allometric formula have been proposed to adjust aortic dimensions, all employing body surface area: aortic size index, Turner syndrome-specific Z-scores, and Z-scores based on a general pediatric and young adult population. In order to understand the differences between these formula we evaluated the relationship between age and aortic size index and compared Turner syndrome-specific Z-scores and pediatric/young adult based Z-scores in a group of girls and women with Turner syndrome. Our results suggest that the aortic size index is highly age-dependent for those under 15 years; and that Turner-specific Z-scores are significantly lower than Z-scores referenced to the general population. Higher Z-scores derived from the general reference population could result in stigmatization, inappropriate restriction from sports, and increasing the risk of unneeded medical or operative treatments. We propose that when estimating aortic dissection risk clinicians use Turner syndrome-specific Z-score for those under fifteen years of age. © 2017 Wiley Periodicals, Inc.

  13. Providers’ perspectives on inbound medical tourism in Central America and the Caribbean: factors driving and inhibiting sector development and their health equity implications

    Science.gov (United States)

    Johnston, Rory; Crooks, Valorie A.; Cerón, Alejandro; Labonté, Ronald; Snyder, Jeremy; Núñez, Emanuel O.; Flores, Walter G.

    2016-01-01

    Background Many governments and health care providers worldwide are enthusiastic to develop medical tourism as a service export. Despite the popularity of this policy uptake, there is relatively little known about the specific local factors prospectively motivating and informing development of this sector. Objective To identify common social, economic, and health system factors shaping the development of medical tourism in three Central American and Caribbean countries and their health equity implications. Design In-depth, semi-structured interviews were conducted in Mexico, Guatemala, and Barbados with 150 health system stakeholders. Participants were recruited from private and public sectors working in various fields: trade and economic development, health services delivery, training and administration, and civil society. Transcribed interviews were coded using qualitative data management software, and thematic analysis was used to identify cross-cutting issues regarding the drivers and inhibitors of medical tourism development. Results Four common drivers of medical tourism development were identified: 1) unused capacity in existing private hospitals, 2) international portability of health insurance, vis-a-vis international hospital accreditation, 3) internationally trained physicians as both marketable assets and industry entrepreneurs, and 4) promotion of medical tourism by public export development corporations. Three common inhibitors for the development of the sector were also identified: 1) the high expense of market entry, 2) poor sector-wide planning, and 3) structural socio-economic issues such as insecurity or relatively high business costs and financial risks. Conclusion There are shared factors shaping the development of medical tourism in Central America and the Caribbean that help explain why it is being pursued by many hospitals and governments in the region. Development of the sector is primarily being driven by public investment promotion

  14. Providers’ perspectives on inbound medical tourism in Central America and the Caribbean: factors driving and inhibiting sector development and their health equity implications

    Directory of Open Access Journals (Sweden)

    Rory Johnston

    2016-11-01

    Full Text Available Background: Many governments and health care providers worldwide are enthusiastic to develop medical tourism as a service export. Despite the popularity of this policy uptake, there is relatively little known about the specific local factors prospectively motivating and informing development of this sector. Objective: To identify common social, economic, and health system factors shaping the development of medical tourism in three Central American and Caribbean countries and their health equity implications. Design: In-depth, semi-structured interviews were conducted in Mexico, Guatemala, and Barbados with 150 health system stakeholders. Participants were recruited from private and public sectors working in various fields: trade and economic development, health services delivery, training and administration, and civil society. Transcribed interviews were coded using qualitative data management software, and thematic analysis was used to identify cross-cutting issues regarding the drivers and inhibitors of medical tourism development. Results: Four common drivers of medical tourism development were identified: 1 unused capacity in existing private hospitals, 2 international portability of health insurance, vis-a-vis international hospital accreditation, 3 internationally trained physicians as both marketable assets and industry entrepreneurs, and 4 promotion of medical tourism by public export development corporations. Three common inhibitors for the development of the sector were also identified: 1 the high expense of market entry, 2 poor sector-wide planning, and 3 structural socio-economic issues such as insecurity or relatively high business costs and financial risks. Conclusion: There are shared factors shaping the development of medical tourism in Central America and the Caribbean that help explain why it is being pursued by many hospitals and governments in the region. Development of the sector is primarily being driven by public

  15. Providers' perspectives on inbound medical tourism in Central America and the Caribbean: factors driving and inhibiting sector development and their health equity implications.

    Science.gov (United States)

    Johnston, Rory; Crooks, Valorie A; Cerón, Alejandro; Labonté, Ronald; Snyder, Jeremy; Núñez, Emanuel O; Flores, Walter G

    2016-01-01

    Many governments and health care providers worldwide are enthusiastic to develop medical tourism as a service export. Despite the popularity of this policy uptake, there is relatively little known about the specific local factors prospectively motivating and informing development of this sector. To identify common social, economic, and health system factors shaping the development of medical tourism in three Central American and Caribbean countries and their health equity implications. In-depth, semi-structured interviews were conducted in Mexico, Guatemala, and Barbados with 150 health system stakeholders. Participants were recruited from private and public sectors working in various fields: trade and economic development, health services delivery, training and administration, and civil society. Transcribed interviews were coded using qualitative data management software, and thematic analysis was used to identify cross-cutting issues regarding the drivers and inhibitors of medical tourism development. Four common drivers of medical tourism development were identified: 1) unused capacity in existing private hospitals, 2) international portability of health insurance, vis-a-vis international hospital accreditation, 3) internationally trained physicians as both marketable assets and industry entrepreneurs, and 4) promotion of medical tourism by public export development corporations. Three common inhibitors for the development of the sector were also identified: 1) the high expense of market entry, 2) poor sector-wide planning, and 3) structural socio-economic issues such as insecurity or relatively high business costs and financial risks. There are shared factors shaping the development of medical tourism in Central America and the Caribbean that help explain why it is being pursued by many hospitals and governments in the region. Development of the sector is primarily being driven by public investment promotion agencies and the private health sector seeking

  16. Disagreements with implications: diverging discourses on the ethics of non-medical use of methylphenidate for performance enhancement.

    Science.gov (United States)

    Forlini, Cynthia; Racine, Eric

    2009-07-06

    There is substantial evidence that methylphenidate (MPH; Ritalin), is being used by healthy university students for non-medical motives such as the improvement of concentration, alertness, and academic performance. The scope and potential consequences of the non-medical use of MPH upon healthcare and society bring about many points of view. To gain insight into key ethical and social issues on the non-medical use of MPH, we examined discourses in the print media, bioethics literature, and public health literature. Our study identified three diverging paradigms with varying perspectives on the nature of performance enhancement. The beneficial effects of MPH on normal cognition were generally portrayed enthusiastically in the print media and bioethics discourses but supported by scant information on associated risks. Overall, we found a variety of perspectives regarding ethical, legal and social issues related to the non-medical use of MPH for performance enhancement and its impact upon social practices and institutions. The exception to this was public health discourse which took a strong stance against the non-medical use of MPH typically viewed as a form of prescription abuse or misuse. Wide-ranging recommendations for prevention of further non-medical use of MPH included legislation and increased public education. Some positive portrayals of the non-medical use of MPH for performance enhancement in the print media and bioethics discourses could entice further uses. Medicine and society need to prepare for more prevalent non-medical uses of neuropharmaceuticals by fostering better informed public debates.

  17. Population genetic analysis of a medicinally significant Australian rainforest tree, Fontainea picrosperma C.T. White (Euphorbiaceae): biogeographic patterns and implications for species domestication and plantation establishment.

    Science.gov (United States)

    Lamont, R W; Conroy, G C; Reddell, P; Ogbourne, S M

    2016-02-29

    Fontainea picrosperma, a subcanopy tree endemic to the rainforests of northeastern Australia, is of medicinal significance following the discovery of the novel anti-cancer natural product, EBC-46. Laboratory synthesis of EBC-46 is unlikely to be commercially feasible and consequently production of the molecule is via isolation from F. picrosperma grown in plantations. Successful domestication and plantation production requires an intimate knowledge of a taxon's life-history attributes and genetic architecture, not only to ensure the maximum capture of genetic diversity from wild source populations, but also to minimise the risk of a detrimental loss in genetic diversity via founder effects during subsequent breeding programs designed to enhance commercially significant agronomic traits. Here we report the use of eleven microsatellite loci (PIC = 0.429; P ID  = 1.72 × 10(-6)) to investigate the partitioning of genetic diversity within and among seven natural populations of F. picrosperma. Genetic variation among individuals and within populations was found to be relatively low (A = 2.831; H E  = 0.407), although there was marked differentiation among populations (PhiPT = 0.248). Bayesian, UPGMA and principal coordinates analyses detected three main genotypic clusters (K = 3), which were present at all seven populations. Despite low levels of historical gene flow (N m  = 1.382), inbreeding was negligible (F = -0.003); presumably due to the taxon's dioecious breeding system. The data suggests that F. picrosperma was previously more continuously distributed, but that rainforest contraction and expansion in response to glacial-interglacial cycles, together with significant anthropogenic effects have resulted in significant fragmentation. This research provides important tools to support plantation establishment, selection and genetic improvement of this medicinally significant Australian rainforest species.

  18. Ethical and legal implications of the risks of medical tourism for patients: a qualitative study of Canadian health and safety representatives’ perspectives

    Science.gov (United States)

    Crooks, Valorie A; Turner, Leigh; Cohen, I Glenn; Bristeir, Janet; Snyder, Jeremy; Casey, Victoria; Whitmore, Rebecca

    2013-01-01

    Objectives Medical tourism involves patients’ intentional travel to privately obtain medical care in another country. Empirical evidence regarding health and safety risks facing medical tourists is limited. Consideration of this issue is dominated by speculation and lacks meaningful input from people with specific expertise in patient health and safety. We consulted with patient health and safety experts in the Canadian province of British Columbia to explore their views concerning risks that medical tourists may be exposed to. Herein, we report on the findings, linking them to existing ethical and legal issues associated with medical tourism. Design We held a focus group in September 2011 in Vancouver, British Columbia with professionals representing different domains of patient health and safety expertise. The focus group was transcribed verbatim and analysed thematically. Participants Seven professionals representing the domains of tissue banking, blood safety, health records, organ transplantation, dental care, clinical ethics and infection control participated. Results Five dominant health and safety risks for outbound medical tourists were identified by participants: (1) complications; (2) specific concerns regarding organ transplantation; (3) transmission of antibiotic-resistant organisms; (4) (dis)continuity of medical documentation and (5) (un)informed decision-making. Conclusions Concern was expressed that medical tourism might have unintended and undesired effects upon patients’ home healthcare systems. The individual choices of medical tourists could have significant public consequences if healthcare facilities in their home countries must expend resources treating postoperative complications. Participants also expressed concern that medical tourists returning home with infections, particularly antibiotic-resistant infections, could place others at risk of exposure to infections that are refractory to standard treatment regimens and thereby pose

  19. Significance of Cooking Oil to Bioaccessibility of Dichlorodiphenyltrichloroethanes (DDTs) and Polybrominated Diphenyl Ethers (PBDEs) in Raw and Cooked Fish: Implications for Human Health Risk.

    Science.gov (United States)

    Mi, Xiu-Bo; Su, Yang; Bao, Lian-Jun; Tao, Shu; Zeng, Eddy Y

    2017-04-26

    The present study examined the bioacessibility of DDTs and PBDEs in cooked fish (yellow grouper; Epinephelus awoara) with and without heating using the colon extended physiologically based extraction test. The bioaccessibility of DDTs and PBDEs increased from 60 and 26% in raw fish to 83 and 63%, respectively, after the addition of oil to raw fish. However, they decreased from 83 to 66% and from 63 to 40%, respectively, when oil-added fish were cooked. Human health risk assessment based on bioaccessible concentrations of DDTs and PBDEs in fish showed that the maximum allowable daily fish consumption rates decreased from 25, 59, and 86 g day -1 to 22, 53, and 77 g day -1 for children, youths, and adults, respectively, after fish were cooked with oil. These findings indicated that the significance of cooking oil to the bioaccessibility of DDTs and PBDEs in food should be considered in assessments of human health risk.

  20. Polyomic profiling reveals significant hepatic metabolic alterations in glucagon-receptor (GCGR knockout mice: implications on anti-glucagon therapies for diabetes

    Directory of Open Access Journals (Sweden)

    Molloy Mark P

    2011-06-01

    Full Text Available Abstract Background Glucagon is an important hormone in the regulation of glucose homeostasis, particularly in the maintenance of euglycemia and prevention of hypoglycemia. In type 2 Diabetes Mellitus (T2DM, glucagon levels are elevated in both the fasted and postprandial states, which contributes to inappropriate hyperglycemia through excessive hepatic glucose production. Efforts to discover and evaluate glucagon receptor antagonists for the treatment of T2DM have been ongoing for approximately two decades, with the challenge being to identify an agent with appropriate pharmaceutical properties and efficacy relative to potential side effects. We sought to determine the hepatic & systemic consequence of full glucagon receptor antagonism through the study of the glucagon receptor knock-out mouse (Gcgr-/- compared to wild-type littermates. Results Liver transcriptomics was performed using Affymetric expression array profiling, and liver proteomics was performed by iTRAQ global protein analysis. To complement the transcriptomic and proteomic analyses, we also conducted metabolite profiling (~200 analytes using mass spectrometry in plasma. Overall, there was excellent concordance (R = 0.88 for changes associated with receptor knock-out between the transcript and protein analysis. Pathway analysis tools were used to map the metabolic processes in liver altered by glucagon receptor ablation, the most notable being significant down-regulation of gluconeogenesis, amino acid catabolism, and fatty acid oxidation processes, with significant up-regulation of glycolysis, fatty acid synthesis, and cholesterol biosynthetic processes. These changes at the level of the liver were manifested through an altered plasma metabolite profile in the receptor knock-out mice, e.g. decreased glucose and glucose-derived metabolites, and increased amino acids, cholesterol, and bile acid levels. Conclusions In sum, the results of this study suggest that the complete ablation

  1. Disagreements with implications: diverging discourses on the ethics of non-medical use of methylphenidate for performance enhancement

    Science.gov (United States)

    Forlini, Cynthia; Racine, Eric

    2009-01-01

    Background There is substantial evidence that methylphenidate (MPH; Ritalin), is being used by healthy university students for non-medical motives such as the improvement of concentration, alertness, and academic performance. The scope and potential consequences of the non-medical use of MPH upon healthcare and society bring about many points of view. Methods To gain insight into key ethical and social issues on the non-medical use of MPH, we examined discourses in the print media, bioethics literature, and public health literature. Results Our study identified three diverging paradigms with varying perspectives on the nature of performance enhancement. The beneficial effects of MPH on normal cognition were generally portrayed enthusiastically in the print media and bioethics discourses but supported by scant information on associated risks. Overall, we found a variety of perspectives regarding ethical, legal and social issues related to the non-medical use of MPH for performance enhancement and its impact upon social practices and institutions. The exception to this was public health discourse which took a strong stance against the non-medical use of MPH typically viewed as a form of prescription abuse or misuse. Wide-ranging recommendations for prevention of further non-medical use of MPH included legislation and increased public education. Conclusion Some positive portrayals of the non-medical use of MPH for performance enhancement in the print media and bioethics discourses could entice further uses. Medicine and society need to prepare for more prevalent non-medical uses of neuropharmaceuticals by fostering better informed public debates. PMID:19580661

  2. Disagreements with implications: diverging discourses on the ethics of non-medical use of methylphenidate for performance enhancement

    Directory of Open Access Journals (Sweden)

    Racine Eric

    2009-07-01

    Full Text Available Abstract Background There is substantial evidence that methylphenidate (MPH; Ritalin, is being used by healthy university students for non-medical motives such as the improvement of concentration, alertness, and academic performance. The scope and potential consequences of the non-medical use of MPH upon healthcare and society bring about many points of view. Methods To gain insight into key ethical and social issues on the non-medical use of MPH, we examined discourses in the print media, bioethics literature, and public health literature. Results Our study identified three diverging paradigms with varying perspectives on the nature of performance enhancement. The beneficial effects of MPH on normal cognition were generally portrayed enthusiastically in the print media and bioethics discourses but supported by scant information on associated risks. Overall, we found a variety of perspectives regarding ethical, legal and social issues related to the non-medical use of MPH for performance enhancement and its impact upon social practices and institutions. The exception to this was public health discourse which took a strong stance against the non-medical use of MPH typically viewed as a form of prescription abuse or misuse. Wide-ranging recommendations for prevention of further non-medical use of MPH included legislation and increased public education. Conclusion Some positive portrayals of the non-medical use of MPH for performance enhancement in the print media and bioethics discourses could entice further uses. Medicine and society need to prepare for more prevalent non-medical uses of neuropharmaceuticals by fostering better informed public debates.

  3. Geochemical processes in marine salt deposits: Their significance and their implications in connection with disposal of radioactive waste within salt domes

    Energy Technology Data Exchange (ETDEWEB)

    Herrmann, A G [Goettingen Univ. (Germany, F.R.). Geochemisches Inst.

    1980-01-01

    Attempts to effect permanent disposal of radioactive wastes in marine evaporites should do nothing to disturb, either in the short or the long term, the present relative stability of such bodies of rock. It is necessary to take account of all of the geochemical and physico-chemical reactions known to have been involved in the processes which formed the evaporites before proceeding to an acceptable strategy for disposal of radionucleides. These processes can be represented as three kinds of metamorphism: 1. solution metamorphism, 2. thermal metamorphism, 3. dynamic metamorphism. In all of the evaporite occurrences in Germany such processes have been influential in altering, on occasion significantly, the primary mineralogical composition and have also promoted a considerable degree of transposition of material. Given similar geochemical and physico-chemical premises, these metamorphic processes could become effective now or in the future. It is therefore necessary to discuss the following criteria when examining salt domes as permanent repositories of highly radioactive substances: (1) Temperatures <= 90/sup 0/ +- 10/sup 0/C at the contact between waste containers and rock salt; (2) Temperatures <= 75/sup 0/C within zones of carnallite rocks; (3) Immobilisation of high-level waste in crystalline forms whenever possible; (4) Systems of additional safety barriers around the waste containers or the unreprocessed spent fuel elements. The geochemical and physical effectiveness of the barriers within an evaporite environment must be guaranteed. For example: Ni-Ti-alloys, corundum, ceramic, anhydrite.

  4. The low risk of precancer after a screening result of human papillomavirus-negative/atypical squamous cells of undetermined significance papanicolaou and implications for clinical management.

    Science.gov (United States)

    Gage, Julia C; Katki, Hormuzd A; Schiffman, Mark; Castle, Philip E; Fetterman, Barbara; Poitras, Nancy E; Lorey, Thomas; Cheung, Li C; Behrens, Catherine; Sharma, Abha; Zhao, Fang-Hui; Cuzick, Jack; Yang, Zi Hua; Kinney, Walter K

    2014-11-01

    Different US practice guidelines have conflicting recommendations for when women should return after a screening result of human papillomavirus (HPV)-negative with an equivocal Papanicolaou (Pap) result of atypical squamous cells of undetermined significance (ASC-US) (ie, return in either 3 or 5 years). One way to determine management is to compare the risk of precancer/cancer after an HPV-negative/ASC-US result with the risks after other negative screening results. For example, if the risk after an HPV-negative/ASC-US result was similar to the risk after a negative Pap test, a 3-year return would be preferred because guidelines agree that women with negative Pap test results should return in 3 years. Alternatively, if the risk after an HPV-negative/ASC-US result is similar to that after a cotest-negative result (HPV negative/Pap test negative), a 5-year return would be preferred because guidelines agree that women testing cotest negative should return in 5 years. The authors compared risks of cervical intraepithelial neoplasia of grade 3 or higher (CIN3+) and cervical cancer among women aged 30 years to 64 years at Kaiser Permanente Northern California with the following test results from 2003 through 2012: 17,191 women testing HPV negative/ASC-US; 980,268 women testing Pap test negative (regardless of HPV result); and 892,882 women testing cotest negative. The 5-year CIN3+ and cancer risks after an HPV-negative/ASC-US result were closer to the risks after a negative Pap test result (CIN3+: 0.48% vs 0.31% [P =.0019]; and cancer: 0.043% vs 0.031% [P =.4]) than after a negative cotest (CIN3+: 0.48% vs 0.11% [P<.0001]; and cancer: 0.043% vs 0.014% [P =.016]). Women testing HPV negative/ASC-US were found to have precancer/cancer risks that were more closely aligned with women with negative Pap test results, suggesting that women testing HPV negative/ASC-US should be managed similarly to women testing negative on Pap tests with a 3-year return for screening. © 2014

  5. Estimation of population doses from diagnostic medical examinations in Japan, 1974. III. Per caput mean marrow dose and leukemia significant dose

    Energy Technology Data Exchange (ETDEWEB)

    Hashizume, T; Maruyama, T; Kumamoto, Y [National Inst. of Radiological Sciences, Chiba (Japan)

    1976-03-01

    The mean per capita marrow dose and leukemia-significant dose from radiographic and fluoroscopic examinations in Japan have been estimated based on a 1974 nation wide survey of randomly sampled hospitals and clinics. To determine the mean marrow dose to an individual from a certain exposure of a given type of examination, the active marrow in the whole body was divided into 119 parts for an adult and 103 for a child. Dosimetric points on which the individual marrow doses were determined were set up in the center of each marrow part. The individual marrow doses at the dosimetric points in the beams of practical diagnostic x-rays were calculated on the basis of the exposure data on the patients selected in the nation wide survey, using depth dose curves experimentally determined for diagnostic x-rays. The mean individual marrow dose was averaged over the active marrow by summing, for each dosimetric point, the product of the fraction of active marrow exposed and the individual marrow dose at the dosimetric point. The leukemia significant dose was calculated by adopting a weighting factor that is, a leukemia significant factor. The factor was determined from the shape of the time-incidence curve for radiation-induced leukemia from the Hiroshima A-bomb and from the survival statistics for the average population. The resultant mean per capita marrow dose from radiographic and fluoroscopic examination was 37.0 and 70.0 mrad/person/year, respectively, with a total of 107.05 mrad/person/year. The leukemia significant dose was 32.1 mrad/person/year for radiographic examination and 61.2 mrad/person/year, with a total of 93.3. These values were compared with those of 1960 and 1969.

  6. Status of Medical Library Resources and Services in Teaching Hospitals in Enugu State, Nigeria: implications for quality health care services

    Directory of Open Access Journals (Sweden)

    Oluchi C. Okeke

    2017-06-01

    Full Text Available Considering the need for quality health information and resultant health care services in any society, this study was carried out to look into the status of library and information resources and services provided by medical libraries in Enugu State, Nigeria. The main objective of the study was to find out the information resources and services available for medical library users towards quality health care provision. Five (5 medical libraries of major teaching hospitals were used for the study with 980 registered users as the study population from where 245 users were sampled. Observation checklist was used to collect data on resources while questionnaire was used to collect data from the respondents on the services provided. The Medical Library Association Standard guided the analysis of data from observation while frequency counts and mean scores were used to analyze data from the questionnaire. Major findings showed that even though some of the required resources and services are available and provided the medical libraries, most of the required resources and services are not adequately provided by these libraries.

  7. Emergency Medical Services Public Health Implications and Interim Guidance for the Ebola Virus in the United States

    Directory of Open Access Journals (Sweden)

    Christopher E. McCoy

    2014-11-01

    Full Text Available The 25th known outbreak of the Ebola Virus Disease (EVD is now a global public health emergency and the World Health Organization (WHO has declared the epidemic to be a Public Health Emergency of International Concern (PHEIC. Since the first cases of the West African epidemic were reported in March 2014, there has been an increase in infection rates of over 13,000% over a 6-month period. The Ebola virus has now arrived in the United States and public health professionals, doctors, hospitals, Emergency Medial Services Administrators, Medical Directors, and policy makers have been working with haste to develop strategies to prevent the disease from reaching epidemic proportions. Prehospital care providers (emergency medical technicians and paramedics and medical first responders (including but not limited to firefighters and law enforcement are the healthcare systems front lines when it comes to first medical contact with patients outside of the hospital setting. Risk of contracting Ebola can be particularly high in this population of first responders if the appropriate precautions are not implemented. This article provides a brief clinical overview of the Ebola Virus Disease and provides a comprehensive summary of the Center for Disease Control and Prevention’s Interim Guidance for Emergency Medical Services (EMS Systems and 9-1-1 Public Safety Answering Points (PSAPS for Management of Patients with Known of Suspected Ebola Virus Disease in the United States. [West J Emerg Med. 2014;15(7:-0.

  8. Assessment of antibiotic resistance genes and integrons in commensal Escherichia coli from the Indian urban waste water: Implications and significance for public health

    Directory of Open Access Journals (Sweden)

    Nambram Somendro Singh

    2017-10-01

    Full Text Available Antibiotics like β-lactams, quinolones/fluoroquinolones, aminoglycosides and tetracycline constitute the major mainstay of treatment against most infectious diseases including Escherichia coli. Indiscriminate use of antibiotics for human and animal well-being has generated an enormous evolutionary pressure on bacteria especially E.coli, which has a highly plastic/evolving genome. Though, antibiotic resistance (AR has been extensively studied in pathogenic E.coli, commensal strains have been studied less owing to lesser clinical significance. However, commensal strains pose a serious threat as reservoirs and transmitters of resistance genes to other bacteria. Therefore, the present study was undertaken to investigate the prevalence of resistance genes and integrons in commensal E.coli isolated from river Yamuna, Delhi, India, which receives plentiful urban waste water. Eighty three well-characterized E.coli strains of phylogroups A and B1 isolated from river Yamuna were investigated. Antimicrobial susceptibilities and minimal inhibitory concentrations (MICs for β-lactams, aminoglycosides, tetracycline and quinolone/fluoroquinolone were determined by disk diffusion and Etest, according to Clinical and Laboratory Standards Institute (CLSI guidelines. Production of Extended spectrum β-lactamases (ESBL and AmpC was investigated. Prevalence of antibiotic-resistance genes for β-lactams (blaTEM,blaSHV, blaCTX-M, blaOXA, blaCMY-42, aminoglycosides (rmtA, rmtB, rmtC, armA, str, aacC2, tetracycline (tetA, tetR, tetM, tetW, and plasmid-mediated quinolone resistance, PMQR (qnrA, qnrB, qnrC, qnrD, qnrS, qep, aac were assessed. Integrons and  gene-cassette arrays were characterized. Commensal E.coli strains showed a higher resistance to ampicillin (95%, less to cefazolin (45% and still lesser to tetracycline (15%. About 19% of these strains showed multidrug resistant (three or more classes of antibiotics, of which 15% also produced ESBLs. None of the

  9. The health and safety implications of local medical support for land seismic crews in remote locations in southeast Asia

    International Nuclear Information System (INIS)

    Win, P.M.; Suter, P.C.

    1991-01-01

    The paper attempts to detail the benefits and drawbacks of hiring local doctors to support the medical services needed for land seismic acquisition crews in remote locations in South East Asia. The actual conditions prevailing among such seismic operations will be presented highlighting the problems and risks involved. The management of these problems will be outlined in terms of prevention and actual diagnosis and treatment of disease and injuries including emergency stabilization and evacuation of critically ill patients. The results and lessons learned will be evaluated and discussed including the economics of setting up a reasonably reliable medical facility. The paper will conclude that local knowledge, high levels of training and low costs make this type of medical support beneficial for such operations and may well be applicable for similar operations in other parts of the world

  10. Clinically significant and sustained weight loss is achievable in obese women with polycystic ovary syndrome followed in a regular medical practice.

    Science.gov (United States)

    Pelletier, Lysanne; Baillargeon, Jean-Patrice

    2010-12-01

    To determine the proportion of obese women with polycystic ovary syndrome (PCOS) losing clinically significant amounts of weight during a standard follow-up by an endocrinologist. Retrospective cohort study. Reproductive Endocrinology Clinic of an academic center. Obese patients with PCOS assessed between May 2002 and September 2008. General nonstandardized advice on weight loss and exercise. Proportion of women losing ≥5% or ≥10% of their initial weight at each of the following time interval: 2-6 months, 6-12 months, 12-18 months, 18-24 months, 24-36 months, and beyond 36 months. One hundred seventeen patients with PCOS and with a mean body mass index (BMI) of 38.7 kg/m(2) and mean age of 28.5 years were followed-up for a median duration of 21.9 months (range, 2.0-61.8 months), with a median of two visits per year. More than 40% of these women lost ≥5% of their initial weight after >6 months of follow-up, and ≥20% lost ≥10% after 1 year of follow-up. More important, these proportions were maintained up to ≥3 years. It is possible for obese women with PCOS to achieve clinically significant and sustained weight loss by following simple advices given in a regular clinical care setting. Therefore, practitioners should not underestimate their impact to facilitate weight loss in women with PCOS. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  11. Definitions of medication-overuse headache in population-based studies and their implications on prevalence estimates

    DEFF Research Database (Denmark)

    Westergaard, Maria L; Hansen, Ebba Holme; Glümer, Charlotte

    2014-01-01

    Case definitions of medication-overuse headache (MOH) in population-based research have changed over time. This study aims to review MOH prevalence reports with respect to these changes, and to propose a practical case definition for future studies based on the ICHD-3 beta....

  12. The changing landscape of expanded access to investigational drugs for patients with unmet medical needs: Ethical implications

    NARCIS (Netherlands)

    E.M. Bunnik (Eline); N. Aarts (Nikkie); S. van de Vathorst (Suzanne)

    2017-01-01

    textabstractWhen patients are told that standard medical treatment options have been exhausted, their treating physicians may start looking for promising new drugs that are not yet approved, and still under investigation. Some patients can be included in clinical trials, but others cannot. It is not

  13. The changing landscape of expanded access to investigational drugs for patients with unmet medical needs: ethical implications

    NARCIS (Netherlands)

    Bunnik, Eline M.; Aarts, Nikkie; van de Vathorst, Suzanne

    2017-01-01

    When patients are told that standard medical treatment options have been exhausted, their treating physicians may start looking for promising new drugs that are not yet approved, and still under investigation. Some patients can be included in clinical trials, but others cannot. It is not widely

  14. Circulation Policies in Academic Medical Libraries: A Comparative Study of Allocation Strategies, Demographic Analysis, Service Offerings, and Implications for Practice

    Science.gov (United States)

    Whitehead, Michele L.; Gutierrez, Laura; Miller, Melody

    2014-01-01

    The purpose of this study is to gain an understanding of current academic medical library circulation polices and examine methods libraries utilize to meet patron needs. Key informants were selected from five states. Statistics regarding financial practices, users, services, space access, and circulation practices were collected via survey…

  15. Camera functional scintiscanning of the kidneys - its significance and value for nuclear-medical renal diagnostics especially in comparison with isotope nephrography

    International Nuclear Information System (INIS)

    Wibmer, A.

    1982-01-01

    The thesis aimed at demonstrating the significance of functional scintiscanning in comparison with radioisotope nephrography and its informative value in individual kidney disease cases. To this end, 248 functional scintigrams of patients taken from various disease groups and 96 functional scintigrams of non-kidney-diseased persons were evaluated. As against nephrography, functional scintigraphic imaging has the advantage of displaying simultaneously both functional graphs and sequential scintigrams. This allows to asses the morphology, location and function of the non-functioning renal parenchyma and to localize and differentiate dysfunctions which are globally detectable in RIN, at a low patient exposure and within one single examination. ''Region-of-Interest'' selection in functional scintiscanning allows an exact demonstration of the kidneys which results in new normal values for the functional parameters. Owing to its case in handling and very low level of patient exposure, functional scintiscanning lends itself to an orientational examination of large patient groups, to an examination of severely ill patients without putting too much strain of them and to follow-up of all nephropathies. It even provides some information in renal insufficiency where other methods fail. However, functional scintiscanning appears to be inappropriate as a diagnostic method in inflammatory processes, hypertension and renal artery stenoses. (orig./MG) [de

  16. A study on stability and medical implications for a complex delay model for CML with cell competition and treatment.

    Science.gov (United States)

    Rădulescu, I R; Cândea, D; Halanay, A

    2014-12-21

    We study a mathematical model describing the dynamics of leukemic and normal cell populations (stem-like and differentiated) in chronic myeloid leukemia (CML). This model is a system of four delay differential equations incorporating three types of cell division. The competition between normal and leukemic stem cell populations for the common microenvironment is taken into consideration. The stability of one steady state is investigated. The results are discussed via their medical interpretation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Ethico-legal aspects of hospital-based blood transfusion practice; implications of professional negligence to medical practitioners: a review

    OpenAIRE

    Orkuma J.A; Ayia O.N.

    2014-01-01

    Background: Blood transfusion is predominantly a hospital-based practice in many resourceconstrained economies like Nigeria, wherein the sourcing, storage, processing and clinical use of blood and blood products resides in the often financial and manpower constrained hospitals. Aim: To identify the ethical and legal issues related to hospital-based blood transfusion practice for medical practitioner. Methods: Relevant articles retrieved via PubMed/MEDLINE and Google scholar search...

  18. Insisting on the Healer's Art: The Implications of Required Participation in a Medical School Course on Values and Humanism.

    Science.gov (United States)

    Rabow, Michael W; Lapedis, Marissa; Feingold, Anat; Thomas, Mark; Remen, Rachel N

    2016-01-01

    Elective courses, by definition, allow medical students to self-select for participation in the class. In a small-group learning setting, students uninterested or not ready for a particular learning topic might change the educational experience ("poison the well") for those students most interested in the topic. It is not known how medical students required to take a course in humanism (that they otherwise would not have elected to take) might be impacted by the course or how their presence might affect students originally interested in the course. Medical students in a required course on humanism and values in medicine will have different experiences based on whether a particular student might have or not have elected to enroll in the course. Students uninterested in taking a course in humanism and values, but required to enroll, will limit the benefit of the course for those students originally interested in participating. In 2012, all 1st-year students at a U.S. medical school were required to take the Healer's Art, an elective on professional values and humanism offered at more than 90 other schools in the United States and internationally. Students completed pre/postcourse surveys assessing emotional exhaustion, work engagement, positive emotions, and cynicism. We analyzed differences between those who would have elected to take the course (Elective students) and those who would not have elected to take it (Required students). Elective students did not differ from Required students in baseline demographic characteristics, emotional exhaustion, work engagement, or positive emotions. At baseline, Elective students did report feeling safer to talk openly, a greater sense of community, and higher levels of cynicism. Over time, there were no differences in course evaluations or outcomes between Elective and Required students. Required students do not differ greatly from those who would have elected to take Healer's Art, and all students appear to have similar

  19. Implications of Patient Portal Transparency in Oncology: Qualitative Interview Study on the Experiences of Patients, Oncologists, and Medical Informaticists.

    Science.gov (United States)

    Alpert, Jordan M; Morris, Bonny B; Thomson, Maria D; Matin, Khalid; Brown, Richard F

    2018-03-26

    Providing patients with unrestricted access to their electronic medical records through patient portals has impacted patient-provider communication and patients' personal health knowledge. However, little is known about how patient portals are used in oncology. The aim of this study was to understand attitudes of the portal's adoption for oncology and to identify the advantages and disadvantages of using the portal to communicate and view medical information. In-depth semistructured interviews were conducted with 60 participants: 35 patients, 13 oncologists, and 12 medical informaticists. Interviews were recorded, transcribed, and thematically analyzed to identify critical incidents and general attitudes encountered by participants. Two primary themes were discovered: (1) implementation practices influence attitudes, in which the decision-making and execution process of introducing portals throughout the hospital did not include the input of oncologists. Lack of oncologists' involvement led to a lack of knowledge about portal functionality, such as not knowing the time period when test results would be disclosed to patients; (2) perceptions of portals as communication tools varies by user type, meaning that each participant group (patients, oncologists, and medical informaticists) had varied opinions about how the portal should be used to transmit and receive information. Oncologists and medical informaticists had difficulty understanding one another's culture and communication processes in their fields, while patients had preferences for how they would like to receive communication, but it largely depended upon the type of test being disclosed. The majority of patients (54%, 19/35) who participated in this study viewed lab results or scan reports via the portal before being contacted by a clinician. Most were relatively comfortable with this manner of disclosure but still preferred face-to-face or telephone communication. Findings from this study indicate that

  20. Managing oral phosphate binder medication expenditures within the Medicare bundled end-stage renal disease prospective payment system: economic implications for large U.S. dialysis organizations.

    Science.gov (United States)

    Park, Haesuk; Rascati, Karen L; Keith, Michael S

    2015-06-01

    From January 2016, payment for oral-only renal medications (including phosphate binders and cinacalcet) was expected to be included in the new Medicare bundled end-stage renal disease (ESRD) prospective payment system (PPS). The implementation of the ESRD PPS has generated concern within the nephrology community because of the potential for inadequate funding and the impact on patient quality of care. To estimate the potential economic impact of the new Medicare bundled ESRD PPS reimbursement from the perspective of a large dialysis organization in the United States. We developed an interactive budget impact model to evaluate the potential economic implications of Medicare payment changes to large dialysis organizations treating patients with ESRD who are receiving phosphate binders. In this analysis, we focused on the budget impact of the intended 2016 integration of oral renal drugs, specifically oral phosphate binders, into the PPS. We also utilized the model to explore the budgetary impact of a variety of potential shifts in phosphate binder market shares under the bundled PPS from 2013 to 2016. The base model predicts that phosphate binder costs will increase to $34.48 per dialysis session in 2016, with estimated U.S. total costs for phosphate binders of over $682 million. Based on these estimates, a projected Medicare PPS $33.44 reimbursement rate for coverage of all oral-only renal medications (i.e., phosphate binders and cinacalcet) would be insufficient to cover these costs. A potential renal drugs and services budget shortfall for large dialysis organizations of almost $346 million was projected. Our findings suggest that large dialysis organizations will be challenged to manage phosphate binder expenditures within the planned Medicare bundled rate structure. As a result, large dialysis organizations may have to make treatment choices in light of potential inadequate funding, which could have important implications for the quality of care for patients

  1. Factors Associated With Medical School Graduates' Intention to Work With Underserved Populations: Policy Implications for Advancing Workforce Diversity.

    Science.gov (United States)

    Garcia, Andrea N; Kuo, Tony; Arangua, Lisa; Pérez-Stable, Eliseo J

    2018-01-01

    Given projected U.S. physician shortages across all specialties that will likely impact underserved areas disproportionately, the authors sought to explore factors most correlated with medical school graduates' intention to work with underserved populations (IWUP). Data from the 2010-2012 Association of American Medical Colleges Medical School Graduation Questionnaire (n = 40,846) were analyzed. Variables (demographics, career preference, debt burden, intention to enter loan forgiveness programs) were examined using chi-square tests and logistic regression models. Respondents included 49.5% (20,228/40,846) women, 16.6% (6,771/40,837) underrepresented minorities (URMs), and 32.4% (13,034/37,342) with primary care intent. The median educational debt was $160,000. Respondents who were women (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.49, 1.70), URMs (aOR 2.50, 95% CI 2.30, 2.72), intended to enter loan forgiveness programs (aOR 2.44, 95% CI 2.26, 2.63), intended to practice primary care (aOR 1.65, 95% CI 1.54, 1.76), and intended to emphasize nonclinical careers (aOR 1.23, 95% CI 1.11, 1.37) had greater odds of reporting IWUP. Among those who chose specialties and careers with a nonclinical emphasis, and among those with greater burdens of educational and consumer debt, URMs were nearly twice as likely as other minorities and whites to report IWUP. Findings suggest physician characteristics that may be associated with filling workforce gaps in underserved areas. Restructuring financial incentive programs to support physician leaders and specialists with characteristics associated with IWUP may complement similar policies in primary care and could have key impacts on health equity in underserved areas.

  2. Data Sharing: A New Editorial Initiative of the International Committee of Medical Journal Editors. Implications for the Editors’ Network

    Directory of Open Access Journals (Sweden)

    Fernando Alfonso, MD

    2017-05-01

    Full Text Available The International Committee of Medical Journal Editors (ICMJE provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship -emphasizing the importance of responsibility and accountability-, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors’ Network of the European Society of Cardiology.

  3. Data sharing: A new editorial initiative of the International Committee of Medical Journal Editors. Implications for the editors’ network

    Directory of Open Access Journals (Sweden)

    Fernando Alfonso

    2017-06-01

    Full Text Available The International Committee of Medical Journal Editors (ICMJE provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship -emphasizing the importance of responsibility and accountability-, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors’ Network of the European Society of Cardiology.

  4. Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance.

    Science.gov (United States)

    Li, Ye; Wu, Qunhong; Xu, Ling; Legge, David; Hao, Yanhua; Gao, Lijun; Ning, Ning; Wan, Gang

    2012-09-01

    To assess the degree to which the Chinese people are protected from catastrophic household expenditure and impoverishment from medical expenses and to explore the health system and structural factors influencing the first of these outcomes. Data were derived from the Fourth National Health Service Survey. An analysis of catastrophic health expenditure and impoverishment from medical expenses was undertaken with a sample of 55 556 households of different characteristics and located in rural and urban settings in different parts of the country. Logistic regression was used to identify the determinants of catastrophic health expenditure. The rate of catastrophic health expenditure was 13.0%; that of impoverishment was 7.5%. Rates of catastrophic health expenditure were higher among households having members who were hospitalized, elderly, or chronically ill, as well as in households in rural or poorer regions. A combination of adverse factors increased the risk of catastrophic health expenditure. Families enrolled in the urban employee or resident insurance schemes had lower rates of catastrophic health expenditure than those enrolled in the new rural corporative scheme. The need for and use of health care, demographics, type of benefit package and type of provider payment method were the determinants of catastrophic health expenditure. Although China has greatly expanded health insurance coverage, financial protection remains insufficient. Policy-makers should focus on designing improved insurance plans by expanding the benefit package, redesigning cost sharing arrangements and provider payment methods and developing more effective expenditure control strategies.

  5. Cancer Counseling of Low-Income Limited English Proficient Latina Women Using Medical Interpreters: Implications for Shared Decision-Making.

    Science.gov (United States)

    Kamara, Daniella; Weil, Jon; Youngblom, Janey; Guerra, Claudia; Joseph, Galen

    2018-02-01

    In cancer genetic counseling (CGC), communication across language and culture challenges the model of practice based on shared decision-making. To date, little research has examined the decision-making process of low-income, limited English proficiency (LEP) patients in CGC. This study identified communication patterns in CGC sessions with this population and assessed how these patterns facilitate or inhibit the decision-making process during the sessions. We analyzed 24 audio recordings of CGC sessions conducted in Spanish via telephone interpreters at two public hospitals. Patients were referred for risk of hereditary breast and ovarian cancer; all were offered genetic testing. Audio files were coded by two bilingual English-Spanish researchers and analyzed using conventional content analysis through an iterative process. The 24 sessions included 13 patients, 6 counselors, and 18 interpreters. Qualitative data analyses identified three key domains - Challenges Posed by Hypothetical Explanations, Misinterpretation by the Medical Interpreter, and Communication Facilitators - that reflect communication patterns and their impact on the counselor's ability to facilitate shared decision-making. Overall, we found an absence of patient participation in the decision-making process. Our data suggest that when counseling LEP Latina patients via medical interpreter, prioritizing information with direct utility for the patient and organizing information into short- and long-term goals may reduce information overload and improve comprehension for patient and interpreter. Further research is needed to test the proposed counseling strategies with this population and to assess how applicable our findings are to other populations.

  6. Gender and Medical Leadership: Student Perceptions and Implications for Developing Future Leaders in Primary and Secondary Care--a Pilot Study.

    Science.gov (United States)

    Crolla, Elizabeth; O'Sullivan, Helen; Bogg, Jan

    2011-10-01

    To explore perceptions of leadership in undergraduate medical students. A quantitative pilot study; anonymous online survey. All undergraduates were invited to participate from one UK medical school; 469 students participated. The survey used Likert scales and open and closed questions. Lack of self-confidence and perceptions of women leaders were issues for undergraduates. A significant number of male undergraduates rated women less able to perform 10 of 12 attributes of leadership. Furthermore, male undergraduates showed greater ambition towards future leadership, with 42.2% males compared to 21.7% females strongly agreeing that they saw themselves in a position of leadership in the future. Networking and tradition were also seen as barriers to females gaining the highest office in the student medical society. The importance of embedding leadership in the curriculum was highlighted by both genders. CONCLUSIONS Barriers to progression still need to be investigated and removed especially because women are expected to comprise the majority of the medical workforce by 2017. There needs to be greater emphasis on mentoring and role models at the undergraduate level and beyond and more awareness of leadership in curricula at all levels. These changes should ultimately improve confidence and change the perception of women in the medical workforce.

  7. Quality assurance of medical education: a case study from Switzerland

    Science.gov (United States)

    Schirlo, Christian; Heusser, Rolf

    2010-01-01

    In the light of ongoing changes and challenges in the European health systems which also have significant implications for undergraduate medical education, the present paper describes the accreditation of medical education programmes in Switzerland focussing on undergraduate medical education. A summary of the methodology used is provided and first experiences as well as future perspectives are discussed in the light of the aim to achieve continuous quality assurance and improvement in medical education. PMID:21818193

  8. Integrated Medical-Dental Delivery Systems: Models in a Changing Environment and Their Implications for Dental Education.

    Science.gov (United States)

    Jones, Judith A; Snyder, John J; Gesko, David S; Helgeson, Michael J

    2017-09-01

    Models and systems of the dental care delivery system are changing. Solo practice is no longer the only alternative for graduating dentists. Over half of recent graduates are employees, and more than ever before, dentists are practicing in groups. This trend is expected to increase over the next 25 years. This article examines various models of dental care delivery, explains why it is important to practice in integrated medical-dental teams, and defines person-centered care, contrasting it with patient-centered care. Systems of care in which teams are currently practicing integrated oral health care delivery are described, along with speculation on the future of person-centered care and the team approach. Critical steps in the education of dental and other health care professionals and the development of clinical models of care in moving forward are considered. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

  9. Data Sharing: A New Editorial Initiative of the International Committee of Medical Journal Editors. Implications for the Editors' Network.

    Science.gov (United States)

    Alfonso, Fernando; Adamyan, Karlen; Artigou, Jean-Yves; Aschermann, Michael; Boehm, Michael; Buendia, Alfonso; Chu, Pao-Hsien; Cohen, Ariel; Cas, Livio Dei; Dilic, Mirza; Doubell, Anton; Echeverri, Dario; Enç, Nuray; Ferreira-González, Ignacio; Filipiak, Krzysztof J; Flammer, Andreas; Fleck, Eckart; Gatzov, Plamen; Ginghina, Carmen; Goncalves, Lino; Haouala, Habib; Hassanein, Mahmoud; Heusch, Gerd; Huber, Kurt; Hulín, Ivan; Ivanusa, Mario; Krittayaphong, Rungroj; Lau, Chu-Pak; Marinskis, Germanas; Mach, François; Moreira, Luiz Felipe; Nieminen, Tuomo; Oukerraj, Latifa; Perings, Stefan; Pierard, Luc; Potpara, Tatjana; Reyes-Caorsi, Walter; Rim, Se-Joong; Rødevand, Olaf; Saade, Georges; Sander, Mikael; Shlyakhto, Evgeny; Timuralp, Bilgin; Tousoulis, Dimitris; Ural, Dilek; Piek, J J; Varga, Albert; Lüscher, Thomas F

    The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship - emphasizing the importance of responsibility and accountability -, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors' Network of the European Society of Cardiology. Copyright © 2017. Publicado por Masson Doyma México S.A.

  10. Con-forming bodies: the interplay of machines and bodies and the implications of agency in medical imaging.

    Science.gov (United States)

    Wood, Lisa A

    2016-06-01

    Attending to the material discursive constructions of the patient body within cone beam computed tomography (CBCT) imaging in radiotherapy treatments, in this paper I describe how bodies and machines co-create images. Using an analytical framework inspired by Science and Technology Studies and Feminist Technoscience, I describe the interplay between machines and bodies and the implications of materialities and agency. I argue that patients' bodies play a part in producing scans within acceptable limits of machines as set out through organisational arrangements. In doing so I argue that bodies are fabricated into the order of work prescribed and embedded within and around the CBCT system, becoming, not only the subject of resulting images, but part of that image. The scan is not therefore a representation of a passive subject (a body) but co-produced by the work of practitioners and patients who actively control (and contort) and discipline their body according to protocols and instructions and the CBCT system. In this way I suggest they are 'con-forming' the CBCT image. A Virtual Abstract of this paper can be found at: https://youtu.be/qysCcBGuNSM. © 2015 Foundation for the Sociology of Health & Illness.

  11. Interdependence in decision-making by medical consultants: implications for improving the efficiency of inpatient physician services.

    Science.gov (United States)

    Wilk, Adam S; Chen, Lena M

    2017-12-01

    Hospital administrators are seeking to improve efficiency in medical consultation services, yet whether consultants make decisions to provide more or less care is unknown. We examined how medical consultants account for prior consultants' care when determining whether to provide intensive consulting care or sign off in the treatment of complex surgical inpatients. We applied three distinct theoretical frameworks in the interpretation of our results. We performed a retrospective cohort study of consultants' care intensity, measured alternately using a dummy variable for providing two or more days consulting (versus one) and a continuous measure of total days consulting, with 100% Medicare claims data from 2007-2010. Our analytic samples included consults for beneficiaries undergoing coronary artery bypass grafting (n = 61,785) or colectomy (n = 33,460) in general acute care hospitals. We compared the care intensity of consultants who observed different patterns of consulting care before their initial consults using ordinary least squares regression models at the patient-physician dyad level, controlling for patient comorbidity and many other patient- and physician-level factors as well as hospital region and year fixed effects. Consultants were less likely to provide intensive consulting care with each additional prior consultant on the case (1.2-1.7 percent) or if a prior consultant rendered intensive consulting care (20.6-21.5 percent) but more likely when prior consults were more concentrated across consultants (2.9-3.1 percent). Effects on consultants' total days consulting were similar. On average, consultants appeared to calibrate their care intensity for individual patients to maximize their value to all patients. Interventions for improving consulting care efficiency should seek to facilitate (not constrain) consultants' decision-making processes.

  12. Rural-to-urban migration and its implication for new cooperative medical scheme coverage and utilization in China

    Directory of Open Access Journals (Sweden)

    Zhang Juying

    2011-06-01

    Full Text Available Abstract Background China has been experiencing the largest rural to urban migration in history. Rural-to-urban migrants are those who leave their hometown for another place in order to work or live without changing their hukou status, which is a household registration system in China, categorizing people as either rural residents or urban residents. Rural-to-urban migrants typically find better job opportunities in destination cities, and these pay higher salaries than available in their home regions. This has served to improve the enrollment rates in the New Cooperative Medical Scheme (NCMS of rural families, protecting households from falling into poverty due to diseases. However, current regulations stipulate that people who are registered in China's rural hukou can only participate in their local NCMS, which in turn poses barriers when migrants seek medical services in the health facilities of their destination cities. To examine this issue in greater depth, this study examined the associations between migration, economic status of rural households, and NCMS enrollment rate, as well as NCMS utilization of rural-to-urban migrants. Methods A multistage cluster sampling procedure was adopted. Our sample included 9,097 households and 36,720 individuals. Chi-square test and T-test were used to examine differences between the two populations of migrants and non-migrants based on age, gender, marriage status, and highest level of education. Ordinal logistic regression was used to examine the association between migration and household economic status. Binary logistic regression was used to examine the associations between household economic status, migration and enrollment in the NCMS. Results Migration was positively associated with improved household economic status. In households with no migrants, only 11.3% of the population was in the richest quintile, whereas the percentage was more than doubled in households with family members who migrated

  13. The "general recognition and acceptance" standard of objectivity for good faith in prescribing: legal and medical implications.

    Science.gov (United States)

    Brushwood, David B

    2007-01-01

    The United States Court of Appeals for the 4th Circuit has ruled that a jury considering charges of drug trafficking against a pain management physician should be instructed that the defendant's good faith is a defense to the charges. The court rejected a subjective standard of good faith, and instead ruled that the good faith of the defendant must be evaluated from an objective perspective. This objective standard requires that the jury determine whether the defendant was practicing in accordance with the standard generally recognized and accepted in the United States. General recognition and acceptance are determined on a case-by-case basis, within the context of a defendant's practice. Simply because a physician's practice is out of the norm for many physicians does not mean it can't be generally recognized and accepted within the standard of medical practice. Expert witness testimony of pain management physicians will assist juries in the application of this standard for good faith in prescribing.

  14. Personality characteristics and attributes of international medical graduates in general practice training: Implications for supporting this valued Australian workforce.

    Science.gov (United States)

    Laurence, Caroline O; Eley, Diann S; Walters, Lucie; Elliott, Taryn; Cloninger, Claude Robert

    2016-10-01

    To describe the personality profiles of International Medical Graduates (IMGs) undertaking General Practice (GP) training in Australia. A better understanding of the personal characteristics of IMGs may inform their training and enhance support for their vital contribution to the Australian rural workforce. Cross-sectional self-report questionnaires. Independent variables included socio-demographics, prior training, the Temperament and Character Inventory, and the Resilience Scale. GP registrars (IMGs = 102; AMGs = 350) training in the Australian General Practice Training rural and general pathway and the Australian College of Rural and Remote Medicine independent pathway. Univariate analysis explored the differences in levels of traits between IMG and AMG registrars. Compared to the general population both groups have moderately high resilience, and well-organised characters with high Self-directedness, high Cooperativeness and low Self-transcendence, supported by temperaments which were high in Persistence and Reward Dependence. IMGs were different than AMGs in two temperament traits, Novelty Seeking and Persistence and two character traits, Self-directedness and Cooperativeness. Factors such as cultural and training backgrounds, personal and professional expectations, and adjustments necessary to assimilate to a new lifestyle and health system are likely to be responsible for differences found between groups. Understanding the personality profiles of IMGs provides opportunities for targeted training and support which may in turn impact on their retention in rural areas. © 2016 National Rural Health Alliance Inc.

  15. Assessing internet access and use in a medically underserved population: implications for providing enhanced health information services.

    Science.gov (United States)

    Zach, Lisl; Dalrymple, Prudence W; Rogers, Michelle L; Williver-Farr, Heather

    2012-03-01

    The relationship between health information seeking, patient engagement and health literacy is not well understood. This is especially true in medically underserved populations, which are often viewed as having limited access to health information. To improve communication between an urban health centre and the community it serves, a team of library and information science researchers undertook an assessment of patients' level and methods of access to and use of the Internet. Data were collected in 53 face-to-face anonymous interviews with patients at the centre. Interviews were tape-recorded for referential accuracy, and data were analysed to identify patterns of access and use. Seventy-two percentage of study participants reported having access to the Internet through either computers or cell phones. Barriers to Internet access were predominantly lack of equipment or training rather than lack of interest. Only 21% of those with Internet access reported using the Internet to look for health information. The findings suggest that lack of access to the Internet in itself is not the primary barrier to seeking health information in this population and that the digital divide exists not at the level of information access but rather at the level of information use. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.

  16. Refugee Policy Implications of U.S. Immigration Medical Screenings: A New Era of Inadmissibility on Health-Related Grounds.

    Science.gov (United States)

    Hong, Mi-Kyung; Varghese, Reshma E; Jindal, Charulata; Efird, Jimmy T

    2017-09-24

    Refugees frequently face extended delays in their efforts to enter the United States (U.S.) and those who are successful, in many cases, encounter overwhelming obstacles, inadequate resources, and a complex system of legal barriers. Travel restrictions based on equivocal health concerns and a drop in refugee admittance ceilings have complicated the situation. The authors retrieved and analyzed peer-reviewed journal articles, government agency press releases, media postings, epidemiologic factsheets, and relevant lay publications to critically assess U.S. policy regarding refugee resettlement based on health-related grounds. While refugees arguably exhibit an increased incidence of measles and tuberculosis compared with the U.S. population, the legitimacy of the medical examination will be undermined if other diseases that are endemic to refugee populations, yet currently deemed admissible, are used to restrict refugees from entering the U.S. This paper addressees the historic refugee policy of the U.S. and its consequent effect on the health of this vulnerable population. The needs of refugees should be carefully considered in the context of increased disease burden and the associated health care challenges of the country as a whole.

  17. The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

    Science.gov (United States)

    Montejo, Angel L.; Montejo, Laura; Baldwin, David S.

    2018-01-01

    Sexual dysfunction often accompanies severe psychiatric illness and can be due to both the mental disorder itself and the use of psychotropic treatments. Many sexual symptoms resolve as the mental state improves, but treatment‐related sexual adverse events tend to persist over time, and are unfortunately under‐recognized by clinicians and scarcely investigated in clinical trials. Treatment‐emergent sexual dysfunction adversely affects quality of life and may contribute to reduce treatment adherence. There are important differences between the various compounds in the incidence of adverse sexual effects, associated with differences in mechanisms of action. Antidepressants with a predominantly serotonergic activity, antipsychotics likely to induce hyperprolactinaemia, and mood stabilizers with hormonal effects are often linked to moderate or severe sexual dysfunction, including decreased libido, delayed orgasm, anorgasmia, and sexual arousal difficulties. Severe mental disorders can interfere with sexual function and satisfaction, while patients wish to preserve a previously satisfactory sexual activity. In many patients, a lack of intimate relationships and chronic deterioration in mental and physical health can be accompanied by either a poor sexual life or a more frequent risky sexual behaviour than in the general population. Here we describe the influence of psychosis and antipsychotic medications, of depression and antidepressant drugs, and of bipolar disorder and mood stabilizers on sexual health, and the optimal management of patients with severe psychiatric illness and sexual dysfunction. PMID:29352532

  18. Development of a Microsimulation Model to Predict Stroke and Long-Term Mortality in Adherent and Nonadherent Medically Managed and Surgically Treated Octogenarians with Asymptomatic Significant Carotid Artery Stenosis.

    Science.gov (United States)

    Luebke, Thomas; Brunkwall, Jan

    2016-08-01

    The primary study objective was to develop a microsimulation model to predict preventable first-ever and recurrent strokes and mortality for a population of medically or surgically managed octogenarians with substantial (>60%) asymptomatic carotid artery stenosis and comparing an adherent with a real-world nonadherent best medical treatment (BMT) regimen subjected to sex. A Monte Carlo microsimulation model was constructed with a 14-year time horizon and with 10,000 patients. Probabilities and values for clinical outcomes were obtained from the current literature. The stratification of the microsimulation estimates by treatment strategy within the female group of octogenarians showed a statistically significant lower stroke rate during follow-up for carotid endarterectomy (CEA) compared with nonadherent BMT (P < 0.0001) as well as compared with adherent BMT (P < 0.0001). In male octogenarians, the CEA strategy was also associated with statistically significant lower stroke rates compared with adherent and nonadherent BMT (P < 0.0001 and P < 0.0001, respectively). For each treatment strategy, female octogenarians had a statistically significant longer overall long-term survival compared with male octogenarians (P < 0.0001, respectively). In terms of stratification by sex, in octogenarian men and women, long-term survival was significantly better for adherent BMT compared with nonadherent BMT, and CEA was associated with a significant better long-term survival compared with nonadherent BMT. In the present microsimulation, in real-world drug adherence, it was likely that a strategy of early endarterectomy was beneficial in octogenarians with significant asymptomatic carotid artery disease compared with BMT alone. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Societal Implications of Health Insurance Coverage for Medically Necessary Services in the U.S. Transgender Population: A Cost-Effectiveness Analysis.

    Science.gov (United States)

    Padula, William V; Heru, Shiona; Campbell, Jonathan D

    2016-04-01

    Recently, the Massachusetts Group Insurance Commission (GIC) prioritized research on the implications of a clause expressly prohibiting the denial of health insurance coverage for transgender-related services. These medically necessary services include primary and preventive care as well as transitional therapy. To analyze the cost-effectiveness of insurance coverage for medically necessary transgender-related services. Markov model with 5- and 10-year time horizons from a U.S. societal perspective, discounted at 3% (USD 2013). Data on outcomes were abstracted from the 2011 National Transgender Discrimination Survey (NTDS). U.S. transgender population starting before transitional therapy. No health benefits compared to health insurance coverage for medically necessary services. This coverage can lead to hormone replacement therapy, sex reassignment surgery, or both. Cost per quality-adjusted life year (QALY) for successful transition or negative outcomes (e.g. HIV, depression, suicidality, drug abuse, mortality) dependent on insurance coverage or no health benefit at a willingness-to-pay threshold of $100,000/QALY. Budget impact interpreted as the U.S. per-member-per-month cost. Compared to no health benefits for transgender patients ($23,619; 6.49 QALYs), insurance coverage for medically necessary services came at a greater cost and effectiveness ($31,816; 7.37 QALYs), with an incremental cost-effectiveness ratio (ICER) of $9314/QALY. The budget impact of this coverage is approximately $0.016 per member per month. Although the cost for transitions is $10,000-22,000 and the cost of provider coverage is $2175/year, these additional expenses hold good value for reducing the risk of negative endpoints--HIV, depression, suicidality, and drug abuse. Results were robust to uncertainty. The probabilistic sensitivity analysis showed that provider coverage was cost-effective in 85% of simulations. Health insurance coverage for the U.S. transgender population is affordable

  20. Reliability of the American Medical Association guides' model for measuring spinal range of motion. Its implication for whole-person impairment rating.

    Science.gov (United States)

    Nitschke, J E; Nattrass, C L; Disler, P B; Chou, M J; Ooi, K T

    1999-02-01

    implications for compensation bodies in Australia and other countries that use the American Medical Association Guides' procedure to estimate impairment in chronic low back pain patients.

  1. Kinking and Torsion Can Significantly Improve the Efficiency of Valveless Pumping in Periodically Compressed Tubular Conduits. Implications for Understanding of the Form-Function Relationship of Embryonic Heart Tubes

    Directory of Open Access Journals (Sweden)

    Florian Hiermeier

    2017-11-01

    Full Text Available Valveless pumping phenomena (peristalsis, Liebau-effect can generate unidirectional fluid flow in periodically compressed tubular conduits. Early embryonic hearts are tubular conduits acting as valveless pumps. It is unclear whether such hearts work as peristaltic or Liebau-effect pumps. During the initial phase of its pumping activity, the originally straight embryonic heart is subjected to deforming forces that produce bending, twisting, kinking, and coiling. This deformation process is called cardiac looping. Its function is traditionally seen as generating a configuration needed for establishment of correct alignments of pulmonary and systemic flow pathways in the mature heart of lung-breathing vertebrates. This idea conflicts with the fact that cardiac looping occurs in all vertebrates, including gill-breathing fishes. We speculate that looping morphogenesis may improve the efficiency of valveless pumping. To test the physical plausibility of this hypothesis, we analyzed the pumping performance of a Liebau-effect pump in straight and looped (kinked configurations. Compared to the straight configuration, the looped configuration significantly improved the pumping performance of our pump. This shows that looping can improve the efficiency of valveless pumping driven by the Liebau-effect. Further studies are needed to clarify whether this finding may have implications for understanding of the form-function relationship of embryonic hearts.

  2. The significance of sense of coherence for the perceptions of task characteristics and stress during interruptions amongst a sample of public health nurses in Hong Kong: implications for nursing management.

    Science.gov (United States)

    Shiu, A T

    1998-08-01

    The study aimed to investigate the significance of sense of coherence (SOC) for the perceptions of task characteristics and for stress perceptions during interruptions of public health nurses (PHNs) with children in Hong Kong. The research design employed the experience sampling method. Convenience sampling was used to recruit 20 subjects. During stage one of the study a watch was worn that gave a signal at six random times each day for seven days to complete an experience sampling diary. PHNs on average responded to 34 signals (80%) to complete the diaries which collected data on work and family juggling, task characteristics, and their effects on mood states. At stage two respondents completed the SOC scale which measured confidence in life as comprehensible, manageable, and meaningful. Two major findings provide the focus for this paper. First, results indicate that there was positive correlation between SOC and perceived task characteristics. Second, results reveal that when interruptions occurred, PHNs with high SOC had higher positive affect and lower negative affect than PHNs with low SOC. These results suggest that SOC as a salutogenic model helps PHNs to cope with the family and work juggling as well as the occupational stress. Implications for nursing management on strengthening SOC of PHNs are discussed.

  3. Medical and psychosocial implications of adolescent extreme obesity – acceptance and effects of structured care, short: Youth with Extreme Obesity Study (YES)

    Science.gov (United States)

    2013-01-01

    Background Prevalence rates of overweight and obesity have increased in German children and adolescents in the last three decades. Adolescents with extreme obesity represent a distinct risk group. On the basis of data obtained by the German Child and Youth Survey (KiGGS) and the German district military offices we estimate that the group of extremely obese adolescents (BMI ≥ 35 kg/m2) currently encompasses approximately 200.000 adolescents aged 14 to 21 yrs. Conventional approaches focusing on weight reduction have largely proven futile for them. In addition, only a small percentage of adolescents with extreme obesity seek actively treatment for obesity while contributing disproportionately strong to health care costs. Because of somatic and psychiatric co-morbidities and social problems adolescents with extreme obesity require special attention within the medical care system. We have initiated the project “Medical and psychosocial implications of adolescents with extreme obesity - acceptance and effects of structured care, short: ‘Youths with Extreme Obesity Study (YES)’”, which aims at improving the medical care and social support structures for youths with extreme obesity in Germany. Methods/Design We focus on identification of these subjects (baseline examination) and their acceptance of diagnostic and subsequent treatment procedures. In a randomized controlled trial (RCT) we will investigate the effectiveness of a low key group intervention not focusing on weight loss but aimed at the provision of obesity related information, alleviation of social isolation, school and vocational integration and improvement of self-esteem in comparison to a control group treated in a conventional way with focus on weight loss. Interested individuals who fulfill current recommended criteria for weight loss surgery will be provided with a structured preparation and follow-up programs. All subjects will be monitored within a long-term observational study to

  4. Medical and psychosocial implications of adolescent extreme obesity - acceptance and effects of structured care, short: Youth with Extreme Obesity Study (YES).

    Science.gov (United States)

    Wabitsch, Martin; Moss, Anja; Reinehr, Thomas; Wiegand, Susanna; Kiess, Wieland; Scherag, André; Holl, Reinhard; Holle, Rolf; Hebebrand, Johannes

    2013-08-29

    Prevalence rates of overweight and obesity have increased in German children and adolescents in the last three decades. Adolescents with extreme obesity represent a distinct risk group. On the basis of data obtained by the German Child and Youth Survey (KiGGS) and the German district military offices we estimate that the group of extremely obese adolescents (BMI ≥ 35 kg/m2) currently encompasses approximately 200.000 adolescents aged 14 to 21 yrs. Conventional approaches focusing on weight reduction have largely proven futile for them. In addition, only a small percentage of adolescents with extreme obesity seek actively treatment for obesity while contributing disproportionately strong to health care costs. Because of somatic and psychiatric co-morbidities and social problems adolescents with extreme obesity require special attention within the medical care system. We have initiated the project "Medical and psychosocial implications of adolescents with extreme obesity--acceptance and effects of structured care, short: 'Youths with Extreme Obesity Study (YES)'", which aims at improving the medical care and social support structures for youths with extreme obesity in Germany. We focus on identification of these subjects (baseline examination) and their acceptance of diagnostic and subsequent treatment procedures. In a randomized controlled trial (RCT) we will investigate the effectiveness of a low key group intervention not focusing on weight loss but aimed at the provision of obesity related information, alleviation of social isolation, school and vocational integration and improvement of self-esteem in comparison to a control group treated in a conventional way with focus on weight loss. Interested individuals who fulfill current recommended criteria for weight loss surgery will be provided with a structured preparation and follow-up programs. All subjects will be monitored within a long-term observational study to elucidate medical and psychosocial outcomes

  5. Spatial distribution of clinical computer systems in primary care in England in 2016 and implications for primary care electronic medical record databases: a cross-sectional population study.

    Science.gov (United States)

    Kontopantelis, Evangelos; Stevens, Richard John; Helms, Peter J; Edwards, Duncan; Doran, Tim; Ashcroft, Darren M

    2018-02-28

    UK primary care databases (PCDs) are used by researchers worldwide to inform clinical practice. These databases have been primarily tied to single clinical computer systems, but little is known about the adoption of these systems by primary care practices or their geographical representativeness. We explore the spatial distribution of clinical computing systems and discuss the implications for the longevity and regional representativeness of these resources. Cross-sectional study. English primary care clinical computer systems. 7526 general practices in August 2016. Spatial mapping of family practices in England in 2016 by clinical computer system at two geographical levels, the lower Clinical Commissioning Group (CCG, 209 units) and the higher National Health Service regions (14 units). Data for practices included numbers of doctors, nurses and patients, and area deprivation. Of 7526 practices, Egton Medical Information Systems (EMIS) was used in 4199 (56%), SystmOne in 2552 (34%) and Vision in 636 (9%). Great regional variability was observed for all systems, with EMIS having a stronger presence in the West of England, London and the South; SystmOne in the East and some regions in the South; and Vision in London, the South, Greater Manchester and Birmingham. PCDs based on single clinical computer systems are geographically clustered in England. For example, Clinical Practice Research Datalink and The Health Improvement Network, the most popular primary care databases in terms of research outputs, are based on the Vision clinical computer system, used by <10% of practices and heavily concentrated in three major conurbations and the South. Researchers need to be aware of the analytical challenges posed by clustering, and barriers to accessing alternative PCDs need to be removed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. Digital medical imaging

    International Nuclear Information System (INIS)

    Goeringer, F.; Mun, S.K.; Kerlin, B.D.

    1989-01-01

    In formulating an implementation strategy for digital medical imaging, three interrelated thrusts have emerged for the defense medical establishment. These thrusts: totally filmless medical imaging on the battlefield, teleradiology, and DIN/PACS for peacetime military health care are discussed. They have implications in their fully developed form as resource savers and quality improvers for the unique aspects of military health care

  7. Implications of design on infection prevention and control practice in a novel hospital unit: the Medical Ward of the 21st Century.

    Science.gov (United States)

    VanSteelandt, Amanda; Conly, John; Ghali, William; Mather, Charles

    2015-01-01

    The physical design of hospital wards is associated with transmission of pathogenic organisms and hospital-acquired infections. A novel hospital unit, the Medical Ward of the 21st Century (W21C), optimizes features for infection prevention and control practices. Ethnographic research on the W21C versus conventional hospital wards examined the experiential and behavioural elements of the different designs. Three recurring themes emerged regarding the design features on the W21C and included visual cues, 'having a place for things', and less sharing of spaces and materials. Observational data of healthcare worker practices demonstrated significantly higher compliance with hand hygiene opportunities on the W21C compared with older hospital units. These findings suggest how the physical design of a hospital ward may enhance infection prevention and control practices.

  8. Medical student knowledge regarding radiology before and after a radiological anatomy module: implications for vertical integration and self-directed learning.

    Science.gov (United States)

    Murphy, Kevin P; Crush, Lee; O'Malley, Eoin; Daly, Fergus E; O'Tuathaigh, Colm M P; O'Connor, Owen J; Cryan, John F; Maher, Michael M

    2014-10-01

    To examine the impact that anatomy-focused radiology teaching has on non-examined knowledge regarding radiation safety and radiology as a specialty. First-year undergraduate medical students completed surveys prior to and after undertaking the first-year anatomy programme that incorporates radiological anatomy. Students were asked opinions on preferred learning methodology and tested on understanding of radiology as a specialty and radiation safety. Pre-module and post-module response rates were 93 % (157/168) and 85 % (136/160), respectively. Pre-module and post-module, self-directed learning (SDL) ranked eighth (of 11) for preferred gross-anatomy teaching formats. Correct responses regarding radiologist/radiographer roles varied from 28-94 % on 16 questions with 4/16 significantly improving post-module. Identification of modalities that utilise radiation significantly improved for five of eight modalities post-module but knowledge regarding relative amount of modality-specific radiation use was variable pre-module and post-module. SDL is not favoured as an anatomy teaching method. Exposure of students to a radiological anatomy module delivered by senior clinical radiologists improved basic knowledge regarding ionising radiation use, but there was no improvement in knowledge regarding radiation exposure relative per modality. A possible explanation is that students recall knowledge imparted in didactic lectures but do little reading around the subject when the content is not examined. • Self-directed learning is not favoured as a gross anatomy teaching format amongst medical students. • An imaging anatomy-focused module improved basic knowledge regarding ionising radiation use. • Detailed knowledge of modality-specific radiation exposure remained suboptimal post-module. • Knowledge of roles within a clinical radiology department showed little change post-module.

  9. Are the effects of drugs to prevent and to treat heart failure always concordant? The statin paradox and its implications for understanding the actions of antidiabetic medications.

    Science.gov (United States)

    Packer, Milton

    2018-03-22

    Most treatments for chronic heart failure are effective both in preventing its onset and reducing its progression. However, statins prevent the development of heart failure, but they do not decrease morbidity and mortality in those with established heart failure. This apparent discordance cannot be explained by an effect to prevent interval myocardial infarctions. Instead, it seems that the disease that statins were preventing in trials of patients with a metabolic disorder was different from the disease that they were treating in trials of chronic heart failure. The most common phenotype of heart failure in patients with obesity and diabetes is heart failure with a preserved ejection fraction (HFpEF). In this disorder, the anti-inflammatory effects of statins might ameliorate myocardial fibrosis and cardiac filling abnormalities, but these actions may have little relevance to patients with heart failure and a reduced ejection fraction (HFrEF), whose primary derangement is cardiomyocyte loss and stretch. These distinctions may explain why statins were ineffective in trials that focused on HFrEF, but have been reported to produce with favourable effects in observational studies of HFpEF. Similarly, selective cytokine antagonists were ineffective in HFrEF, but have been associated with benefits in HFpEF. These observations may have important implications for our understanding of the effects of antihyperglycaemic medications. Glucagon-like peptide-1 receptor agonists have had neutral effects on heart failure events in people at risk for HFpEF, but have exerted deleterious actions in HFrEF. Similarly, sodium-glucose co-transporter 2 inhibitors, which exert anti-inflammatory effects and reduce heart failure events in patients who are prone to HFpEF, may not be effective in HFrEF. The distinctions between HFrEF and HFpEF may explain why the effects of drugs on heart failure events in diabetes trials may not be relevant to their use in patients with systolic dysfunction

  10. Experienced and potential medical tourists' service quality expectations.

    Science.gov (United States)

    Guiry, Michael; Scott, Jeannie J; Vequist, David G

    2013-01-01

    The paper's aim is to compare experienced and potential US medical tourists' foreign health service-quality expectations. Data were collected via an online survey involving 1,588 US consumers engaging or expressing an interest in medical tourism. The sample included 219 experienced and 1,369 potential medical tourists. Respondents completed a SERVQUAL questionnaire. Mann-Whitney U-tests were used to determine significant differences between experienced and potential US medical tourists' service-quality expectations. For all five service-quality dimensions (tangibles, reliability, responsiveness, assurance and empathy) experienced medical tourists had significantly lower expectations than potential medical tourists. Experienced medical tourists also had significantly lower service-quality expectations than potential medical tourists for 11 individual SERVQUAL items. Results suggest using experience level to segment medical tourists. The study also has implications for managing medical tourist service-quality expectations at service delivery point and via external marketing communications. Managing medical tourists' service quality expectations is important since expectations can significantly influence choice processes, their experience and post-consumption behavior. This study is the first to compare experienced and potential US medical tourist service-quality expectations. The study establishes a foundation for future service-quality expectations research in the rapidly growing medical tourism industry.

  11. 胸腔积液腺苷脱氨酶对内科胸腔镜检查临床病例选择的意义%Clinical significance of adenosine deaminase in selection patient for medical thoracoscopy

    Institute of Scientific and Technical Information of China (English)

    李玺; 黄小艳; 刘斌; 荣福

    2017-01-01

    Objective To evaluate clinical significance of adenosine deaminase (ADA) in selection patient for medical thoracoscopy.Methods A retrospective analysis of January 2013 to April 2016,198 cases unexplained pleural effusion patients were divided into youth group,middle-aged and elderly groups.To determine the sensitivity and specificity of ADA≥45 U/L or ADA≥45 U/L combine percentage of lymphocytes in white blood cells ≥50% as the diagnosis criteria of tuberculous pleurisy,and analysis gender and age influence on ADA.Results The diagnosis of medical thoracoscopy in unexplained pleural effusion was 98.9 %.The sensitivity and specificity of ADA≥45 U/L in diagnosis of tuberculous pleurisy were 73.3% and 89.2%;The sensitivity and specificity of ADA≥ 45 U/L combine percentage of lymphocytes in white blood cells≥ 50% in diagnosis of tuberculous pleurisy were 71% and 98.5%.Especially in youth group,the sensitivity and specificity of ADA ≥ 45 U/L combine percentage of lymphocytes in white blood cells≥50% in diagnosis of tuberculous pleurisy was 100%.Conclusions If young patients have typical clinical manifestations of tuberculous pleurisy and ADA≥45 U/L percentage of lymphocytes in white blood cells ≥ 50% in pleural effusion,anti-TB treatment without further thoracoscopy is appropriate;For middle-aged and elderly patients of unexplained pleural liquid,thoracoscopy is recommended to avoid misdiagnosis.%目的 探讨胸腔积液腺苷脱氨酶(ADA)对内科胸腔镜检查临床病例选择的意义.方法 回顾性分析2013年1月至2016年4月经内科胸腔镜检查的不明原因胸腔积液患者198例,分为青年组、中年组和老年组,以胸腔积液ADA≥45 U/L或ADA≥45 U/L联合淋巴细胞占白细胞比例≥50%作为诊断结核性胸膜炎的标准,确定其敏感度和特异度,并分析性别、年龄对ADA的影响.结果 内科胸腔镜对不明原因胸腔积液的诊断率为98.9%.胸腔积液ADA≥45 U/L诊

  12. Policy implications of medical tourism development in destination countries: revisiting and revising an existing framework by examining the case of Jamaica

    NARCIS (Netherlands)

    Johnston, R.; Crooks, V.A.; Ormond, M.E.

    2015-01-01

    Background - Medical tourism is now targeted by many hospitals and governments worldwide for further growth and investment. Southeast Asia provides what is perhaps the best documented example of medical tourism development and promotion on a regional scale, but interest in the practice is growing in

  13. Systematic Review and Meta-analysis of the Effects of Caffeine in Fatigued Shift Workers: Implications for Emergency Medical Services Personnel

    Science.gov (United States)

    2018-01-11

    Background: Emergency Medical Services (EMS) workers may experience fatigue as a consequence of shift work. We reviewed the literature to determine the impact of caffeine as a countermeasure to fatigue in EMS personnel and related shift workers. Meth...

  14. Data Sharing: A New Editorial Initiative of the International Committee of Medical Journal Editors. Implications for the Editors´ Network

    NARCIS (Netherlands)

    Alfonso, Fernando; Adamyan, Karlen; Artigou, Jean-Yves; Aschermann, Michael; Boehm, Michael; Buendia, Alfonso; Chu, Pao-Hsien; Cohen, Ariel; Cas, Livio Dei; Dilic, Mirza; Doubell, Anton; Echeverri, Dario; Enç, Nuray; Ferreira-González, Ignacio; Filipiak, Krzysztof J.; Flammer, Andreas; Fleck, Eckart; Gatzov, Plamen; Ginghina, Carmen; Goncalves, Lino; Haouala, Habib; Hassanein, Mahmoud; Heusch, Gerd; Huber, Kurt; Hulín, Ivan; Ivanusa, Mario; Krittayaphong, Rungroj; Lau, Chu-Pak; Marinskis, Germanas; Mach, François; Moreira, Luiz Felipe; Nieminen, Tuomo; Oukerraj, Latifa; Perings, Stefan; Pierard, Luc; Potpara, Tatjana; Reyes-Caorsi, Walter; Rim, Se-Joong; Rødevand, Olaf; Saade, Georges; Sander, Mikael; Shlyakhto, Evgeny; Timuralp, Bilgin; Tousoulis, Dimitris; Ural, Dilek; Piek, J. J.; Varga, Albert; Lüscher, Thomas F.

    2017-01-01

    The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical

  15. The Muddle of Medicalization

    DEFF Research Database (Denmark)

    Sholl, Jonathan

    2017-01-01

    to describe inappropriate or abusive instances of medical authority. Yet, while this standard approach claims that medicalization is a growing problem, it assumes that there is simply one “medical model” and that the expanding realm of “the medical” can be more or less clearly delineated. Moreover, while...... of medical discourse. In doing so, I will explore the distinction between medicalization and pathologization, a distinction that is often overlooked and that brings with it many conceptual and practical implications. After defining these terms, I will use some examples to show that while pathologizing...

  16. Advanced Medication Dispenser

    Directory of Open Access Journals (Sweden)

    A.I. Alexan

    2013-12-01

    Full Text Available Medication dispensing is an important activity that can have major implications if done improperly. Dispensing must be done in the correct time interval, at the correct user, with the correct drug and dose. We propose a smart medication dispenser that can satisfy these needs and provide a mechanism for supervision. In order to ensure that the dispensing process is error free, the concept of a new smart medication container is used. A smart medication container is “smart” as it holds the medication dispensing parameters for the drugs it contains: dispensing time and date and name. Based on this information, the actual dispensing is done.

  17. [The significance of student competitions for the development of motivation for education and the acquisition of professional competences in the students the Department of Forensic Medical Expertise of the Sechenovsky University].

    Science.gov (United States)

    Pigolkin, Yu I; Lomakin, Yu V; Leonova, E N

    2018-01-01

    Russia joined the Bologna process in 2003 and since that time has become integrated into the unified European educational space. The key element of the new form of the higher education process is the self-guided unsupervised work of the students. Motivation is needed to promote the involvement of the students in the educational process which implies the necessity of the goal-oriented initiative for the acquisition of professional knowledge and practical experience in the field of forensic medicine. To achieve this goal, the Department of Forensic Medicine of I.M. Sechenov First Moscow State Medical University places special emphasis on the experience with carrying out student competitions. Each such competition consists of several contests focused on the solution of a specific problem, e.g. the inspection of the place of occurrence under investigation with a gunshot or punctured-and-incised wound, forensic medical autopsy, problem studies, and intelligence tests. All the contests and problem studies are held in the form of an interactive game. The experience gained in the course of the student competitions gives practical evidence that the interdepartmental intelligence contests contribute to raising the interest of students in forensic medicine. The open competition provides a highly efficient tool for the popularization of scientific knowledge and the promotion of interest in the participation in the forensic medical research activities. Moreover, the student competitions facilitate formation of the earlier professional skills indispensable for team working and the development of abilities for making decisions under the extreme conditions. In addition, the contests teach the participants the art of public appearance. They improve the quality of vocational training in forensic medicine and help to establish the first professional contacts at the interinstitutional (including international) level.

  18. An Evaluation of a Voluntary Academic Medical Center Website Designed to Improve Access to Health Education among Consumers: Implications for E-Health and M-Health

    Science.gov (United States)

    Harris-Hollingsworth, Nicole Rosella

    2012-01-01

    Academic Medical Centers across the United States provide health libraries on their web portals to disseminate health promotion and disease prevention information, in order to assist patients in the management of their own care. However, there is a need to obtain consumer input, consumer satisfaction, and to conduct formal evaluations. The purpose…

  19. 2. The Virtuous Physician. A New Translation of a Pseudo-Hippocratic Text and Its Implications for the History of Moral Inquiry; or, The Significance of an Insignificant Text

    Directory of Open Access Journals (Sweden)

    Elliott Burton Martin, Jr.

    2012-12-01

    Full Text Available This article presents a new translation of the previously little-studied pseudo-Hippocratic text, Precepts, with commentary, and a broader discussion of the work in its context at a crossroads in the history of moral inquiry. A distillation of the schools of medical thought between the age of Hippocrates and the age of Galen, Precepts is not an oath, but a set of pragmatic, comprehensive guidelines for the comportment and practice of what the unknown author describes ideally as the ‘virtuous physician’. I propose a new way of interpreting the development of Greek ethical notions, as exemplified in our sample text, as the inevitable philosophic product of the religious influence of the Ancient Near East. Rather than suggest a conflict between the polytheists and the challenge of monotheism, I describe an interplay between the two belief systems. I propose that the Greek attempts at reconciliation between these systems were the critical impetus for the development of moral inquiry alongside the birth of ‘rationalism’. In other words, it will be seen that it was through the avenue of the Greek enlightenment that the ancient physician transformed from physician-priest to physician-philosopher.

  20. The decline of judicial deference to medical opinion in medical negligence litigation in Malaysia.

    Science.gov (United States)

    Kassim, Puteri Nemie J

    2008-06-01

    The decision of the Federal Court of Malaysia in abandoning the Bolam principle in relation to doctor's duty to disclose risks has clearly marked the decline of judicial deference to medical opinion in medical negligence litigation in Malaysia. It is undeniable that the Bolam principle has acted as a gatekeeper to the number of claims against medical practitioners. This has always been seen as necessary to protect the society from unwanted effects of defensive medicine. However, will these changes contribute significantly to the growth of medical negligence cases in Malaysia? This article will trace the development of the Bolam principle in medical negligence litigation in Malaysia since 1965 and analyse the influence of selected Commonwealth cases on the development. The implications of the Federal Court ruling will also be discussed.

  1. Assessment of ADHD Documentation from Candidates Requesting Americans with Disabilities Act (ADA) Accommodations for the National Board of Osteopathic Medical Examiners COMLEX Exam

    Science.gov (United States)

    Joy, Javed A.; Julius, Rose J.; Akter, Rashida; Baron, David A.

    2010-01-01

    Purpose: Every year increasing numbers of candidates request special accommodations for high-stakes medical licensing examinations, due to ADHD, on the basis of the Americans with Disabilities Act (ADA). This poses significant challenges for both the applicant and the medical boards and has significant financial, legal, and ethical implications.…

  2. Interpretation of 'Unnatural death' in coronial law: A review of the English legal process of decision making, statutory interpretation, and case law: The implications for medical cases and coronial consistency.

    Science.gov (United States)

    Harris, Andrew; Walker, Andrew

    2018-04-23

    The article examines the decision-making process for medical reporting of deaths to a coroner and the statutory basis for coronial decisions whether to investigate. It analyses what is published about the consistency of decision making of coroners and discusses what should be the legal basis for determining whether a particular death is natural or unnatural in English law. There is a review of English case law, including the significance of Touche and Benton and the development of 'unnatural' as a term of art, which informs what the courts have held to be an unnatural death. What case law indicates about multiple causes and the significance of the wording in the Coroners & Justice Act 2009 that triggers an investigation are considered. It highlights the importance of considering the medical cause of death and to what extent information other than the initial death report is required, before making the decision that the coroner's duty to open an investigation is triggered. The article concludes that a two-stage test is required. Firstly, is the cause of death medically unnatural? Secondly, whether the circumstances themselves are unnatural or such as to make a medically natural cause of death unnatural. If the coroner has reason to suspect the medical cause of death is unnatural per se the statutory duty to investigate will be engaged, regardless of the circumstances.

  3. Conception of Pharmacological Knowledge and Needs Amongst Nigerian Medical Students at Lagos State University College of Medicine: Implication for Future Biomedical Science in Africa.

    Science.gov (United States)

    Agaga, Luther Agbonyegbeni; John, Theresa Adebola

    2016-08-30

    In Nigeria, medical students are trained in more didactic environments than their counterparts in researchintensive academic medical centers. Their conception of pharmacology was thus sought. Students who are taking/have takenthe medical pharmacology course completed an 18-question survey within 10min by marking one/more choices fromalternatives. Instructions were: "Dear Participant, Please treat as confidential, give your true view, avoid influences, avoidcrosstalk, return survey promptly." Out of 301 students, 188 (62.46%) participated. Simple statistics showed: 61.3%respondents associated pharmacology with medicine, 24.9% with science, 16.8 % with industry, and 11.1% with government;32.8% want to know clinical pharmacology, 7.1% basic pharmacology, 6.7% pharmacotherapy, and 34.2% want a blend ofall three; 57.8% want to know clinical uses of drugs, 44.8% mechanisms of action, 44.4% side effects, and 31.1% differentdrugs in a group; 45.8% prefer to study lecturers' notes, 26.7% textbooks, 9.8% the Internet, and 2.7% journals; 46.7% usestandard textbooks, 11.5% revision texts, 2.66% advanced texts, and 8.4% no textbook; 40.4% study pharmacology to beable to treat patients, 39.1% to complete the requirements for MBBS degree, 8.9% to know this interesting subject, and 3.1%to make money. Respondents preferring aspects of pharmacology were: 42.7, 16, 16, and 10 (%) respectively for mechanismsof action, pharmacokinetics, side effects, and drug lists. Medical students' conception and need for pharmacology werebased on MBBS degree requirements; they lacked knowledge/interest in pharmacology as a science and may not be thepotential trusts for Africa's future pharmacology.

  4. Theoretical overview and socio-cultural implications of urban dwellers patronage of trado-medical homes and services in Nigerian urban centres

    Directory of Open Access Journals (Sweden)

    Ojua, T.A.

    2013-03-01

    Full Text Available Global connectivity and developmental strides and the quest for human improvement as well as cultural behaviors of people is creating a concern for intellectual articulation. While Sociologists and Anthropologists alike look for a multi-cultural linkage for national and global development, as service provisions and acquisitions are being achieved at different areas. One of these is the increasing trado-medical centers in urban areas to meet or compliment orthodox medical services for good health. The problem of fake drugs, inactive or inefficient healing or curative strength of the orthodox services, high cost, and poor distribution, etc. has made the trado-medical services enjoy high patronage. This shows the viability of the different centers in a developing nation like Nigeria and which are especially being utilized by the urban dwellers for various reasons. This recently is becoming comparable with what exist in the rural areas. The paper discovered that irrespective of the social reconscientisation education/enlightenment and campaign at various levels against the patronage of these centers, they seem to progressively succeed in their own right. Some major ailments are being handled successfully although without any scientific means. Therefore, the paper recommends amongst others the improved and regulated policy measure of these practitioners. They should be professionally registered and proper training or induction made with clear ethical codes and principles adopted for effective performance etc. not as alternative medicine, but complementary medicine to orthodox practices.

  5. Medical equipment in government health facilities: missed opportunities.

    Science.gov (United States)

    Pardeshi, Geeta S

    2005-01-01

    The availability and optimal utilization of medical equipment is important for improving the quality of health services. Significant investments are made for the purchase, maintenance and repair of medical equipment. Inadequate management of these equipment will result in financial losses and deprive the public of the intended benefits. This analysis is based on the conceptual framework drawn from the WHO recommended- lifecycle of medical equipment. (1) To identify the problems in different stages of the life cycle. (2) To assess its financial implications and effect on service delivery. Analysis of secondary data from the latest Comptroller and Auditor General (CAG) Reports for the states in India. The study variables were category of equipment, financial implications and problems in the stages of life cycle. Calculation of proportions. A total of forty instances mentioning problems in the first phase of the life cycle of medical equipment were noted in 12 state reports. The equipment from the radiology department (15), equipment in the wards (5), laboratory (3) and operation theatres (4) were the ones most frequently implicated. In a majority of cases the financial implications amounted to twenty-five lakhs. The financial implications were in the form of extra expenditure, unfruitful expenditure or locking of funds. In 25 cases the equipment could not be put to use because of non-availability of trained staff and inadequate infrastructural support. Careful procurement, incoming inspection, successful installation and synchronization of qualified trained staff and infrastructural support will ensure timely onset of use of the equipment.

  6. Medical photography: current technology, evolving issues and legal perspectives.

    Science.gov (United States)

    Harting, M T; DeWees, J M; Vela, K M; Khirallah, R T

    2015-04-01

    Medical photographic image capture and data management has undergone a rapid and compelling change in complexity over the last 20 years. This is because of multiple factors, including significant advances in ease of photograph capture, alongside an evolution of mechanisms of data portability/dissemination, combined with governmental focus on health information privacy. Literature to guide medical, legal, governmental and business professionals when dealing with issues related to medical photography is virtually nonexistent. Herein, we will address the breadth of uses of medical photography, device properties/specific devices utilised for image capture, methods of data transfer and dissemination and patient perceptions and attitudes regarding photography in a medical setting. In addition, we will address the legal implications, including legal precedent, copyright and privacy law, informed consent, protected health information and the Health Insurance Portability and Accountability Act (HIPAA), as they pertain to medical photography. © 2015 John Wiley & Sons Ltd.

  7. Studies of acute and chronic radiation injury at the Biological and Medical Research Division, Argonne National Laboratory, 1953-1970: Description of individual studies, data files, codes, and summaries of significant findings

    Energy Technology Data Exchange (ETDEWEB)

    Grahn, D.; Fox, C.; Wright, B.J.; Carnes, B.A.

    1994-05-01

    Between 1953 and 1970, studies on the long-term effects of external x-ray and {gamma} irradiation on inbred and hybrid mouse stocks were carried out at the Biological and Medical Research Division, Argonne National Laboratory. The results of these studies, plus the mating, litter, and pre-experimental stock records, were routinely coded on IBM cards for statistical analysis and record maintenance. Also retained were the survival data from studies performed in the period 1943-1953 at the National Cancer Institute, National Institutes of Health, Bethesda, Maryland. The card-image data files have been corrected where necessary and refiled on hard disks for long-term storage and ease of accessibility. In this report, the individual studies and data files are described, and pertinent factors regarding caging, husbandry, radiation procedures, choice of animals, and other logistical details are summarized. Some of the findings are also presented. Descriptions of the different mouse stocks and hybrids are included in an appendix; more than three dozen stocks were involved in these studies. Two other appendices detail the data files in their original card-image format and the numerical codes used to describe the animal`s exit from an experiment and, for some studies, any associated pathologic findings. Tabular summaries of sample sizes, dose levels, and other variables are also given to assist investigators in their selection of data for analysis. The archive is open to any investigator with legitimate interests and a willingness to collaborate and acknowledge the source of the data and to recognize appropriate conditions or caveats.

  8. Studies of acute and chronic radiation injury at the Biological and Medical Research Division, Argonne National Laboratory, 1953-1970: Description of individual studies, data files, codes, and summaries of significant findings

    International Nuclear Information System (INIS)

    Grahn, D.; Fox, C.; Wright, B.J.; Carnes, B.A.

    1994-05-01

    Between 1953 and 1970, studies on the long-term effects of external x-ray and γ irradiation on inbred and hybrid mouse stocks were carried out at the Biological and Medical Research Division, Argonne National Laboratory. The results of these studies, plus the mating, litter, and pre-experimental stock records, were routinely coded on IBM cards for statistical analysis and record maintenance. Also retained were the survival data from studies performed in the period 1943-1953 at the National Cancer Institute, National Institutes of Health, Bethesda, Maryland. The card-image data files have been corrected where necessary and refiled on hard disks for long-term storage and ease of accessibility. In this report, the individual studies and data files are described, and pertinent factors regarding caging, husbandry, radiation procedures, choice of animals, and other logistical details are summarized. Some of the findings are also presented. Descriptions of the different mouse stocks and hybrids are included in an appendix; more than three dozen stocks were involved in these studies. Two other appendices detail the data files in their original card-image format and the numerical codes used to describe the animal's exit from an experiment and, for some studies, any associated pathologic findings. Tabular summaries of sample sizes, dose levels, and other variables are also given to assist investigators in their selection of data for analysis. The archive is open to any investigator with legitimate interests and a willingness to collaborate and acknowledge the source of the data and to recognize appropriate conditions or caveats

  9. Significant concentration changes of chemical components of PM_1 in the Yangtze River Delta area of China and the implications for the formation mechanism of heavy haze–fog pollution

    International Nuclear Information System (INIS)

    Zhang, Y.W.; Zhang, X.Y.; Zhang, Y.M.; Shen, X.J.; Sun, J.Y.; Ma, Q.L.; Yu, X.M.; Zhu, J.L.; Zhang, L.; Che, H.C.

    2015-01-01

    Since the winter season of 2013, a number of persistent haze–fog events have occurred in central-eastern China. Continuous measurements of the chemical and physical properties of PM_1 at a regional background station in the Yangtze River Delta area of China from 16 Nov. to 18 Dec., 2013 revealed several haze–fog events, among which a heavy haze–fog event occurred between 6 Dec. and 8 Dec. The mean concentration of PM_1 was 212 μg m"−"3 in the heavy haze–fog period, which was about 10 times higher than on clean days and featured a peak mass concentration that reached 298 μg m"−"3. Organics were the largest contributor to the dramatic rise of PM_1 on heavy haze–fog days (average mass concentration of 86 μg m"−"3), followed by nitrate (58 μg m"−"3), sulfate (35 μg m"−"3), ammonium (29 μg m"−"3), and chloride (4.0 μg m"−"3). Nitrate exhibited the largest increase (~ 20 factors), associated with a significant increase in NO_x. This was mainly attributable to increased coal combustion emissions, relative to motor vehicle emissions, and was caused by short-distance pollutant transport within surrounding areas. Low-volatility oxidized organic aerosols (OA) (LV-OOA) and biomass-burning OA (BBOA) also increased sharply on heavy haze–fog days, exhibiting an enhanced oxidation capacity of the atmosphere and increased emissions from biomass burning. The strengthening of the oxidation capacity during the heavy pollution episode, along with lower solar radiation, was probably due to increased biomass burning, which were important precursors of O_3. The prevailing meteorological conditions, including low wind and high relative humidity, and short distance transported gaseous and particulate matter surrounding of the sampling site, coincided with the increased pollutant concentrations mainly from biomass-burning mentioned above to cause the persistent haze–fog event in the YRD area. - Highlights: • Formation mechanism of a heavy haze-fog event

  10. Significant concentration changes of chemical components of PM{sub 1} in the Yangtze River Delta area of China and the implications for the formation mechanism of heavy haze–fog pollution

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Y.W. [Key Laboratory of Atmospheric Chemistry, Chinese Academy of Meteorological Sciences, Beijing 100081 (China); Zhang, X.Y., E-mail: xiaoye@cams.cma.gov.cn [Key Laboratory of Atmospheric Chemistry, Chinese Academy of Meteorological Sciences, Beijing 100081 (China); Zhang, Y.M.; Shen, X.J. [Key Laboratory of Atmospheric Chemistry, Chinese Academy of Meteorological Sciences, Beijing 100081 (China); Sun, J.Y. [Key Laboratory of Atmospheric Chemistry, Chinese Academy of Meteorological Sciences, Beijing 100081 (China); State Key Laboratory of Cryospheric Sciences, Cold and Arid Region Environmental and Engineering Research Institute, Chinese Academy of Sciences, Lanzhou 730000 (China); Ma, Q.L.; Yu, X.M. [Lin' an Regional Air Background Station, Lin' an 311307 (China); Zhu, J.L. [School of Atmospheric Sciences, Nanjing University, Nanjing 210093 (China); Zhang, L.; Che, H.C. [Key Laboratory of Atmospheric Chemistry, Chinese Academy of Meteorological Sciences, Beijing 100081 (China); College of Earth Science, University of Chinese Academy of Sciences, Beijing 100049 (China)

    2015-12-15

    Since the winter season of 2013, a number of persistent haze–fog events have occurred in central-eastern China. Continuous measurements of the chemical and physical properties of PM{sub 1} at a regional background station in the Yangtze River Delta area of China from 16 Nov. to 18 Dec., 2013 revealed several haze–fog events, among which a heavy haze–fog event occurred between 6 Dec. and 8 Dec. The mean concentration of PM{sub 1} was 212 μg m{sup −3} in the heavy haze–fog period, which was about 10 times higher than on clean days and featured a peak mass concentration that reached 298 μg m{sup −3}. Organics were the largest contributor to the dramatic rise of PM{sub 1} on heavy haze–fog days (average mass concentration of 86 μg m{sup −3}), followed by nitrate (58 μg m{sup −3}), sulfate (35 μg m{sup −3}), ammonium (29 μg m{sup −3}), and chloride (4.0 μg m{sup −3}). Nitrate exhibited the largest increase (~ 20 factors), associated with a significant increase in NO{sub x}. This was mainly attributable to increased coal combustion emissions, relative to motor vehicle emissions, and was caused by short-distance pollutant transport within surrounding areas. Low-volatility oxidized organic aerosols (OA) (LV-OOA) and biomass-burning OA (BBOA) also increased sharply on heavy haze–fog days, exhibiting an enhanced oxidation capacity of the atmosphere and increased emissions from biomass burning. The strengthening of the oxidation capacity during the heavy pollution episode, along with lower solar radiation, was probably due to increased biomass burning, which were important precursors of O{sub 3}. The prevailing meteorological conditions, including low wind and high relative humidity, and short distance transported gaseous and particulate matter surrounding of the sampling site, coincided with the increased pollutant concentrations mainly from biomass-burning mentioned above to cause the persistent haze–fog event in the YRD area. - Highlights

  11. Expression of proteins FGFR3, PI3K, AKT, p21Waf1/Cip1 and cyclins D1 and D3 in patients with T1 bladder tumours: clinical implications and prognostic significance.

    Science.gov (United States)

    Blanca Pedregosa, A M; Sánchez-González, Á; Carrasco Valiente, J; Ruiz García, J M; Gómez Gómez, E; López Beltrán, A; Requena Tapia, M J

    2017-04-01

    To determine the differential protein expression of biomarkers FGFR3, PI3K (subunits PI3Kp110α, PI3KClassIII, PI3Kp85), AKT, p21Waf1/Cip1 and cyclins D1 and D3 in T1 bladder cancer versus healthy tissue and to study their potential role as early recurrence markers. This is a prospective study that employed a total of 67 tissue samples (55 cases of T1 bladder tumours that underwent transurethral resection and 12 cases of adjacent healthy mucosa). The protein expression levels were assessed using Western blot, and the means and percentages were compared using Student's t-test and the chi-squared test. The survival analysis was conducted using the Kaplan-Meier method and the log-rank test. Greater protein expression was detected for FGFR3, PI3Kp110α, PI3KClassIII, cyclins D1 and D3 and p21Waf1/Cip1 in the tumour tissue than in the healthy mucosa. However, these differences were not significant for PI3Kp85 and AKT. We observed statistically significant correlations between early recurrence and PI3Kp110α, PI3KClassIII, PI3Kp85 and AKT (P=.003, P=.045, P=.050 and P=.028, respectively), between the tumour type (primary vs. recurrence) and cyclin D3 (P=.001), between the tumour size and FGFR3 (P=.035) and between multifocality and cyclin D1 (P=.039). The survival analysis selected FGFR3 (P=.024), PI3Kp110α (P=.014), PI3KClassIII (P=.042) and AKT (P=.008) as markers of early-recurrence-free survival. There is an increase in protein expression levels in bladder tumour tissue. The overexpression of FGFR3, PI3Kp110α, PI3KClassIII and AKT is associated with increased early-recurrence-free survival for patients with T1 bladder tumours. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Review fantastic medical implications of 3D-printing in liver surgeries, liver regeneration, liver transplantation and drug hepatotoxicity testing: A review.

    Science.gov (United States)

    Wang, Jing-Zhang; Xiong, Nan-Yan; Zhao, Li-Zhen; Hu, Jin-Tian; Kong, De-Cheng; Yuan, Jiang-Yong

    2018-06-07

    The epidemiological trend in liver diseases becomes more serious worldwide. Several recent articles published by International Journal of Surgery in 2018 particularly emphasized the encouraging clinical benefits of hepatectomy, liver regeneration and liver transplantation, however, there are still many technical bottlenecks underlying these therapeutic approaches. Remarkably, a few preliminary studies have shown some clues to the role of three-dimensional (3D) printing in improving traditional therapy for liver diseases. Here, we concisely elucidated the curative applications of 3D-printing (no cells) and 3D Bio-printing (with hepatic cells), such as 3D-printed patient-specific liver models and devices for medical education, surgical simulation, hepatectomy and liver transplantation, 3D Bio-printed hepatic constructs for liver regeneration and artificial liver, 3D-printed liver tissues for evaluating drug's hepatotoxicity, and so on. Briefly, 3D-printed liver models and bioactive tissues may facilitate a lot of key steps to cure liver disorders, predictably bringing promising clinical benefits. This work further provides novel insights into facilitating treatment of hepatic carcinoma, promoting liver regeneration both in vivo and in vitro, expanding transplantable liver resources, maximizing therapeutic efficacy as well as minimizing surgical complications, medical hepatotoxicity, operational time, economic costs, etc. Copyright © 2018. Published by Elsevier Ltd.

  13. The completeness of electronic medical record data for patients with Type 2 Diabetes in primary care and its implications for computer modelling of predicted clinical outcomes.

    Science.gov (United States)

    Staff, Michael; Roberts, Christopher; March, Lyn

    2016-10-01

    To describe the completeness of routinely collected primary care data that could be used by computer models to predict clinical outcomes among patients with Type 2 Diabetes (T2D). Data on blood pressure, weight, total cholesterol, HDL-cholesterol and glycated haemoglobin levels for regular patients were electronically extracted from the medical record software of 12 primary care practices in Australia for the period 2000-2012. The data was analysed for temporal trends and for associations between patient characteristics and completeness. General practitioners were surveyed to identify barriers to recording data and strategies to improve its completeness. Over the study period data completeness improved up to around 80% complete although the recording of weight remained poorer at 55%. T2D patients with Ischaemic Heart Disease were more likely to have their blood pressure recorded (OR 1.6, p=0.02). Practitioners reported not experiencing any major barriers to using their computer medical record system but did agree with some suggested strategies to improve record completeness. The completeness of routinely collected data suitable for input into computerised predictive models is improving although other dimensions of data quality need to be addressed. Copyright © 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  14. Implicative Algebras

    African Journals Online (AJOL)

    Tadesse

    In this paper we introduce the concept of implicative algebras which is an equivalent definition of lattice implication algebra of Xu (1993) and further we prove that it is a regular Autometrized. Algebra. Further we remark that the binary operation → on lattice implicative algebra can never be associative. Key words: Implicative ...

  15. Patterns of Primary Tumor Invasion and Regional Lymph Node Spread Based on Magnetic Resonance Imaging in Early-Stage Nasal NK/T-cell Lymphoma: Implications for Clinical Target Volume Definition and Prognostic Significance

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Run-Ye [Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Liu, Kang [Department of Imaging Diagnosis, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Wang, Wei-Hu; Jin, Jing; Song, Yong-Wen; Wang, Shu-Lian; Liu, Yue-Ping; Ren, Hua; Fang, Hui; Liu, Qing-Feng; Yang, Yong; Chen, Bo; Qi, Shu-Nan; Lu, Ning-Ning; Tang, Yu; Tang, Yuan; Li, Ning [Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Ouyang, Han [Department of Imaging Diagnosis, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Li, Ye-Xiong, E-mail: yexiong12@163.com [Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China)

    2017-01-01

    Purpose: This study aimed to determine the pathways of primary tumor invasion (PTI) and regional lymph node (LN) spread based on magnetic resonance imaging (MRI) in early-stage nasal NK/T-cell lymphoma (NKTCL), to improve clinical target volume (CTV) delineation and evaluate the prognostic value of locoregional extension patterns. Methods and Materials: A total of 105 patients with newly diagnosed early-stage nasal NKTCL who underwent pretreatment MRI were retrospectively reviewed. All patients received radiation therapy with or without chemotherapy. Results: The incidences of PTI and regional LN involvement were 64.7% and 25.7%, respectively. Based on the incidence of PTI, involved sites surrounding the nasal cavity were classified into 3 risk subgroups: high-risk (>20%), intermediate-risk (5%-20%), and low-risk (<5%). The most frequently involved site was the nasopharynx (35.2%), followed by the maxillary (21.9%) and ethmoid (21.9%) sinuses. Local disease and regional LN spread followed an orderly pattern without LN skipping. The retropharyngeal nodes (RPNs) were most frequently involved (19.0%), followed by level II (11.4%). The 5-year overall survival (OS), progression-free survival (PFS), and locoregional control (LRC) rates for all patients were 72.8%, 65.2%, and 90.0%, respectively. The presence of PTI and regional LN involvement based on MRI significantly and negatively affected PFS and OS. Conclusions: Early-stage nasal NKTCL presents with a high incidence of PTI but a relatively low incidence of regional LN spread. Locoregional spread followed an orderly pattern, and PTI and regional LN spread are powerful prognostic factors for poorer survival outcomes. CTV reduction may be feasible for selected patients.

  16. The effect of ethnicity on the performance of protein-creatinine ratio in the prediction of significant proteinuria in pregnancies at risk of or with established hypertension: an implementation audit and cost implications.

    Science.gov (United States)

    Bhatti, Sadia; Cordina, Mark; Penna, Leonie; Sherwood, Roy; Dew, Tracy; Kametas, Nikos A

    2018-05-01

    The replacement of 24-h urine collection by protein-creatinine ratio (PCR) for the diagnosis of preeclampsia has been recently recommended. However, the literature is conflicting and there are concerns about the impact of demographic characteristics on the performance of PCR. This was an implementation audit of the introduction of PCR in a London Tertiary obstetric unit. The performance of PCR in the prediction of proteinuria ≥300 mg/day was assessed in 476 women with suspected preeclampsia who completed a 24-h urine collection and an untimed urine sample for PCR calculation. Multivariate logistic regression was used to assess the independent predictors of significant proteinuria. In a pregnant population, ethnicity and PCR are the main predictors of ≥300 mg proteinuria in a 24-h urine collection. A PCR cut-off of 30 mg/mmol would have incorrectly classified as non-proteinuric, 41.4% and 22.9% of black and non-black women, respectively. Sensitivity of 100% is achieved at cut-offs of 8.67 and 20.56 mg/mmol for black and non-black women, respectively. Applying these levels as a screening tool to inform the need to perform a 24-h urine collection in 1000 women, would lead to a financial saving of €2911 in non-black women and to an additional cost of €3269 in black women. Our data suggest that a move from screening for proteinuria with a 24-h urine collection to screening with urine PCR is not appropriate for black populations. However, the move may lead to cost-saving if used in the white population with a PCR cut-off of 20.5. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

  17. Expression of HIF-1α and Markers of Angiogenesis Are Not Significantly Different in Triple Negative Breast Cancer Compared to Other Breast Cancer Molecular Subtypes: Implications for Future Therapy.

    Science.gov (United States)

    Yehia, Lamis; Boulos, Fouad; Jabbour, Mark; Mahfoud, Ziyad; Fakhruddin, Najla; El-Sabban, Marwan

    2015-01-01

    Triple negative breast cancer lacks estrogen, progesterone and epidermal growth factor receptors rendering it refractory to available targetedtherapies. TNBC is associated with central fibrosis and necrosis, both indicators of tumor hypoxia. Hypoxia inducible factor 1α is up-regulated under hypoxia and its expression is associated with induction of angiogenesis resulting in proliferation, aggressive tumor phenotype and metastasis. In this study we evaluate the potential use of HIF-1α as aTNBC-specific marker. 62 TNBC, 64 HER2+, and 64 hormone-receptors positive breast cancer cases were evaluated for central fibrosis and necrosis, HIF-1α, HIF-1β, VEGFR3, CD31 expression and microvessel density. RNA extraction from paraffin-embedded samples, followed by quantitative real-time polymerase chain reaction (qRT-PCR) evaluation of HIF-1α and VEGF transcripts was performed on 54 cases (18 from each subtype). HIF-1α protein was expressed in 35.5% TNBC, 45.3% HER2+and 25.0% ER+/PR+ (p = 0.055; χ2 test). PCRanalysis of subgroup of breast cancers, 84.2% expressed HIF-1α protein and its transcripts, while only 66.7% expressed VEGF transcripts simultaneously with the HIF-1α protein and its transcripts. Central fibrosis and necrosis was highest in TNBC (p = 0.015; χ2 test), while MVD was comparable among all groups (p = 0.928; χ2 test). VEGFR3 was highest in TNBC expressing HIF-1α. HIF-1β protein was expressed in 32.0% of HIF-1α(+), and in (44.3%) of HIF-1α(-) breast cancer cases (p = 0.033; χ2 test). Moreover, HIF-1α expression in cases with central fibrosis and necrosis was highest in the HER2+ followed by the TNBC (p = 0.156; χ2 test). A proportion of TNBC express HIF-1α but not in a significantly different manner from other breast cancer subtypes. The potential of anti-HIF-1α targeted therapy is therefore not a candidate for exclusive use in TNBC, but should be considered in all breast cancers, especially in the setting of clinically aggressive or

  18. Meta-analysis Reveals Genome-Wide Significance at 15q13 for Nonsyndromic Clefting of Both the Lip and the Palate, and Functional Analyses Implicate GREM1 As a Plausible Causative Gene

    Science.gov (United States)

    Ludwig, Kerstin U.; Ahmed, Syeda Tasnim; Böhmer, Anne C.; Sangani, Nasim Bahram; Varghese, Sheryil; Klamt, Johanna; Schuenke, Hannah; Gültepe, Pinar; Hofmann, Andrea; Rubini, Michele; Aldhorae, Khalid Ahmed; Steegers-Theunissen, Regine P.; Rojas-Martinez, Augusto; Reiter, Rudolf; Borck, Guntram; Knapp, Michael; Nakatomi, Mitsushiro; Graf, Daniel; Mangold, Elisabeth; Peters, Heiko

    2016-01-01

    Nonsyndromic orofacial clefts are common birth defects with multifactorial etiology. The most common type is cleft lip, which occurs with or without cleft palate (nsCLP and nsCLO, respectively). Although genetic components play an important role in nsCLP, the genetic factors that predispose to palate involvement are largely unknown. In this study, we carried out a meta-analysis on genetic and clinical data from three large cohorts and identified strong association between a region on chromosome 15q13 and nsCLP (P = 8.13×10−14 for rs1258763; relative risk (RR): 1.46, 95% confidence interval (CI): 1.32–1.61)) but not nsCLO (P = 0.27; RR: 1.09 (0.94–1.27)). The 5 kb region of strongest association maps downstream of Gremlin-1 (GREM1), which encodes a secreted antagonist of the BMP4 pathway. We show during mouse embryogenesis, Grem1 is expressed in the developing lip and soft palate but not in the hard palate. This is consistent with genotype-phenotype correlations between rs1258763 and a specific nsCLP subphenotype, since a more than two-fold increase in risk was observed in patients displaying clefts of both the lip and soft palate but who had an intact hard palate (RR: 3.76, CI: 1.47–9.61, Pdifflip or palate defects in Grem1-deficient mice, wild type embryonic palatal shelves developed divergent shapes when cultured in the presence of ectopic Grem1 protein (P = 0.0014). The present study identified a non-coding region at 15q13 as the second, genome-wide significant locus specific for nsCLP, after 13q31. Moreover, our data suggest that the closely located GREM1 gene contributes to a rare clinical nsCLP entity. This entity specifically involves abnormalities of the lip and soft palate, which develop at different time-points and in separate anatomical regions. PMID:26968009

  19. Significant concentration changes of chemical components of PM1 in the Yangtze River Delta area of China and the implications for the formation mechanism of heavy haze-fog pollution.

    Science.gov (United States)

    Zhang, Y W; Zhang, X Y; Zhang, Y M; Shen, X J; Sun, J Y; Ma, Q L; Yu, X M; Zhu, J L; Zhang, L; Che, H C

    2015-12-15

    Since the winter season of 2013, a number of persistent haze-fog events have occurred in central-eastern China. Continuous measurements of the chemical and physical properties of PM1 at a regional background station in the Yangtze River Delta area of China from 16 Nov. to 18 Dec., 2013 revealed several haze-fog events, among which a heavy haze-fog event occurred between 6 Dec. and 8 Dec. The mean concentration of PM1 was 212μgm(-3) in the heavy haze-fog period, which was about 10 times higher than on clean days and featured a peak mass concentration that reached 298μgm(-3). Organics were the largest contributor to the dramatic rise of PM1 on heavy haze-fog days (average mass concentration of 86μgm(-3)), followed by nitrate (58μgm(-3)), sulfate (35μgm(-3)), ammonium (29μgm(-3)), and chloride (4.0μgm(-3)). Nitrate exhibited the largest increase (~20 factors), associated with a significant increase in NOx. This was mainly attributable to increased coal combustion emissions, relative to motor vehicle emissions, and was caused by short-distance pollutant transport within surrounding areas. Low-volatility oxidized organic aerosols (OA) (LV-OOA) and biomass-burning OA (BBOA) also increased sharply on heavy haze-fog days, exhibiting an enhanced oxidation capacity of the atmosphere and increased emissions from biomass burning. The strengthening of the oxidation capacity during the heavy pollution episode, along with lower solar radiation, was probably due to increased biomass burning, which were important precursors of O3. The prevailing meteorological conditions, including low wind and high relative humidity, and short distance transported gaseous and particulate matter surrounding of the sampling site, coincided with the increased pollutant concentrations mainly from biomass-burning mentioned above to cause the persistent haze-fog event in the YRD area. Copyright © 2015. Published by Elsevier B.V.

  20. Medical Rituals and Media Rituals

    OpenAIRE

    Zoltán Zsinkó-Szabó

    2013-01-01

    In the present article the author examines the ritual elements of theprofessionalization during medical studies, and its interference with media content of medical significance, comparing the role of medical and media rituals on the way of becoming a doctor. It is to be explored how these medical soap operas, medical dramas, medical thrillers or crime stories do exert influence on medical identity and role expectations. Do medical students and their relatives (withmedical expertise frequently...

  1. Parental distress and catastrophic thoughts about child pain: implications for parental protective behavior in the context of child leukemia-related medical procedures.

    Science.gov (United States)

    Caes, Line; Vervoort, Tine; Devos, Patricia; Verlooy, Joris; Benoit, Yves; Goubert, Liesbet

    2014-09-01

    Treatment for childhood leukemia requires frequent lumbar punctures (LP) and bone marrow aspirations (BMA), often described by children and parents as more distressing than the disease itself. Findings in schoolchildren and chronic pain samples indicate that increased parental distress may increase parental protective, pain-attending behavior, which is associated with more child pain and distress. However, in the context of invasive medical procedures, it is unknown which parents are likely to become most distressed and engage in pain-attending behavior, and how this impacts the children's experiences. The present study investigated the impact of parental catastrophic thoughts upon parental distress and pain-attending behavior (verbal and nonverbal). Furthermore, the association between parental responses and the children's pain behavior, pain, and distress was examined. A total of 46 parents of children with leukemia (range, 0.6 to 15 y) who underwent a LP/BMA procedure participated in this study. Parental catastrophizing was assessed before and parental and child distress was assessed after the LP/BMA procedure. Parental pain-attending behavior and the child's pain behavior were observed before and after the LP/BMA procedure. Findings indicated that heightened parental catastrophic thinking contributed to increased parental distress during LP/BMA and less pain-attending behavior before the LP/BMA procedure, especially in young children. In contrast, heightened distress in parents with high levels of catastrophizing contributed to increased engagement in postprocedural pain-attending behavior. For young children, increased preprocedural pain-attending behavior was related to more child distress, pain, and pain behavior. The findings demonstrate the importance of parental catastrophic thinking in understanding their caregiving responses and preparing parents and children for painful invasive medical procedures.

  2. Provider Education about Glaucoma and Glaucoma Medications during Videotaped Medical Visits

    Directory of Open Access Journals (Sweden)

    Betsy Sleath

    2014-01-01

    Full Text Available Objective. The purpose of this study was to examine how patient, physician, and situational factors are associated with the extent to which providers educate patients about glaucoma and glaucoma medications, and which patient and provider characteristics are associated with whether providers educate patients about glaucoma and glaucoma medications. Methods. Patients with glaucoma who were newly prescribed or on glaucoma medications were recruited and a cross-sectional study was conducted at six ophthalmology clinics. Patients’ visits were videotape recorded and patients were interviewed after visits. Generalized estimating equations were used to analyze the data. Results. Two hundred and seventy-nine patients participated. Providers were significantly more likely to educate patients about glaucoma and glaucoma medications if they were newly prescribed glaucoma medications. Providers were significantly less likely to educate African American patients about glaucoma. Providers were significantly less likely to educate patients of lower health literacy about glaucoma medications. Conclusion. Eye care providers did not always educate patients about glaucoma or glaucoma medications. Practice Implications. Providers should consider educating more patients about what glaucoma is and how it is treated so that glaucoma patients can better understand their disease. Even if a patient has already been educated once, it is important to reinforce what has been taught before.

  3. The involvement of medical doctors in hospital governance and implications for quality management: a quick scan in 19 and an in depth study in 7 OECD countries.

    Science.gov (United States)

    Rotar, A M; Botje, D; Klazinga, N S; Lombarts, K M; Groene, O; Sunol, R; Plochg, T

    2016-05-24

    Hospital governance is broadening its orientation from cost and production controls towards 'improving performance on clinical outcomes'. Given this new focus one might assume that doctors are drawn into hospital management across OECD countries. Hospital performance in terms of patient health, quality of care and efficiency outcomes is supposed to benefit from their involvement. However, international comparative evidence supporting this idea is limited. Just a few studies indicate that there may be a positive relationship between medical doctors being part of hospital boards, and overall hospital performance. More importantly, the assumed relationship between these so-called doctor managers and hospital performance has remained a 'black-box' thus far. However, there is an increasing literature on the implementation of quality management systems in hospitals and their relation with improved performance. It seems therefore fair to assume that the relation between the involvement of doctors in hospital management and improved hospital performance is partly mediated via quality management systems. The threefold aim of this paper is to 1) perform a quick scan of the current situation with regard to doctor managers in hospital management in 19 OECD countries, 2) explore the phenomenon of doctor managers in depth in 7 OECD countries, and 3) investigate whether doctor involvement in hospital management is associated with more advanced implementation of quality management systems. This study draws both on a quick scan amongst country coordinators in OECD's Health Care Quality Indicator program, and on the DUQuE project which focused on the implementation of quality management systems in European hospitals. This paper reports two main findings. First, medical doctors fulfil a broad scope of managerial roles at departmental and hospital level but only partly accompanied by formal decision making responsibilities. Second, doctor managers having more formal decision making

  4. Contribution of radiodiagnosis to genetically significant dose

    International Nuclear Information System (INIS)

    Pele, J.M.; Ouvrard, R.

    Surveys were carried out in France on 33,000 X-ray medical examinations. The genetically significant dose to the whole population from roentgenography and fluoroscopy, for typical examinations, should be about 65mrads [fr

  5. Detecting Novelty and Significance

    Science.gov (United States)

    Ferrari, Vera; Bradley, Margaret M.; Codispoti, Maurizio; Lang, Peter J.

    2013-01-01

    Studies of cognition often use an “oddball” paradigm to study effects of stimulus novelty and significance on information processing. However, an oddball tends to be perceptually more novel than the standard, repeated stimulus as well as more relevant to the ongoing task, making it difficult to disentangle effects due to perceptual novelty and stimulus significance. In the current study, effects of perceptual novelty and significance on ERPs were assessed in a passive viewing context by presenting repeated and novel pictures (natural scenes) that either signaled significant information regarding the current context or not. A fronto-central N2 component was primarily affected by perceptual novelty, whereas a centro-parietal P3 component was modulated by both stimulus significance and novelty. The data support an interpretation that the N2 reflects perceptual fluency and is attenuated when a current stimulus matches an active memory representation and that the amplitude of the P3 reflects stimulus meaning and significance. PMID:19400680

  6. Significant NRC Enforcement Actions

    Data.gov (United States)

    Nuclear Regulatory Commission — This dataset provides a list of Nuclear Regulartory Commission (NRC) issued significant enforcement actions. These actions, referred to as "escalated", are issued by...

  7. Usability inspection to improve an electronic provincial medication repository.

    Science.gov (United States)

    Kitson, Nicole A; Price, Morgan; Bowen, Michael; Lau, Francis

    2013-01-01

    Medication errors are a significant source of actual and potential harm for patients. Community medication records have the potential to reduce medication errors, but they can also introduce unintended consequences when there is low fit to task (low cognitive fit). PharmaNet is a provincially managed electronic repository that contains the records for community-based pharmacy-dispensed medications in British Columbia. This research explores the usability of PharmaNet, as a representative community-based medication repository. We completed usability inspections of PharmaNet through vendor applications. Vendor participants were asked to complete activity-driven scenarios, which highlighted aspects of medication management workflow. Screen recording was later reviewed. Heuristics were applied to explore usability issues and improvement opportunities. Usability inspection was conducted with four PharmaNet applications. Ninety-six usability issues were identified; half of these had potential implications for patient safety. These were primarily related to login and logout procedures; display of patient name; display of medications; update and display of alert information; and the changing or discontinuation of medications. PharmaNet was designed primarily to support medication dispensing and billing activities by community pharmacies, but is also used to support care providers with monitoring and prescribing activities. As such, some of the features do not have a strong fit for other clinical activities. To improve fit, we recommend: having a Current Medications List and Displaying Medication Utilization Charts.

  8. Significance, mechanisms and environmental implications of microbial bio-mineralization

    International Nuclear Information System (INIS)

    Benzerara, K.; Miot, J.; Morin, G.; Ona-Nguema, G.; Skouri-Panet, F.; Ferard, C.

    2011-01-01

    Microorganisms can mediate the formation of minerals by a process called bio-mineralization. This process offers an efficient way to sequester inorganic pollutants within relatively stable solid phases. Here we review some of the main mechanisms involved in the mediation of mineral precipitation by microorganisms. This includes supersaturation caused by metabolic activity, the triggering of nucleation by production of more or less specific organic molecules, and the impact of mineral growth. While these processes have been widely studied in the laboratory, assessment of their importance in the environment is more difficult. We illustrate this difficulty using a case study on an As-contaminated acid mine drainage located in the South of France (Carnoules, Gard). In particular, we explore the potential relationships that might exist between microbial diversity and mineral precipitation. The present review, far from being exhaustive, highlights some recent advances in the field of bio-mineralogy and provides non-specialists an introduction to some of the main approaches and some questions that remain unanswered. (authors)

  9. THE CONSTITUTIONAL PRINCIPLE OF EQUALITY - LEGAL SIGNIFICANCE AND SOCIAL IMPLICATIONS -

    Directory of Open Access Journals (Sweden)

    Marius ANDREESCU

    2017-12-01

    Full Text Available The equality in human rights and obligations, the equality of citizens before the law are fundamental categories of the theories on social democracy but also conditions of the lawful state, without which constitutional democracy cannot be conceived. In Romanian Constitution, this principle is consecrated in the form of equality of the citizens before the law and public authorities. There are also particular aspects of this principle consecrated in the Constitution. The constitutional principle of equality requires that equal treatment be applied to equal situations. This social and legal reality implies numerous interferences between the principle of equality and other constitutional principles. In this study, by using theoretical and jurisprudential arguments, we intend to demonstrate that, in relation to contemporary social reality, equality, as a constitutional principle, is a particular aspect of the principle of proportionality. The latter one expresses in essence the ideas of: fairness, justice, reasonableness and fair appropriateness of state decisions to the facts and legitimate aims proposed.

  10. The coagulopathy in sepsis: significance and implications for treatment

    Directory of Open Access Journals (Sweden)

    Berardino Pollio

    2011-09-01

    Full Text Available Sepsis related coagulopathy ranges from mild laboratory alterations up to severe disseminated intravascular coagulation (DIC. There is evidence that DIC is involved in the pathogenesis of microvascular dysfunction contributing to organ failure. Additionally, the systemic activation of coagulation, by consuming platelets and coagulation factors, may cause bleeding. Thrombin generation via the tissue factor/factor VIIa route, contemporary depression of antithrombin and protein C anticoagulant system, as well as impaired fibrin degradation, due to high circulating levels of PAI-1, contribute to enhanced intravascular fibrin deposition. This deranged coagulopathy is an independent predictor of clinical outcome in patients with severe sepsis. Innovative supportive strategies aiming at the inhibition of coagulation activation comprise inhibition of tissue factor-mediated activation or restoration of physiological anticoagulant pathways, as the administration of recombinant human activated protein C or concentrate. In spite of some promising initial studies, additional trials are needed to define their clinical effectiveness in adults and children with severe sepsis.

  11. External audit of clinical practice and medical decision making in a new Asian oncology center: Results and implications for both developing and developed nations

    International Nuclear Information System (INIS)

    Shakespeare, Thomas P.; Back, Michael F.; Lu, Jiade J.; Lee, Khai Mun; Mukherjee, Rahul K.

    2006-01-01

    Purpose: The external audit of oncologist clinical practice is increasingly important because of the incorporation of audits into national maintenance of certification (MOC) programs. However, there are few reports of external audits of oncology practice or decision making. Our institution (The Cancer Institute, Singapore) was asked to externally audit an oncology department in a developing Asian nation, providing a unique opportunity to explore the feasibility of such a process. Methods and Materials: We audited 100 randomly selected patients simulated for radiotherapy in 2003, using a previously reported audit instrument assessing clinical documentation/quality assurance and medical decision making. Results: Clinical documentation/quality assurance, decision making, and overall performance criteria were adequate 74.4%, 88.3%, and 80.2% of the time, respectively. Overall 52.0% of cases received suboptimal management. Multivariate analysis revealed palliative intent was associated with improved documentation/clinical quality assurance (p = 0.07), decision making (p 0.007), overall performance (p = 0.003), and optimal treatment rates (p 0.07); non-small-cell lung cancer or central nervous system primary sites were associated with better decision making (p = 0.001), overall performance (p = 0.03), and optimal treatment rates (p = 0.002). Conclusions: Despite the poor results, the external audit had several benefits. It identified learning needs for future targeting, and the auditor provided facilitating feedback to address systematic errors identified. Our experience was also helpful in refining our national revalidation audit instrument. The feasibility of the external audit supports the consideration of including audit in national MOC programs

  12. Developing High-Functioning Teams: Factors Associated With Operating as a "Real Team" and Implications for Patient-Centered Medical Home Development.

    Science.gov (United States)

    Stout, Somava; Zallman, Leah; Arsenault, Lisa; Sayah, Assaad; Hacker, Karen

    2017-01-01

    Team-based care is a foundation of health care redesign models like the patient-centered medical home (PCMH). Yet few practices rigorously examine how the implementation of PCMH relates to teamwork. We identified factors associated with the perception of a practice operating as a real team. An online workforce survey was conducted with all staff of 12 primary care sites of Cambridge Health Alliance at different stages of PCMH transformation. Bivariate and multivariate analyses of factors associated with teamwork perceptions were conducted. In multivariate models, having effective leadership was the main factor associated with practice teamwork perceptions (odds ratio [OR], 10.49; 95% confidence interval [CI], 5.39-20.43); in addition, practicing at a site in an intermediate stage of PCMH transformation was also associated with enhanced team perceptions (OR, 2.44; 95% CI, 1.28-4.64). In a model excluding effective leadership, respondents at sites in an intermediate stage of PCMH transformation (OR, 1.95; 95% CI, 1.1-3.4) and who had higher care team behaviors (such as huddles and weekly meetings; OR, 3.41; 95% CI, 1.30-8.92), higher care team perceptions (OR, 2.65; 95% CI, 1.15-6.11), and higher job satisfaction (OR, 2.00; 95% CI, 1.02-3.92) had higher practice teamwork perceptions. This study highlights the strong association between effective leadership, care team behaviors and perceptions, and job satisfaction with perceptions that practices operate as real teams. Although we cannot infer causality with these cross-sectional data, this study raises the possibility that providing attention to these factors may be important in augmenting practice teamwork perceptions.

  13. Data Sharing: A New Editorial Initiative of the International Committee of Medical Journal Editors. Implications for the Editors´ Network.

    Science.gov (United States)

    Alfonso, Fernando; Adamyan, Karlen; Artigou, Jean-Yves; Aschermann, Michael; Boehm, Michael; Buendia, Alfonso; Chu, Pao-Hsien; Cohen, Ariel; Cas, Livio Dei; Dilic, Mirza; Doubell, Anton; Echeverri, Dario; Enç, Nuray; Ferreira-González, Ignacio; Filipiak, Krzysztof J; Flammer, Andreas; Fleck, Eckart; Gatzov, Plamen; Ginghina, Carmen; Goncalves, Lino; Haouala, Habib; Hassanein, Mahmoud; Heusch, Gerd; Huber, Kurt; Hulín, Ivan; Ivanusa, Mario; Krittayaphong, Rungroj; Lau, Chu-Pak; Marinskis, Germanas; Mach, François; Moreira, Luiz Felipe; Nieminen, Tuomo; Oukerraj, Latifa; Perings, Stefan; Pierard, Luc; Potpara, Tatjana; Reyes-Caorsi, Walter; Rim, Se-Joong; Rødevand, Olaf; Saade, Georges; Sander, Mikael; Shlyakhto, Evgeny; Timuralp, Bilgin; Tousoulis, Dimitris; Ural, Dilek; Piek, J J; Varga, Albert; Lüscher, Thomas F

    2017-05-01

    The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship - emphasizing the importance of responsibility and accountability-, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors´ Network of the European Society of Cardiology. Resumo O Comitê Internacional de Editores de Revistas Médicas (ICMJE) fornece recomendações para aprimorar o padrão editorial e a qualidade científica das revistas biomédicas. Tais recomendações variam desde requisitos técnicos de uniformização até assuntos editoriais mais complexos e elusivos, como os aspectos éticos do processo científico. Recentemente, foram propostos registro de ensaios clínicos, divulgação de conflitos de interesse e novos critérios de autoria, enfatizando a importância da responsabilidade e da responsabilização. No último ano, lançou-se uma nova iniciativa editorial para fomentar o compartilhamento dos dados de ensaios clínicos. Esta revisão discute essa nova iniciativa visando a aumentar a conscientização de leitores, investigadores, autores e editores filiados à Rede de Editores da Sociedade Europeia de Cardiologia.

  14. Medicalization, markets and consumers.

    Science.gov (United States)

    Conrad, Peter; Leiter, Valerie

    2004-01-01

    This paper examines the impact of changes in the medical marketplace on medicalization in U.S. society. Using four cases (Viagra, Paxil, human growth hormone and in vitro fertilization), we focus on two aspects of the changing medical marketplace: the role of direct-to-consumer advertising of prescription drugs and the emergence of private medical markets. We demonstrate how consumers and pharmaceutical corporations contribute to medicalization, with physicians, insurance coverage, and changes in regulatory practices playing facilitating roles. In some cases, insurers attempt to counteract medicalization by restricting access. We distinguish mediated and private medical markets, each characterized by differing relationships with corporations, insurers, consumers, and physicians. In the changing medical environment, with medical markets as intervening factors, corporations and insurers are becoming more significant determinants in the medicalization process.

  15. Medical exposures requirements, present situation and prospects

    International Nuclear Information System (INIS)

    Cardenas Herrera, Juan

    2012-01-01

    Scope of medical exposures is studied, these include: exposure to patients as part of their diagnosis or treatment, exposures to persons who knowingly have assisted patients, exposures volunteers included in biomedical research programs. Medical exposures have contributed their benefits for human health improvement: possess a necessary character that people have to be exposed to radiation doses to achieve their goals, convergence of risk and benefit in the same individual is presented, variability is implicated in dose given to patients in terms of size and distribution, have contributed significantly to the doses received by the world population. Despite the above attributes and generally contribute to the direct benefit of the patient, long has been given less attention than other forms of exposure, there still potential for dose reduction to patients as a result of the applications of ionizing radiation. Currently have used for nuclear medicine diagnostic x-ray procedures, exams MN, radiotherapy, tomography, both medical and dental radiology. (author) [es

  16. Burnout in medical students: a systematic review.

    Science.gov (United States)

    Ishak, Waguih; Nikravesh, Rose; Lederer, Sara; Perry, Robert; Ogunyemi, Dotun; Bernstein, Carol

    2013-08-01

    Burnout is a state of mental and physical exhaustion related to work or care-giving activities. Distress during medical school can lead to burnout, with significant consequences, particularly if burnout continues into residency and beyond. The authors reviewed literature pertaining to medical student burnout, its prevalence, and its relationship to personal, environmental, demographic and psychiatric factors. We ultimately offer some suggestions to address and potentially ameliorate the current dilemma posed by burnout during medical education. A literature review was conducted using a PubMed/Medline, and PsycInfo search from 1974 to 2011 using the keywords: 'burnout', 'stress', 'well-being', 'self-care', 'psychiatry' and 'medical students'. Three authors agreed independently on the studies to be included in this review. The literature reveals that burnout is prevalent during medical school, with major US multi-institutional studies estimating that at least half of all medical students may be affected by burnout during their medical education. Studies show that burnout may persist beyond medical school, and is, at times, associated with psychiatric disorders and suicidal ideation. A variety of personal and professional characteristics correlate well with burnout. Potential interventions include school-based and individual-based activities to increase overall student well-being. Burnout is a prominent force challenging medical students' well-being, with concerning implications for the continuation of burnout into residency and beyond. To address this highly prevalent condition, educators must first develop greater awareness and understanding of burnout, as well as of the factors that lead to its development. Interventions focusing on generating wellness during medical training are highly recommended. © 2013 John Wiley & Sons Ltd.

  17. Inhaler Reminders Significantly Improve Asthma Patients' Use of Controller Medications

    Science.gov (United States)

    ... Conditions Drug Guide Conditions Dictionary Just for Kids Library School Tools Videos Virtual Allergist Education & Training Careers in ... Support the AAAAI Foundation Donate Utility navigation Español Journals Annual Meeting Member Login / My Membership Search navigation ...

  18. Significance of Pharmacogenetics and Pharmacogenomics Research in Current Medical Practice.

    Science.gov (United States)

    Prakash, Swayam; Agrawal, Suraksha

    2016-01-01

    Human genome sequencing highlights the involvement of genetic variation towards differential risk of human diseases, presence of different phenotypes, and response to pharmacological elements. This brings the field of personalized medicine to forefront in the era of modern health care. Numerous recent approaches have shown that how variation in the genome at single nucleotide level can be used in pharmacological research. The two broad aspects that deal with pharmacological research are pharmacogenetics and pharmacogenomics. This review encompasses how these variations have created the basis of pharmacogenetics and pharmacogenomics research and important milestones accomplished in these two fields in different diseases. It further discusses at length their importance in disease diagnosis, response of drugs, and various treatment modalities on the basis of genetic determinants.

  19. Differences in Neuroticism Between Patients with Glaucoma Who Have Discontinued Visits to Ophthalmologists and Those Who Make Regular Visits: Implications for Adherence to Topical Glaucoma Medications.

    Science.gov (United States)

    Nakano, Tadashi; Kodaka, Fumitoshi; Tsuneoka, Hiroshi

    2016-12-01

    Neuroticism is a personality trait often described in individuals with glaucoma (GLC), but is not necessarily representative of the total population of patients. There is a population of patients with GLC who are invisible to clinical ophthalmologists; in other words, those who once have been diagnosed with GLC, but spontaneously stop visiting an ophthalmologist. Little is known about their neuroticism personality trait. In the present study, the authors compared the level of neuroticism between patients no longer visiting an ophthalmologist and those who continue visit them regularly. Patients were assigned to two groups according to the duration of their last visit to an ophthalmologist: the Discontinued group included those patients who had not visited an ophthalmologist for the last 6 months, and the Regular Visitor group included those patients who continued to make regular visits to an ophthalmologist. The Japanese version of Ten Items Personality Inventory (TIPI-J), a questionnaire specifically used to assess the Big Five personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and openness), was completed by patients through a dedicated website. Three-hundred and seventy-three patients with GLC were recruited. The neuroticism score from the TIPI-J in the Discontinued group was significantly lower than that in the Regular Visitor group (7.63 ± 2.23 vs. 8.23 ± 2.21, respectively; P = 0.01). No significant difference was found in the other TIPI-J sub-item scores between the Discontinued and the Regular Visitor groups. In this study, the authors showed that neuroticism trait in patients with GLC who have discontinued visiting their ophthalmologists was lower than that in patients who regularly visited them, on the basis of the Big Five personality traits as measured by the TIPT-J. Santen Pharmaceutical Co., Ltd.

  20. Significant Tsunami Events

    Science.gov (United States)

    Dunbar, P. K.; Furtney, M.; McLean, S. J.; Sweeney, A. D.

    2014-12-01

    Tsunamis have inflicted death and destruction on the coastlines of the world throughout history. The occurrence of tsunamis and the resulting effects have been collected and studied as far back as the second millennium B.C. The knowledge gained from cataloging and examining these events has led to significant changes in our understanding of tsunamis, tsunami sources, and methods to mitigate the effects of tsunamis. The most significant, not surprisingly, are often the most devastating, such as the 2011 Tohoku, Japan earthquake and tsunami. The goal of this poster is to give a brief overview of the occurrence of tsunamis and then focus specifically on several significant tsunamis. There are various criteria to determine the most significant tsunamis: the number of deaths, amount of damage, maximum runup height, had a major impact on tsunami science or policy, etc. As a result, descriptions will include some of the most costly (2011 Tohoku, Japan), the most deadly (2004 Sumatra, 1883 Krakatau), and the highest runup ever observed (1958 Lituya Bay, Alaska). The discovery of the Cascadia subduction zone as the source of the 1700 Japanese "Orphan" tsunami and a future tsunami threat to the U.S. northwest coast, contributed to the decision to form the U.S. National Tsunami Hazard Mitigation Program. The great Lisbon earthquake of 1755 marked the beginning of the modern era of seismology. Knowledge gained from the 1964 Alaska earthquake and tsunami helped confirm the theory of plate tectonics. The 1946 Alaska, 1952 Kuril Islands, 1960 Chile, 1964 Alaska, and the 2004 Banda Aceh, tsunamis all resulted in warning centers or systems being established.The data descriptions on this poster were extracted from NOAA's National Geophysical Data Center (NGDC) global historical tsunami database. Additional information about these tsunamis, as well as water level data can be found by accessing the NGDC website www.ngdc.noaa.gov/hazard/

  1. Marijuana: modern medical chimaera.

    Science.gov (United States)

    Lamarine, Roland J

    2012-01-01

    Marijuana has been used medically since antiquity. In recent years there has been a resurgence of interest in medical applications of various cannabis preparations. These drugs have been cited in the medical literature as potential secondary treatment agents for severe pain, muscle spasticity, anorexia, nausea, sleep disturbances, and numerous other uses. This article reviews the research literature related to medical applications of various forms of cannabis. Benefits related to medical use of cannabinoids are examined and a number of potential risks associated with cannabis use, both medical and recreational, are considered. There is a clearly identified need for further research to isolate significant benefits from the medical application of cannabinoids and to establish dosage levels, appropriate delivery mechanisms and formulations, and to determine what role, if any, cannabinoids might play in legitimate medical applications. It is also imperative to determine if reported dangers pose a significant health risks to users.

  2. The association between physical symptoms and depression among medical students in Bahrain.

    Science.gov (United States)

    Abdelaziz, Ammar M Y; Alotaibi, Khalid T; Alhurayyis, Jarah H; Alqahtani, Turky A; Alghamlas, Aamer M; Algahtani, Haifa M; Jahrami, Haitham A

    2017-12-15

    To examine the association between depression and physical symptoms among medical students in Bahrain.   The present study employed a cross-sectional design.  A total of 160 students were recruited, 41.3% were male and 58.8% female, using a convenience sampling approach. Participants completed the validated Patients Health Questionnaires (PHQs) in which they provided information about demographics, physical symptoms, and depression. Results were considered significant if p medical students in Bahrain.  Medical educators should take such symptoms seriously among medical students as it may have serious consequences on the mental health of medical students. In practice, adequate awareness initiatives should be organized and provided for medical students to help them overcome their challenges they face. Additionally, incorporating screening self-screening strategies in the medical curriculum can be beneficial for early detections of mental health problems. The Implications and limitations of the study are discussed.

  3. Testing Significance Testing

    Directory of Open Access Journals (Sweden)

    Joachim I. Krueger

    2018-04-01

    Full Text Available The practice of Significance Testing (ST remains widespread in psychological science despite continual criticism of its flaws and abuses. Using simulation experiments, we address four concerns about ST and for two of these we compare ST’s performance with prominent alternatives. We find the following: First, the 'p' values delivered by ST predict the posterior probability of the tested hypothesis well under many research conditions. Second, low 'p' values support inductive inferences because they are most likely to occur when the tested hypothesis is false. Third, 'p' values track likelihood ratios without raising the uncertainties of relative inference. Fourth, 'p' values predict the replicability of research findings better than confidence intervals do. Given these results, we conclude that 'p' values may be used judiciously as a heuristic tool for inductive inference. Yet, 'p' values cannot bear the full burden of inference. We encourage researchers to be flexible in their selection and use of statistical methods.

  4. Safety significance evaluation system

    International Nuclear Information System (INIS)

    Lew, B.S.; Yee, D.; Brewer, W.K.; Quattro, P.J.; Kirby, K.D.

    1991-01-01

    This paper reports that the Pacific Gas and Electric Company (PG and E), in cooperation with ABZ, Incorporated and Science Applications International Corporation (SAIC), investigated the use of artificial intelligence-based programming techniques to assist utility personnel in regulatory compliance problems. The result of this investigation is that artificial intelligence-based programming techniques can successfully be applied to this problem. To demonstrate this, a general methodology was developed and several prototype systems based on this methodology were developed. The prototypes address U.S. Nuclear Regulatory Commission (NRC) event reportability requirements, technical specification compliance based on plant equipment status, and quality assurance assistance. This collection of prototype modules is named the safety significance evaluation system

  5. Predicting significant torso trauma.

    Science.gov (United States)

    Nirula, Ram; Talmor, Daniel; Brasel, Karen

    2005-07-01

    Identification of motor vehicle crash (MVC) characteristics associated with thoracoabdominal injury would advance the development of automatic crash notification systems (ACNS) by improving triage and response times. Our objective was to determine the relationships between MVC characteristics and thoracoabdominal trauma to develop a torso injury probability model. Drivers involved in crashes from 1993 to 2001 within the National Automotive Sampling System were reviewed. Relationships between torso injury and MVC characteristics were assessed using multivariate logistic regression. Receiver operating characteristic curves were used to compare the model to current ACNS models. There were a total of 56,466 drivers. Age, ejection, braking, avoidance, velocity, restraints, passenger-side impact, rollover, and vehicle weight and type were associated with injury (p < 0.05). The area under the receiver operating characteristic curve (83.9) was significantly greater than current ACNS models. We have developed a thoracoabdominal injury probability model that may improve patient triage when used with ACNS.

  6. Gas revenue increasingly significant

    International Nuclear Information System (INIS)

    Megill, R.E.

    1991-01-01

    This paper briefly describes the wellhead prices of natural gas compared to crude oil over the past 70 years. Although natural gas prices have never reached price parity with crude oil, the relative value of a gas BTU has been increasing. It is one of the reasons that the total amount of money coming from natural gas wells is becoming more significant. From 1920 to 1955 the revenue at the wellhead for natural gas was only about 10% of the money received by producers. Most of the money needed for exploration, development, and production came from crude oil. At present, however, over 40% of the money from the upstream portion of the petroleum industry is from natural gas. As a result, in a few short years natural gas may become 50% of the money revenues generated from wellhead production facilities

  7. Tumor significant dose

    International Nuclear Information System (INIS)

    Supe, S.J.; Nagalaxmi, K.V.; Meenakshi, L.

    1983-01-01

    In the practice of radiotherapy, various concepts like NSD, CRE, TDF, and BIR are being used to evaluate the biological effectiveness of the treatment schedules on the normal tissues. This has been accepted as the tolerance of the normal tissue is the limiting factor in the treatment of cancers. At present when various schedules are tried, attention is therefore paid to the biological damage of the normal tissues only and it is expected that the damage to the cancerous tissues would be extensive enough to control the cancer. Attempt is made in the present work to evaluate the concent of tumor significant dose (TSD) which will represent the damage to the cancerous tissue. Strandquist in the analysis of a large number of cases of squamous cell carcinoma found that for the 5 fraction/week treatment, the total dose required to bring about the same damage for the cancerous tissue is proportional to T/sup -0.22/, where T is the overall time over which the dose is delivered. Using this finding the TSD was defined as DxN/sup -p/xT/sup -q/, where D is the total dose, N the number of fractions, T the overall time p and q are the exponents to be suitably chosen. The values of p and q are adjusted such that p+q< or =0.24, and p varies from 0.0 to 0.24 and q varies from 0.0 to 0.22. Cases of cancer of cervix uteri treated between 1978 and 1980 in the V. N. Cancer Centre, Kuppuswamy Naidu Memorial Hospital, Coimbatore, India were analyzed on the basis of these formulations. These data, coupled with the clinical experience, were used for choice of a formula for the TSD. Further, the dose schedules used in the British Institute of Radiology fraction- ation studies were also used to propose that the tumor significant dose is represented by DxN/sup -0.18/xT/sup -0.06/

  8. Uranium chemistry: significant advances

    International Nuclear Information System (INIS)

    Mazzanti, M.

    2011-01-01

    The author reviews recent progress in uranium chemistry achieved in CEA laboratories. Like its neighbors in the Mendeleev chart uranium undergoes hydrolysis, oxidation and disproportionation reactions which make the chemistry of these species in water highly complex. The study of the chemistry of uranium in an anhydrous medium has led to correlate the structural and electronic differences observed in the interaction of uranium(III) and the lanthanides(III) with nitrogen or sulfur molecules and the effectiveness of these molecules in An(III)/Ln(III) separation via liquid-liquid extraction. Recent work on the redox reactivity of trivalent uranium U(III) in an organic medium with molecules such as water or an azide ion (N 3 - ) in stoichiometric quantities, led to extremely interesting uranium aggregates particular those involved in actinide migration in the environment or in aggregation problems in the fuel processing cycle. Another significant advance was the discovery of a compound containing the uranyl ion with a degree of oxidation (V) UO 2 + , obtained by oxidation of uranium(III). Recently chemists have succeeded in blocking the disproportionation reaction of uranyl(V) and in stabilizing polymetallic complexes of uranyl(V), opening the way to to a systematic study of the reactivity and the electronic and magnetic properties of uranyl(V) compounds. (A.C.)

  9. Meaning and significance of

    Directory of Open Access Journals (Sweden)

    Ph D Student Roman Mihaela

    2011-05-01

    Full Text Available The concept of "public accountability" is a challenge for political science as a new concept in this area in full debate and developement ,both in theory and practice. This paper is a theoretical approach of displaying some definitions, relevant meanings and significance odf the concept in political science. The importance of this concept is that although originally it was used as a tool to improve effectiveness and eficiency of public governance, it has gradually become a purpose it itself. "Accountability" has become an image of good governance first in the United States of America then in the European Union.Nevertheless,the concept is vaguely defined and provides ambiguous images of good governance.This paper begins with the presentation of some general meanings of the concept as they emerge from specialized dictionaries and ancyclopaedies and continues with the meanings developed in political science. The concept of "public accontability" is rooted in economics and management literature,becoming increasingly relevant in today's political science both in theory and discourse as well as in practice in formulating and evaluating public policies. A first conclusin that emerges from, the analysis of the evolution of this term is that it requires a conceptual clarification in political science. A clear definition will then enable an appropriate model of proving the system of public accountability in formulating and assessing public policies, in order to implement a system of assessment and monitoring thereof.

  10. Legal, Social and Psycho-Medical Effects of Abortion

    OpenAIRE

    Mavrić, Bisera

    2012-01-01

    This work deals with the relationship between induced abortion and mental health with a special focus on the area of political controversy. This article explores the historical background of the abortion and its legislative implications in Europe with special reference to Bosnia and Herzegovina. This work is based on etnographich, analitical and historical aproaches. It explains abortion in medical terms and analyzes the psychological effects of the abortion. This is a significant and challan...

  11. Significant Radionuclides Determination

    Energy Technology Data Exchange (ETDEWEB)

    Jo A. Ziegler

    2001-07-31

    The purpose of this calculation is to identify radionuclides that are significant to offsite doses from potential preclosure events for spent nuclear fuel (SNF) and high-level radioactive waste expected to be received at the potential Monitored Geologic Repository (MGR). In this calculation, high-level radioactive waste is included in references to DOE SNF. A previous document, ''DOE SNF DBE Offsite Dose Calculations'' (CRWMS M&O 1999b), calculated the source terms and offsite doses for Department of Energy (DOE) and Naval SNF for use in design basis event analyses. This calculation reproduces only DOE SNF work (i.e., no naval SNF work is included in this calculation) created in ''DOE SNF DBE Offsite Dose Calculations'' and expands the calculation to include DOE SNF expected to produce a high dose consequence (even though the quantity of the SNF is expected to be small) and SNF owned by commercial nuclear power producers. The calculation does not address any specific off-normal/DBE event scenarios for receiving, handling, or packaging of SNF. The results of this calculation are developed for comparative analysis to establish the important radionuclides and do not represent the final source terms to be used for license application. This calculation will be used as input to preclosure safety analyses and is performed in accordance with procedure AP-3.12Q, ''Calculations'', and is subject to the requirements of DOE/RW-0333P, ''Quality Assurance Requirements and Description'' (DOE 2000) as determined by the activity evaluation contained in ''Technical Work Plan for: Preclosure Safety Analysis, TWP-MGR-SE-000010'' (CRWMS M&O 2000b) in accordance with procedure AP-2.21Q, ''Quality Determinations and Planning for Scientific, Engineering, and Regulatory Compliance Activities''.

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

    African Journals Online (AJOL)

    patients with diabetes, 62% of patients with hypertension and 88% of patients with .... like cardiovascular disease.28-30 Pro-inflammatory amino-acids, such as .... glucose homeostasis.53 In contrast a great number of recent studies have ...

  13. The Medical Implications of Women On Submarines

    Science.gov (United States)

    2001-11-26

    which is in turn influenced by sex, genetics, nutrition, and exercise both before and after this age.50, 51 Postmenopausal women lose bone mass at...for 20-25% of women’s visits, the most common of which were dysfunctional uterine bleeding or amenorrhea , contraceptive issues, pregnancy or ruling...pregnancy induced hypertension, fetal death and low birth weight infants144, and low frequency whole body vibration in the 1-10 hz range, which has been

  14. Drones--ethical considerations and medical implications.

    Science.gov (United States)

    Pepper, Tom

    2012-01-01

    Drones enhance military capability and form a potent element of force protection, allowing humans to be removed from hazardous environments and tedious jobs. However, there are moral, legal, and political dangers associated with their use. Although a time may come when it is possible to develop a drone that is able to autonomously and ethically engage a legitimate target with greater reliability than a human, until then military drones demand a crawl-walk-run development methodology, consent by military personnel for weapon use, and continued debate about the complex issues surrounding their deployment.

  15. Abortion - medical

    Science.gov (United States)

    Therapeutic medical abortion; Elective medical abortion; Induced abortion; Nonsurgical abortion ... A medical, or nonsurgical, abortion can be done within 7 weeks from the first day of the woman's last ...

  16. Clinical significance of the fabella

    International Nuclear Information System (INIS)

    Dodevski, A.; Lazarova-Tosovska, D.; Zhivadinovik, J.; Lazareska, M.

    2012-01-01

    Full text: Introduction: There is variable number of sesamoid bones in the human body; one of them is fabella, located in the tendon of the gastrocnemius muscle. Aim of this study was to investigate the frequency of occurrence of fabella in the Macedonian population and to discuss about clinical importance of this bone. Materials and methods: We retrospectively examined radiographs of 53 patients who had knee exams undertaken for a variety of clinical reasons, performed as a part of their medical treatment. Over a time span of six months, 53 patients (38 males and 15 females, age range 19-60 years, mean age of 36.7±12.3 years) were examined. Results: In seven (13.2%) patients of 53 analyzed reports, fabella was found in the lateral tendon of gastrocnemius muscle. We did not find a significant gender or side difference in the appearance of fabella. Conclusion: Although anatomic studies emphasized a lack of significance of the fabella, this bone has been associated with a spectrum of pathology affecting the knee as fabellar syndrome, perineal nerve injury and fracture. We should think of this sesamoid bone while performing diagnostic and surgical procedures

  17. Family medicine: Perception and attitudes among Indian medical students

    Directory of Open Access Journals (Sweden)

    Ilhaam Ashraf

    2018-01-01

    Full Text Available Context: Currently, family medicine is not taught as a part of the undergraduate medical curriculum in India. In this context, the perceptions and attitudes of Indian medical students regarding family medicine as a career choice were studied. Aims: This study aims to study the perceptions and attitudes prevalent among Indian medical students regarding family medicine as a career choice and discuss its future implications. Settings and Design: Cross-sectional survey study design. Methods and Material: We conducted a cross-sectional survey of undergraduate medical (MBBS students attending the 2016 medical student conference DEMEDCON at Sri Devaraj Urs Medical College in Kolar, Karnataka, India. Besides demographics, the survey included questions pertaining to awareness, exposure, and interest in family medicine in India. We also asked an open-ended question regarding the respondent's perception of the future of family medicine in India. Statistical Analysis: Simple statistics such as mean and frequency (% were calculated. Given the small sample size, no formal tests for statistical significance were performed. Results: Responses were collected from 45 students between the ages of 18–24 from 6 medical colleges across Karnataka and Puducherry. The majority (64% of respondents were in their 3rd or 4th year of medical college. 98% of respondents expressed a desire to learn more about family medicine as a specialty, and 82% expressed a need to introduce it as a subject in medical college. However, only 58% were aware of the Medical Council of India accredited status of family medicine in India. Conclusions: There exists a significant lack of awareness and inadequate exposure among Indian medical students toward family medicine. Nonetheless, there is widespread optimism and a desire to learn more about the subject. Increased awareness and avenues for exposure to family medicine in the formal undergraduate medical curriculum is the need of the hour.

  18. Consultant medical trainers, modernising medical careers (MMC and the European time directive (EWTD: tensions and challenges in a changing medical education context

    Directory of Open Access Journals (Sweden)

    Payne Heather

    2008-05-01

    Full Text Available Abstract Background We analysed the learning and professional development narratives of Hospital Consultants training junior staff ('Consultant Trainers' in order to identify impediments to successful postgraduate medical training in the UK, in the context of Modernising Medical Careers (MMC and the European Working Time Directive (EWTD. Methods Qualitative study. Learning and continuing professional development (CPD, were discussed in the context of Consultant Trainers' personal biographies, organisational culture and medical education practices. We conducted life story interviews with 20 Hospital Consultants in six NHS Trusts in Wales in 2005. Results Consultant Trainers felt that new working patterns resulting from the EWTD and MMC have changed the nature of medical education. Loss of continuity of care, reduced clinical exposure of medical trainees and loss of the popular apprenticeship model were seen as detrimental for the quality of medical training and patient care. Consultant Trainers' perceptions of medical education were embedded in a traditional medical education culture, which expected long hours' availability, personal sacrifices and learning without formal educational support and supervision. Over-reliance on apprenticeship in combination with lack of organisational support for Consultant Trainers' new responsibilities, resulting from the introduction of MMC, and lack of interest in pursuing training in teaching, supervision and assessment represent potentially significant barriers to progress. Conclusion This study identifies issues with significant implications for the implementation of MMC within the context of EWTD. Postgraduate Deaneries, NHS Trusts and the new body; NHS: Medical Education England should deal with the deficiencies of MMC and challenges of ETWD and aspire to excellence. Further research is needed to investigate the views and educational practices of Consultant Medical Trainers and medical trainees.

  19. A Closer Look at Racism and Heterosexism in Medical Students' Clinical Decision-Making Related to HIV Pre-Exposure Prophylaxis (PrEP): Implications for PrEP Education.

    Science.gov (United States)

    Calabrese, Sarah K; Earnshaw, Valerie A; Krakower, Douglas S; Underhill, Kristen; Vincent, Wilson; Magnus, Manya; Hansen, Nathan B; Kershaw, Trace S; Mayer, Kenneth H; Betancourt, Joseph R; Dovidio, John F

    2018-04-01

    Social biases among healthcare providers could limit PrEP access. In this survey study of 115 US medical students, we examined associations between biases (racism and heterosexism) and PrEP clinical decision-making and explored prior PrEP education as a potential buffer. After viewing a vignette about a PrEP-seeking MSM patient, participants reported anticipated patient behavior (condomless sex, extra-relational sex, and adherence), intention to prescribe PrEP to the patient, biases, and background characteristics. Minimal evidence for racism affecting clinical decision-making emerged. In unadjusted analyses, heterosexism indirectly affected prescribing intention via all anticipated behaviors, tested as parallel mediators. Participants expressing greater heterosexism more strongly anticipated increased risk behavior and adherence problems, which were associated with lower prescribing intention. The indirect effect via condomless sex remained significant adjusting for background characteristics. Prior PrEP education did not buffer any indirect effects. Heterosexism may compromise PrEP provision to MSM and should be addressed in PrEP-related medical education.

  20. Detection of significant protein coevolution.

    Science.gov (United States)

    Ochoa, David; Juan, David; Valencia, Alfonso; Pazos, Florencio

    2015-07-01

    The evolution of proteins cannot be fully understood without taking into account the coevolutionary linkages entangling them. From a practical point of view, coevolution between protein families has been used as a way of detecting protein interactions and functional relationships from genomic information. The most common approach to inferring protein coevolution involves the quantification of phylogenetic tree similarity using a family of methodologies termed mirrortree. In spite of their success, a fundamental problem of these approaches is the lack of an adequate statistical framework to assess the significance of a given coevolutionary score (tree similarity). As a consequence, a number of ad hoc filters and arbitrary thresholds are required in an attempt to obtain a final set of confident coevolutionary signals. In this work, we developed a method for associating confidence estimators (P values) to the tree-similarity scores, using a null model specifically designed for the tree comparison problem. We show how this approach largely improves the quality and coverage (number of pairs that can be evaluated) of the detected coevolution in all the stages of the mirrortree workflow, independently of the starting genomic information. This not only leads to a better understanding of protein coevolution and its biological implications, but also to obtain a highly reliable and comprehensive network of predicted interactions, as well as information on the substructure of macromolecular complexes using only genomic information. The software and datasets used in this work are freely available at: http://csbg.cnb.csic.es/pMT/. pazos@cnb.csic.es Supplementary data are available at Bioinformatics online. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  1. Comparing millennial and generation X medical students at one medical school.

    Science.gov (United States)

    Borges, Nicole J; Manuel, R Stephen; Elam, Carol L; Jones, Bonnie J

    2006-06-01

    Two main generational cohorts comprising students enrolled in medical schools today are Generation Xers (born 1965-1980) and Millennial students (born 1981-1999). A subset is Cuspars (born 1975-1980), who share traits with both generations. Population theorists ascribe different personal characteristics, attitudes, and preferences to each group. The authors examined whether selected characteristics describing Generation X and Millennial students were quantifiable using a personality measure. Differences among Generation X, Millennial, and Cuspar medical students were investigated. Eight hundred and nine medical students (399 females and 410 males) who matriculated between 1989-94 and 2001-04 at the Northeastern Ohio Universities College of Medicine completed the 16 Personality Factor Questionnaire (16PF). Differences in responses to the 16PF among the three generations were analyzed using multivariate analysis of variance (MANOVA). Analyses showed significant differences for Generation X versus Millennial students on 10 of the 16 personality factors. Millennial students scored significantly higher than Generation X students on factors including Rule-Consciousness, Emotional Stability, and Perfectionism; Generation X students scored higher than Millennials on Self-Reliance. Millennials also were significantly different from Generation Xers on several other factors. Significant differences were noted among Cuspars, Generation Xers, and Millennials. The 16PF is a useful tool to examine differences among these groups and to help understand the factors that constitute their personalities. Given differences among the generational groups, the authors forecast possible educational implications for medical school academic affairs and student services, and suggest areas for future research.

  2. The effect of teaching medical ethics on medical students' moral reasoning.

    Science.gov (United States)

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

    1989-12-01

    A study assessed the effect of incorporating medical ethics into the medical curriculum and the relative effects of two methods of implementing that curriculum, namely, lecture and case-study discussions. Results indicate a statistically significant increase (p less than or equal to .0001) in the level of moral reasoning of students exposed to the medical ethics course, regardless of format. Moreover, the unadjusted posttest scores indicated that the case-study method was significantly (p less than or equal to .03) more effective than the lecture method in increasing students' level of moral reasoning. When adjustment were made for the pretest scores, however, this difference was not statistically significant (p less than or equal to .18). Regression analysis by linear panel techniques revealed that age, gender, undergraduate grade-point average, and scores on the Medical College Admission Test were not related to the changes in moral-reasoning scores. All of the variance that could be explained was due to the students' being in one of the two experimental groups. In comparison with the control group, the change associated with each experimental format was statistically significant (lecture, p less than or equal to .004; case study, p less than or equal to .0001). Various explanations for these findings and their implications are given.

  3. Medical tourism.

    Science.gov (United States)

    Leggat, Peter

    2015-01-01

    Medical tourism is a burgeoning industry in our region. It involves patients travelling outside of their home country for medical treatment. This article provides an outline of the current research around medical tourism, especially its impact on Australians. Patients are increasingly seeking a variety of medical treatments abroad, particularly those involving cosmetic surgery and dental treatment, often in countries in South-East Asia. Adverse events may occur during medical treatment abroad, which raises medico-legal and insurance issues, as well as concerns regarding follow-up of patients. General practitioners need to be prepared to offer advice, including travel health advice, to patients seeking medical treatment abroad.

  4. "Knife before wife": an exploratory study of gender and the UK medical profession.

    Science.gov (United States)

    Miller, Karen; Clark, Donna

    2008-01-01

    The paper aims to explore the increasing feminisation of the medical profession and career progression of women in the medical profession. Furthermore, the paper explores the implications of gender segregation in the medical profession for health service provision. The paper presents an overview of studies in this area and draws upon primary, empirical research with medical practitioners and medical students. However, unlike most other studies the sample includes male and female participants. The research involved elite interviews and self-completion questionnaires in order to provide perspectives of both male and female medical practitioners and medical students. The findings are consistent with those of other studies; that gender discrimination and segregation is still prevalent in the medical profession. But there are significant differences in perceptions between the genders. Moreover, it is concluded that the gendered career structure and organisational culture of the health sector and medical profession create a role conflict between personal and professional lives. The current difficulties in reconciling this role conflict create barriers to the career progression of women in the medical profession. Further research in this area could include a longitudinal study of medical students and the impact of changes in the design of medical training and career structures to assess whether these changes enable female career progression in the medical profession. Further analysis is needed of gendered practices and career development in specific specialist areas, and the role of the medical profession, NHS and Royal Colleges should play in addressing gender and career progression in medicine. Gender segregation (vertical and horizontal) in the medical profession will have implications for the attraction, retention and increased shortages of practitioners in hospital and surgical specialities with the resultant economic and health provision inefficiencies. The paper

  5. Medical Management

    Science.gov (United States)

    ... org Close Charcot-Marie-Tooth Disease (CMT) Medical Management Although there’s no cure for CMT, there are ... individualized physical therapy program. For more on medical management of CMT, see Surgery Sometimes, Bracing Often, Caution ...

  6. Medical Identity

    DEFF Research Database (Denmark)

    Musaeus, Peter

    2015-01-01

    Purpose: To examine philosophical stances underpinning medical identity and assess the conceptual relationship between physician, medical practice and culture. Argument: Medical identity is about the ideals and moral positions that physicians take when justifying themselves. Medical identity...... hedonistic versus sentimentalist approaches to medical identity. The sociocultural philosophical analysis of medical identity can shed light on what it means conceptually for a physician to harbor beliefs associated with him/her being taken to be an autonomous professional. It is important because it touches...... on the meaning of being a compassionate, good and skilled physician, making its relevance to person-centered medicine self-evident. Conclusion: Medical identity should be analyzed with reference to literature, philosophy and medical practice in order for the physician to exercise a reflective position...

  7. [Medical negligence].

    Science.gov (United States)

    Zipper, St G

    2016-06-01

    Medical negligence is a matter of growing public interest. This review outlines various aspects of medical negligence: epidemiology, taxonomy, and the risks, causes, psychology, management and prevention of errors.

  8. Medical Illustration

    Science.gov (United States)

    ... as medical books, journals, magazines, pharma or biotech marketing, films, online video, exhibits, posters, wall charts, educational ... of the health career profession with strong communication skills, medical illustrators work closely with clients to interpret ...

  9. Learner-centred medical education: Improved learning or increased stress?

    Science.gov (United States)

    McLean, Michelle; Gibbs, Trevor J

    2009-12-01

    Globally, as medical education undergoes significant reform towards more "learner-centred" approaches, specific implications arise for medical educators and learners. Although this learner-centredness is grounded in educational theory, a point of discussion would be whether the application and practice of these new curricula alleviate or exacerbate student difficulties and levels of stress. This commentary will argue that while this reform in medical education is laudable, with positive implications for learning, medical educators may not have understood or perhaps not embraced "learner-centredness" in its entirety. During their training, medical students are expected to be "patient-centred". They are asked to apply a biopsychosocial model, which takes cognisance of all aspects of a patient's well-being. While many medical schools profess that their curricula reflect these principles, in reality, many may not always practice what they preach. Medical training all too often remains grounded in the biomedical model, with the cognitive domain overshadowing the psychosocial development and needs of learners. Entrusted by parents and society with the education and training of future healthcare professionals, medical education needs to move to a "learner-centred philosophy", in which the "whole" student is acknowledged. As undergraduate and post-graduate students increasingly apply their skills in an international arena, this learner-centredness should equally encapsulate the gender, cultural and religious diversity of both patients and students. Appropriate support structures, role models and faculty development are required to develop skills, attitudes and professional behaviour that will allow our graduates to become caring and sensitive healthcare providers.

  10. Quantitative Description of Medical Student Interest in Neurology and Psychiatry.

    Science.gov (United States)

    Ramos, Raddy L; Cuoco, Joshua A; Guercio, Erik; Levitan, Thomas

    2016-07-01

    Given the well-documented shortage of physicians in primary care and several other specialties, quantitative understanding of residency application and matching data among osteopathic and allopathic medical students has implications for predicting trends in the physician workforce. To estimate medical student interest in neurology and psychiatry based on numbers of applicants and matches to neurology and psychiatry osteopathic and allopathic residency programs. Also, to gauge students' previous academic experience with brain and cognitive sciences. The number of available postgraduate year 1 positions, applicants, and matches from graduating years 2011 through 2015 were collected from the National Matching Services Inc and the American Association of Colleges of Osteopathic Medicine for osteopathic programs and the National Resident Matching Program and the Association of American Medical Colleges for allopathic programs. To determine and compare osteopathic and allopathic medical students' interest in neurology and psychiatry, the number of positions, applicants, and matches were analyzed considering the number of total osteopathic and allopathic graduates in the given year using 2-tailed χ2 analyses with Yates correction. In addition, osteopathic and allopathic medical schools' websites were reviewed to determine whether neurology and psychiatry rotations were required. Osteopathic medical students' reported undergraduate majors were also gathered. Compared with allopathic medical students, osteopathic medical students had significantly greater interest (as measured by applicants) in neurology (χ21=11.85, Pneurology and psychiatry residency programs. Approximately 6% of osteopathic vs nearly 85% of allopathic medical schools had required neurology rotations. Nearly 10% of osteopathic applicants and matriculants had undergraduate coursework in brain and cognitive sciences. Osteopathic medical students demonstrated greater interest than allopathic medical

  11. Addressing Medical Errors in Hand Surgery

    OpenAIRE

    Johnson, Shepard P.; Adkinson, Joshua M.; Chung, Kevin C.

    2014-01-01

    Influential think-tank such as the Institute of Medicine has raised awareness about the implications of medical errors. In response, organizations, medical societies, and institutions have initiated programs to decrease the incidence and effects of these errors. Surgeons deal with the direct implications of adverse events involving patients. In addition to managing the physical consequences, they are confronted with ethical and social issues when caring for a harmed patient. Although there is...

  12. [Medical technology and medical education].

    Science.gov (United States)

    von Mallek, D; Biersack, H-J; Mull, R; Wilhelm, K; Heinz, B; Mellert, F

    2010-08-01

    The education of medical professionals is divided into medical studies, postgraduate training leading to the qualification as a specialist, and continuing professional development. During education, all scientific knowledge and practical skills are to be acquired, which enable the physician to practice responsibly in a specialized medical area. In the present article, relevant curricula are analyzed regarding the consideration of medical device-related topics, as the clinical application of medical technology has reached a central position in modern patient care. Due to the enormous scientific and technical progress, this area has become as important as pharmacotherapy. Our evaluation shows that medical device-related topics are currently underrepresented in the course of medical education and training and should be given greater consideration in all areas of medical education. Possible solutions are presented.

  13. EVA Physiology and Medical Considerations Working in the Suit

    Science.gov (United States)

    Parazynski, Scott

    2012-01-01

    This "EVA Physiology and Medical Considerations Working in the Suit" presentation covers several topics related to the medical implications and physiological effects of suited operations in space from the perspective of a physician with considerable first-hand Extravehicular Activity (EVA) experience. Key themes include EVA physiology working in a pressure suit in the vacuum of space, basic EVA life support and work support, Thermal Protection System (TPS) inspections and repairs, and discussions of the physical challenges of an EVA. Parazynski covers the common injuries and significant risks during EVAs, as well as physical training required to prepare for EVAs. He also shares overall suit physiological and medical knowledge with the next generation of Extravehicular Mobility Unit (EMU) system designers.

  14. Significance and survival of Enterococci during the house fly development.

    Science.gov (United States)

    Ghosh, Anuradha; Akhtar, Mastura; Holderman, Chris; Zurek, Ludek

    2014-01-01

    House flies are among the most important nonbiting insect pests of medical and veterinary importance. Larvae develop in decaying organic substrates and their survival strictly depends on an active microbial community. House flies have been implicated in the ecology and transmission of enterococci, including multi-antibiotic-resistant and virulent strains of Enterococcus faecalis. In this study, eight American Type Culture Collection type strains of enterococci including Enterococcus avium, Enterococcus casseliflavus, Enterococcus durans, Enterococcus hirae, Enterococcus mundtii, Enterococcus gallinarum, Enterococcusfaecalis, and Enterococcusfaecium were evaluated for their significance in the development of house flies from eggs to adults in bacterial feeding assays. Furthermore, the bacterial colonization of the gut of teneral flies as well as the importance of several virulence traits of E. faecalis in larval mortality was assessed. Overall survival of house flies (egg to adult) was significantly higher when grown with typically nonpathogenic enterococcal species such as E. hirae (76.0% survival), E. durans (64.0%), and E. avium (64.0%) compared with that with clinically important species E. faecalis (24.0%) and E. faecium (36.0%). However, no significant differences in survival of house fly larvae were detected when grown with E. faecalis strains carrying various virulence traits, including isogenic mutants of the human clinical isolate E. faecalis V583 with in-frame deletions of gelatinase, serine protease, and capsular polysaccharide serotype C. Enterococci were commonly detected in fly puparia (range: 75-100%; concentration: 103-105 CFU/puparium);however, the prevalence of enterococci in teneral flies varied greatly: from 25.0 (E. casseliflavus) to 89.5% (E. hirae). In conclusion, depending on the species, enterococci variably support house fly larval development and colonize the gut of teneral adults. The human pathogenic species, E. faecalis and E. faecium

  15. Difficulty eating and significant weight loss in joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type.

    Science.gov (United States)

    Baeza-Velasco, Carolina; Van den Bossche, Thomas; Grossin, Daniel; Hamonet, Claude

    2016-06-01

    Joint Hypermobility Syndrome, also known as Ehlers-Danlos Syndrome Hypermobility Type (JHS/EDS-HT), is a heritable disorder of connective tissue, common but poorly known by the medical community. Although generalized joint hypermobility and fragility of tissues have been described as core features, recent research highlights the multisystemic nature of JHS/EDS-HT, which presents with a wide range of articular and extra-articular symptoms. Among these, gastrointestinal problems, temporomandibular disorders, and smell and taste abnormalities are common among those affected, having significant implications for eating. The present work reviews the literature linking JHS/EDS-HT and eating problems. Two illustrative case reports, in which JHS/EDS-HT manifestations contribute to developing and maintaining disturbed eating behaviors and significant weight loss, are presented.

  16. Medical marijuana.

    OpenAIRE

    Marmor, J B

    1998-01-01

    Although many clinical studies suggest the medical utility of marijuana for some conditions, the scientific evidence is weak. Many patients in California are self-medicating with marijuana, and physicians need data to assess the risks and benefits. The only reasonable solution to this problem is to encourage research on the medical effects of marijuana. The current regulatory system should be modified to remove barriers to clinical research with marijuana. The NIH panel has identified several...

  17. Attitudes Toward Medical Cannabis Legalization Among Serbian Medical Students.

    Science.gov (United States)

    Vujcic, Isidora; Pavlovic, Aleksandar; Dubljanin, Eleonora; Maksimovic, Jadranka; Nikolic, Aleksandra; Sipetic-Grujicic, Sandra

    2017-07-29

    Currently, medical cannabis polices are experiencing rapid changes, and an increasing number of nations around the world legalize medical cannabis for certain groups of patients, including those in Serbia. To determine medical students' attitudes toward medical cannabis legalization and to examine the factors influencing their attitudes. Fourth-year medical students at the Faculty of Medicine, University of Belgrade, had participated in a cross-sectional study. Data were collected by an anonymous questionnaire. Overall, 63.4% students supported medical cannabis legalization, and only 20.8% supported its legalization for recreational use. Students who previously used marijuana (p medical cannabis legalization compared with students who never used them. Support for marijuana recreational use was also related to prior marijuana (p cancer (90.4%) and chronic pain (74.2%) were correctly reported approved medical indications by more than half the students. Students who supported medical cannabis legalization showed better knowledge about indications, in contrast to opponents for legalization who showed better knowledge about side effects. Beliefs that using medical cannabis is safe and has health benefits were correlated with support for legalization, and previous marijuana and alcohol use, while beliefs that medical cannabis poses health risks correlated most strongly with previous marijuana use. Conclusions/Importance: The medical students' attitudes toward medical cannabis legalization were significantly correlated with previous use of marijuana and alcohol, knowledge about medical indications and side effects, and their beliefs regarding medical cannabis health benefits and risks.

  18. Against medical ethics: a response to Cassell

    OpenAIRE

    Seedhouse, David

    1998-01-01

    This paper responds to Dr Cassell's request for a fuller explanation of my argument in the paper, Against medical ethics: a philosopher's view. A distinction is made between two accounts of ethics in general, and the philosophical basis of health work ethics is briefly stated. The implications of applying this understanding of ethics to medical education are discussed.

  19. Medical education: Changes and perspectives

    Science.gov (United States)

    Zhang, Qin; Lee, Liming; Gruppen, Larry D.; Ba, Denian

    2013-01-01

    As medical education undergoes significant internationalization, it is important for the medical education community to understand how different countries structure and provide medical education. This article highlights the current landscape of medical education in China, particularly the changes that have taken place in recent years. It also examines policies and offers suggestions about future strategies for medical education in China. Although many of these changes reflect international trends, Chinese medical education has seen unique transformations that reflect its particular culture and history. PMID:23631405

  20. Could patients' coughing have communicative significance?

    Science.gov (United States)

    Bailey, Julia V

    2008-01-01

    Medical discourse positions patients with coughs and colds negatively, so consulting health services with 'minor' respiratory illness is therefore more accountable than for other medical problems. Patients face dilemmas since they must persuade doctors of the doctorability of their illness without being seen as hypochondriacal, and they risk losing face if doctors decide that there is nothing much wrong. It is known that the placement of non-lexical features of talk such as laughing or crying can have interactional meaning. Using a data set of video-recorded doctor-patient cough and cold consultations, this study explores whether patients' coughing could have communicative significance. The study is a qualitative analysis of 33 consultations drawing on a constructionist, sociolinguistic analytic approach. Coughing is co-ordinated with talk rather than occurring randomly. Coughing helps patients to demonstrate the doctorability of their symptoms and to legitimize their claims for medical attention. Coughing is also associated with resistance to 'no problem' diagnoses, resulting in changes in the trajectory of talk (for example, soliciting more explanation from doctors and/or re-negotiation of doctors' investigation or treatment plans). Coughing is undoubtedly a manifestation of respiratory illness, but also has communicative significance in consultations for coughs and colds.

  1. Medical Terminology.

    Science.gov (United States)

    Mercer County Community Coll., Trenton, NJ.

    This document is one of a series of student workbooks developed for workplace skill development courses or workshops by Mercer County Community College (New Jersey) and its partners. Designed to help employees of medical establishments learn medical terminology, this course provides information on basic word structure, body parts, suffixes and…

  2. Significant variables associated with epilepsy

    International Nuclear Information System (INIS)

    Cheema, F.A.; Qayyum, K.; Ahmad, N.; Makhdoomi, A.; Safdar, A.; Asif, A.; Chaudhry, H.R.

    2003-01-01

    Objective: To study the characteristics of the epileptics and the risk factors contributing to the development of epilepsy. Results: Majority of the subjects were single (77.84%), 1st born among their siblings (25.95%), belonged to low social class (50.63%), and unemployed(25.31%). The major risk factors were family history of illness (23.52%) and positive medical problem around birth (12.66%). The presence of family history of illness, positive medical problem around birth and advanced maternal age at birth were associated with early onset of epilepsy. Vulnerability for the epilepsy also increases among hospital deliveries. Conclusion: Although the present study has identified various risk factors, yet the results need to be further confirmed through case-control studies. (author)

  3. Medical Rituals and Media Rituals

    Directory of Open Access Journals (Sweden)

    Zoltán Zsinkó-Szabó

    2013-01-01

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

  4. A Quantitative Study of Empathy in Pakistani Medical Students: A Multicentered Approach.

    Science.gov (United States)

    Tariq, Nabia; Rasheed, Tariq; Tavakol, Mohsen

    2017-10-01

    To examine the empathy level of undergraduate medical students in Pakistan. Three hypotheses are developed based on the literature review. (1) Female medical students have a higher level of empathy than do male students. (2) Empathy scores vary during the medical school years in Pakistani students. (3) Medical students interested in people-oriented specialties would score higher than the students interested in technology-oriented specialties. This is a quantitative inquiry approach using a cross-sectional design of 1453 students from 8 Pakistani medical schools, both private and state. The sample consists of 41.1% (n = 597) male students and 58.9% (n = 856) female students. Empirical data are collected using the Jefferson Scale of Physician Empathy (JSPE), a well-validated self-administered questionnaire. The mean empathy score among students is 4.77 with a standard deviation of 0.72. The results show that there is no statistically significant association between the empathy scores and gender, t(1342.36) = -0.053, P = .95). There is a statistically significant difference between the empathy scores and the years of medical school, F(14, 1448) = 4.95, P = .01. Concerning the specialty interests, there is no statistically significant difference between the empathy score and specialty interests. The findings of this study showed that in Western countries, medical students performed better than Pakistani medical students on the empathy scale. This finding has important implications for Pakistani medical educators to improve the interpersonal skills of medical students in the context of patient care. Inconsistent with our expectations and experiences, our findings do not support that female medical students scored better than their male counterparts on the empathy scale. Because of the nature of a cross-sectional study, it is impossible to argue the decline of empathy during medical school training.

  5. Self‐medication patterns among medical students in South India

    Directory of Open Access Journals (Sweden)

    Nitasha Bhat

    2012-04-01

    Full Text Available BackgroundSelf-medication results in wastage of resources, increases resistance of pathogens and generally causes serious health hazards such as adverse drug reactions, prolonged suffering and drug dependence. This study was undertaken to determine the reasons for self-medication and the pattern of self-medication among medical students.MethodThis cross-sectional descriptive study was conducted at the K.S. Hegde Medical Academy, Mangalore. The participants were medical students from first to final year. Medical students were selected through convenience sampling. The data was collected using a pre-tested semi-structured questionnaire. The data was analysed using SPSS version 16 and the results expressed as proportions.ResultsA total of 200 students, 121 (60.5% female and 79 (39.5% male, were included in the study. Of the medical students surveyed, self-medication was reported among 92%. The respondents who used self-medication found it to be time-saving in providing relief from minor ailments. The most common ailments for which self-medication were used were: the common cold (69%, fever (63% and headache (60%. The students consulted their textbooks (39% and seniors or classmates (38% for the medications. Antipyretics (71%, analgesics (65%, antihistamines (37% and antibiotics (34% were the most common self-medicated drugs. Of the respondents, 33% were unaware of the adverse effects of the medication and 5% had experienced adverse reactions. The majority (64% of students advised medications to others, more often to family and friends.ConclusionThe prevalence of self-medication among medical students is high, facilitated by the easy availability of drugs and information from textbooks or seniors. A significant number of students are unaware of the adverse effects of the medication that they themselves take and suggest to others. Therefore, potential problems of self-medication should be emphasised to the students.

  6. Medical instruments in museums

    DEFF Research Database (Denmark)

    Söderqvist, Thomas; Arnold, Ken

    2011-01-01

    This essay proposes that our understanding of medical instruments might benefit from adding a more forthright concern with their immediate presence to the current historical focus on simply decoding their meanings and context. This approach is applied to the intriguingly tricky question of what...... actually is meant by a "medical instrument." It is suggested that a pragmatic part of the answer might lie simply in reconsidering the holdings of medical museums, where the significance of the physical actuality of instruments comes readily to hand....

  7. Medical exposures. Annex G

    International Nuclear Information System (INIS)

    1982-01-01

    This Annex examines medical irradiation of the human body done in the course of diagnostic x ray procedures, in diagnostic nuclear medicine by internally administered radionuclides, and in radiation therapy. Doses to patients from various medical procedures have been assessed, both in order to follow trends and to make it possible to see which procedures are most significant with regard to possible radiation risks. This Annex also presents data on the distribution of doses among irradiated persons.

  8. A Qualitative Study of Medical Mistrust, Perceived Discrimination, and Risk Behavior Disclosure to Clinicians by U.S. Male Sex Workers and Other Men Who Have Sex with Men: Implications for Biomedical HIV Prevention.

    Science.gov (United States)

    Underhill, Kristen; Morrow, Kathleen M; Colleran, Christopher; Holcomb, Richard; Calabrese, Sarah K; Operario, Don; Galárraga, Omar; Mayer, Kenneth H

    2015-08-01

    Access to biomedical HIV prevention technologies such as pre-exposure prophylaxis (PrEP) requires individuals to disclose risk behavior to clinicians, but experiences of discrimination and medical mistrust may limit disclosure among male sex workers and other MSM. We explored experiences of perceived discrimination, medical mistrust, and behavior disclosure among male sex workers compared to other men who have sex with men (MSM). We conducted 56 interviews with MSM and compared findings about medical mistrust, discrimination, and disclosure for 31 men who engaged in sex work vs. 25 men who did not. MSM who engaged in sex work reported more medical mistrust and healthcare discrimination due to issues beyond MSM behavior/identity (e.g., homelessness, substance use, poverty). MSM who did not report sex work described disclosing sex with men to clinicians more often. Both subgroups reported low PrEP awareness, but willingness to disclose behavior to obtain PrEP. Medical mistrust and perceived discrimination create barriers for sexual behavior disclosure to clinicians, potentially impeding access to PrEP and other forms of biomedical HIV prevention. These barriers may be higher among male sex workers compared to other MSM, given overlapping stigmas including sex work, substance use, homelessness, and poverty. An intersectionality framework for understanding multiple stigmas can help to identify how these dynamics may limit access to biomedical HIV prevention among male sex workers, as well as suggesting strategies for addressing stigmas to improve the delivery of PrEP and other HIV prevention approaches in this population.

  9. What do we know about medical tourism? A review of the literature with discussion of its implications for the UK National Health Service as an example of a public health care system.

    Science.gov (United States)

    Hanefeld, Johanna; Smith, Richard; Horsfall, Daniel; Lunt, Neil

    2014-01-01

    Medical tourism is a growing phenomenon. This review of the literature maps current knowledge and discusses findings with reference to the UK National Health Service (NHS). Databases were systematically searched between September 2011 and March 2012 and 100 papers were selected for review. The literature shows specific types of tourism depending on treatment, eg, dentistry, cosmetic, or fertility. Patient motivation is complex and while further research is needed, factors beyond cost, including availability and distance, are clearly important. The provision of medical tourism varies. Volume of patient travel, economic cost and benefit were established for 13 countries. It highlights contributions not only to recipient countries' economies but also to a possible growth in health systems' inequities. Evidence suggests that UK patients travel abroad to receive treatment, complications arise and are treated by the NHS, indicating costs from medical travel for originating health systems. It demonstrates the importance of quality standards and holds lessons as the UK and other EU countries implement the EU Directive on cross-border care. Lifting the private-patient-cap for NHS hospitals increases potential for growth in inbound medical tourism; yet no research exists on this. Research is required on volume, cost, patient motivation, industry, and on long-term health outcomes in medical tourists. © 2014 International Society of Travel Medicine.

  10. The Establishment and operation of Longjing Medical College - The History of Longjing Medical College as Frontier History: Focusing on its ‘Disconnection’ and ‘Continuity’ -

    Directory of Open Access Journals (Sweden)

    Mira MOON

    2017-08-01

    Government of Jirinsheng(吉林省政府 which were the administrative institution by the Chinese Communist Party in turns. In the end, Longjing Medical College was reorganized into the Medical Department of Dongbei Junzheng Daxue Jilin Fenxiao (1947. 3 and the first branch of the Chinese Medical College (1948. 1, a medical education institution focused on nurturing the medical personnel required for the Chinese Civil War. In January 1949, the first branch moved to Harbin, merged with the second branch there, and was transformed into Harbin Medical College. Afterwards, the Yanbian Koreans played a major role to establish Yanbian Medical College in a basis of the teachers and buildings left by the moving-out of the first branch(1948. 10. 1. Now, Yanbian Medical College is the official body of Yanbian University Medical Center. Longjing Medical College, which has such a complicated history, is partially ‘disconnected’ from the Yanbian medical educational institutions in the post-war era in terms of its possession, operation objective, and academic system. However, many of the early members of the Longjing Medical College were not only teachers and students of the Longjing Exploitation Medical School, but also a few of them continued to teach at the Medical Department of Dongbei Junzheng Daxue Jilin Fenxiao, the first branch of the Chinese Medical College, and Yanbian Medical College. Particularly, several members actively participated in the establishment of each school or in the position of the top leader of the school. Also, all the medical education institutions referred to above used the building and facilities of Longjing Exploitation Medical School until the period of Yanbian Medical College. As such, the history of Longjing Medical College as frontier history, gives us a difficult, but significant question on the meanings of ‘disconnection’ and ‘continuity’ in history and their implications.

  11. Cardiac Medications

    Science.gov (United States)

    ... cholesterol from circulating in the blood. Watch an animation of how statins work. Reason for Medication Used ... Kindle Fire Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

  12. Medication Guide

    Science.gov (United States)

    ... Size Small Text Medium Text Large Text Contrast Dark on Light Light on Dark Donate Search Menu Donate What is Glaucoma? Care ... Low Vision Resources Medication Guide Resources on the Web » See All Articles Where the Money Goes Have ...

  13. Medical Cyclotrons

    Science.gov (United States)

    Friesel, D. L.; Antaya, T. A.

    Particle accelerators were initially developed to address specific scientific research goals, yet they were used for practical applications, particularly medical applications, within a few years of their invention. The cyclotron's potential for producing beams for cancer therapy and medical radioisotope production was realized with the early Lawrence cyclotrons and has continued with their more technically advanced successors — synchrocyclotrons, sector-focused cyclotrons and superconducting cyclotrons. While a variety of other accelerator technologies were developed to achieve today's high energy particles, this article will chronicle the development of one type of accelerator — the cyclotron, and its medical applications. These medical and industrial applications eventually led to the commercial manufacture of both small and large cyclotrons and facilities specifically designed for applications other than scientific research.

  14. Medical imaging

    International Nuclear Information System (INIS)

    Loshkajian, A.

    2000-01-01

    This didactical book presents the medical imaging techniques: radiography, scanner, nuclear magnetic resonance (NMR). Examples are given for the most common pathologies in all domains of medicine. (J.S.)

  15. Medical Imaging.

    Science.gov (United States)

    Barker, M. C. J.

    1996-01-01

    Discusses four main types of medical imaging (x-ray, radionuclide, ultrasound, and magnetic resonance) and considers their relative merits. Describes important recent and possible future developments in image processing. (Author/MKR)

  16. MEDICAL STAFF SCHEDULING USING SIMULATED ANNEALING

    Directory of Open Access Journals (Sweden)

    Ladislav Rosocha

    2015-07-01

    Full Text Available Purpose: The efficiency of medical staff is a fundamental feature of healthcare facilities quality. Therefore the better implementation of their preferences into the scheduling problem might not only rise the work-life balance of doctors and nurses, but also may result into better patient care. This paper focuses on optimization of medical staff preferences considering the scheduling problem.Methodology/Approach: We propose a medical staff scheduling algorithm based on simulated annealing, a well-known method from statistical thermodynamics. We define hard constraints, which are linked to legal and working regulations, and minimize the violations of soft constraints, which are related to the quality of work, psychic, and work-life balance of staff.Findings: On a sample of 60 physicians and nurses from gynecology department we generated monthly schedules and optimized their preferences in terms of soft constraints. Our results indicate that the final value of objective function optimized by proposed algorithm is more than 18-times better in violations of soft constraints than initially generated random schedule that satisfied hard constraints.Research Limitation/implication: Even though the global optimality of final outcome is not guaranteed, desirable solutionwas obtained in reasonable time. Originality/Value of paper: We show that designed algorithm is able to successfully generate schedules regarding hard and soft constraints. Moreover, presented method is significantly faster than standard schedule generation and is able to effectively reschedule due to the local neighborhood search characteristics of simulated annealing.

  17. Medical education.

    Science.gov (United States)

    Krishnan, P

    1992-01-01

    In theory, the Medical Council of India (MCI) determines the standards and qualifications of medical schools. It also sanctions curricula and ensures standards. Yet no standards exist on the mode of selection in medical schools, duration of study, course content, student stipends or period of internship. It takes 4.5 years to finish medical school. Students undergo preclinical, paraclinical, and clinical training. Most courses are in English which tends to favor the urban elite. Students cannot always communicate with patients in local languages. Textbooks often provide medical examples unrelated to India. Pedagogy consists mainly of lectures and rote learning predominates. Curricula tend not to provide courses in community health. Students pick up on the elitist attitudes of the faculty. For example, faculty do not put much emphasis on community health, individual health, equity in health care delivery, and teamwork. Further the education system is not patient oriented, but hospital or disease oriented. Faculty should train students in creating sanitation programs, knowing local nutritious foods, and in making community diagnoses. Yet they tend to be practitioners 1st then educators. Further faculty are not paid well and are not always invited to take part in improving curriculum, so morale is often low. Moreover experience in health planning and management issues is not required for administrators. In addition, medical schools are not well equipped with learning aids, libraries, or teaching staff. Tax revenues finance medical education. 75% of graduating physicians set up a private practice. Further many physicians go to urban areas. 34-57% emigrate to other countries. The problems of medical education will not be solved until the political and economic system becomes more responsive to the health needs of the people.

  18. Medical tourism

    OpenAIRE

    Abbas Ghanbari; Khadijeh Zirak Moradlu; Morteza Ramazani

    2014-01-01

    Medical tourism is considered as one of the tourism dimensions and it can contribute to the stabilized and dynamic development of a country's economy. Since it is cost-effective industry, most developing countries have focused on this industry and they are planning to develop this industry. Not only does Zanjan province, as the central region in medicine services, enjoy different kinds of variety and acceptable medical specialties but also it has historical, natural, and religious tourism pot...

  19. Medical Applications

    OpenAIRE

    Biscari, C.; Falbo, L.

    2016-01-01

    The use of accelerators for medical applications has evolved from initial experimentation to turn-key devices commonly operating in hospitals. New applications are continuously being developed around the world, and the hadrontherapy facilities of the newest generation are placed at the frontier between industrial production and advanced R&D. An introduction to the different medical application accelerators is followed by a description of the hadrontherapy facilities, with special emphasis on ...

  20. Medical radiation

    International Nuclear Information System (INIS)

    1992-01-01

    This leaflet in the At-a-Glance Series describes the medical use of X-rays, how X-rays help in diagnosis, radiation protection of the patient, staff protection, how radioactive materials in nuclear medicine examinations help in diagnosis and the use of radiation in radiotherapy. Magnetic resonance imaging, a diagnostic technique involving no ionizing radiation, is also briefly examined. The role of the NRPB in the medical use of radiation is outlined. (UK)

  1. Medical negligence.

    OpenAIRE

    Rosen, M.

    1992-01-01

    The progress made in diagnostic and therapeutic medicine has resulted in an increase in the number of malpractice suits brought against medical practitioners. To constitute negligence it must be shown that the conduct of the accused did not measure up to the standard of care the law required of him in the particular circumstances and that he acted with guilt and therefore can be blamed for the deed. This paper describes medical practitioner negligence and reviews relevant cases.

  2. A randomized trial comparing in person and electronic interventions for improving adherence to oral medications in schizophrenia.

    Science.gov (United States)

    Velligan, Dawn; Mintz, Jim; Maples, Natalie; Xueying, Li; Gajewski, Stephanie; Carr, Heather; Sierra, Cynthia

    2013-09-01

    Poor adherence to medication leads to symptom exacerbation and interferes with the recovery process for patients with schizophrenia. Following baseline assessment, 142 patients in medication maintenance at a community mental health center were randomized to one of 3 treatments for 9 months: (1) PharmCAT, supports including pill containers, signs, alarms, checklists and the organization of belongings established in weekly home visits from a PharmCAT therapist; (2) Med-eMonitor (MM), an electronic medication monitor that prompts use of medication, cues the taking of medication, warns patients when they are taking the wrong medication or taking it at the wrong time, record complaints, and, through modem hookup, alerts treatment staff of failures to take medication as prescribed; (3) Treatment as Usual (TAU). All patients received the Med-eMonitor device to record medication adherence. The device was programmed for intervention only in the MM group. Data on symptoms, global functioning, and contact with emergency services and police were obtained every 3 months. Repeated measures analyses of variance for mixed models indicated that adherence to medication was significantly better in both active conditions than in TAU (both p<0.0001). Adherence in active treatments ranged from 90-92% compared to 73% in TAU based on electronic monitoring. In-person and electronic interventions significantly improved adherence to medication, but that did not translate to improved clinical outcomes. Implications for treatment and health care costs are discussed.

  3. Prognostic significance of diagnostic laparoscopy for spontaneous fertility

    NARCIS (Netherlands)

    Mol, B. W.; Swart, P.; Bossuyt, P. M.; van der Veen, F.

    1999-01-01

    OBJECTIVE: To determine the prognostic significance of laparoscopy results for fertility outcome. STUDY DESIGN: Consecutive patients undergoing hysterosalpingography and laparoscopy for subfertility in our department between May 1985 and November 1987 were identified from medical records. The impact

  4. Selenium: environmental significance, pollution, and biological treatment technologies.

    Science.gov (United States)

    Tan, Lea Chua; Nancharaiah, Yarlagadda V; van Hullebusch, Eric D; Lens, Piet N L

    2016-01-01

    Selenium is an essential trace element needed for all living organisms. Despite its essentiality, selenium is a potential toxic element to natural ecosystems due to its bioaccumulation potential. Though selenium is found naturally in the earth's crust, especially in carbonate rocks and volcanic and sedimentary soils, about 40% of the selenium emissions to atmospheric and aquatic environments are caused by various industrial activities such as mining-related operations. In recent years, advances in water quality and pollution monitoring have shown that selenium is a contaminant of potential environmental concern. This has practical implications on industry to achieve the stringent selenium regulatory discharge limit of 5μgSeL(-1) for selenium containing wastewaters set by the United States Environmental Protection Agency. Over the last few decades, various technologies have been developed for the treatment of selenium-containing wastewaters. Biological selenium reduction has emerged as the leading technology for removing selenium from wastewaters since it offers a cheaper alternative compared to physico-chemical treatments and is suitable for treating dilute and variable selenium-laden wastewaters. Moreover, biological treatment has the advantage of forming elemental selenium nanospheres which exhibit unique optical and spectral properties for various industrial applications, i.e. medical, electrical, and manufacturing processes. However, despite the advances in biotechnology employing selenium reduction, there are still several challenges, particularly in achieving stringent discharge limits, the long-term stability of biogenic selenium and predicting the fate of bioreduced selenium in the environment. This review highlights the significance of selenium in the environment, health, and industry and biotechnological advances made in the treatment of selenium contaminated wastewaters. The challenges and future perspectives are overviewed considering recent

  5. Evaluation of Self Medication Amongst Nursing Students of Bastar Region: A Questionnaire Based Study

    Directory of Open Access Journals (Sweden)

    Syed Sajid Ali

    2015-07-01

    Full Text Available  Self-medication provides low cost alternative for expensive medical management but inappropriate use can cause problems. For Nursing undergraduates such practice has special significance since they have medical knowledge but very superficial and also its application is limited.  Hence the present study was planned to evaluate the status of students studying in different years of B.Sc. Nursing.To determine the prevalence, attitude and knowledge of self medication amongst the students of Government Nursing College, Jagdalpur(ChhatisgarhThis questionnaire based study was performed on 142 Nursing students of 1st, 2nd and 3rd year aged between17-24 years. Mean age was found to be 20.5 years (±2.5years. A prevalidated questionnaire was distributed amongst the participants after explaining the purpose of the study and taking informed consent. The results obtained from this study showed that out of 142 students 120 (84.50 % students used self medicationCommonest source of information for self medication were seniors and colleagues 40(33.33%, and the most common indication for self medication was common cold 41(34.16 %.D’cold Total 49(40.83% was the most common medication used as self medication .Only 16 (13.33% students were having the knowledge about content, dose, duration of therapy and adverse drug reaction of the medication that they used. The most common source to obtain medicines for self medication was pharmaceutical store 80 (66.67 %.The findings from this study highlights the striking prevalence of self medication among nursing students, the lack of knowledge and the risks associated with them. We recommend that a global approach must be taken to prevent this problem from escalating which would involve awareness and education regarding the implications of self medication, strategies to prevent the supply of medicines without prescription by pharmacies and strict rules regarding pharmaceutical advertising.

  6. Virtue in Medical Practice: An Exploratory Study.

    Science.gov (United States)

    Kotzee, Ben; Ignatowicz, Agnieszka; Thomas, Hywel

    2017-03-01

    Virtue ethics has long provided fruitful resources for the study of issues in medical ethics. In particular, study of the moral virtues of the good doctor-like kindness, fairness and good judgement-have provided insights into the nature of medical professionalism and the ethical demands on the medical practitioner as a moral person. Today, a substantial literature exists exploring the virtues in medical practice and many commentators advocate an emphasis on the inculcation of the virtues of good medical practice in medical education and throughout the medical career. However, until very recently, no empirical studies have attempted to investigate which virtues, in particular, medical doctors and medical students tend to have or not to have, nor how these virtues influence how they think about or practise medicine. The question of what virtuous medical practice is, is vast and, as we have written elsewhere, the question of how to study doctors' moral character is fraught with difficulty. In this paper, we report the results of a first-of-a-kind study that attempted to explore these issues at three medical schools (and associated practice regions) in the United Kingdom. We identify which character traits are important in the good doctor in the opinion of medical students and doctors and identify which virtues they say of themselves they possess and do not possess. Moreover, we identify how thinking about the virtues contributes to doctors' and medical students' thinking about common moral dilemmas in medicine. In ending, we remark on the implications for medical education.

  7. Medical tourism

    Directory of Open Access Journals (Sweden)

    Abbas Ghanbari

    2014-08-01

    Full Text Available Medical tourism is considered as one of the tourism dimensions and it can contribute to the stabilized and dynamic development of a country's economy. Since it is cost-effective industry, most developing countries have focused on this industry and they are planning to develop this industry. Not only does Zanjan province, as the central region in medicine services, enjoy different kinds of variety and acceptable medical specialties but also it has historical, natural, and religious tourism potentials. In this survey, the researcher investigated the existing potentials of Zanjan province based on descriptive - analytical tourism in offering and providing medical services and accommodation. The survey reports that offered services in tourism were not acceptable and satisfactory.

  8. Historical Significant Volcanic Eruption Locations

    Data.gov (United States)

    Department of Homeland Security — A significant eruption is classified as one that meets at least one of the following criteriacaused fatalities, caused moderate damage (approximately $1 million or...

  9. Disseminating relevant health information to underserved audiences: implications of the Digital Divide Pilot Projects*

    Science.gov (United States)

    Kreps, Gary L.

    2005-01-01

    Objective: This paper examines the influence of the digital divide on disparities in health outcomes for vulnerable populations, identifying implications for medical and public libraries. Method: The paper describes the results of the Digital Divide Pilot Projects demonstration research programs funded by the National Cancer Institute to test new strategies for disseminating relevant health information to underserved and at-risk audiences. Results: The Digital Divide Pilot Projects field-tested innovative systemic strategies for helping underserved populations access and utilize relevant health information to make informed health-related decisions about seeking appropriate health care and support, resisting avoidable and significant health risks, and promoting their own health. Implications: The paper builds on the Digital Divide Pilot Projects by identifying implications for developing health communication strategies that libraries can adopt to provide digital health information to vulnerable populations. PMID:16239960

  10. The Effects of Medical Marijuana Laws on Potency

    Science.gov (United States)

    Pacula, Rosalie Liccardo; Heaton, Paul

    2014-01-01

    Background Marijuana potency has risen dramatically over the past two decades. In the United States, it is unclear whether state medical marijuana policies have contributed to this increase. Methods Employing a differences-in-differences model within a mediation framework, we analyzed data on n = 39,157 marijuana samples seized by law enforcement in 51 U.S. jurisdictions between 1990-2010, producing estimates of the direct and indirect effects of state medical marijuana laws on potency, as measured by Δ9-tetrahydrocannabinol content. Results We found evidence that potency increased by a half percentage point on average after legalization of medical marijuana, although this result was not significant. When we examined specific medical marijuana supply provisions, results suggest that legal allowances for retail dispensaries had the strongest influence, significantly increasing potency by about one percentage point on average. Our mediation analyses examining the mechanisms through which medical marijuana laws influence potency found no evidence of direct regulatory impact. Rather, the results suggest that the impact of these laws occurs predominantly through a compositional shift in the share of the market captured by high-potency sinsemilla. Conclusion Our findings have important implications for policymakers and those in the scientific community trying to understand the extent to which greater availability of higher potency marijuana increases the risk of negative public health outcomes, such as drugged driving and drug-induced psychoses. Future work should reconsider the impact of medical marijuana laws on health outcomes in light of dramatic and ongoing shifts in both marijuana potency and the medical marijuana policy environment. PMID:24502887

  11. Characteristics of mentoring relationships formed by medical students and faculty

    Science.gov (United States)

    Dimitriadis, Konstantinos; von der Borch, Philip; Störmann, Sylvère; Meinel, Felix G.; Moder, Stefan; Reincke, Martin; Fischer, Martin R.

    2012-01-01

    Background Little is known about the characteristics of mentoring relationships formed between faculty and medical students. Individual mentoring relationships of clinical medical students at Munich Medical School were characterized quantitatively and qualitatively. Methods All students signing up for the mentoring program responded to a questionnaire on their expectations (n = 534). Mentees were asked to give feedback after each of their one-on-one meetings (n = 203). A detailed analysis of the overall mentoring process and its characteristics was performed. For qualitative text analysis, free-text items were analyzed and categorized by two investigators. Quantitative analysis was performed using descriptive statistics and Wilcoxon-test to assess differences in grades between students with and without mentors. Results High-performing students were significantly more likely to participate in the mentoring program (pmentors as counselors (88.9%), providers of ideas (85.0%), and role models (73.3%). Mentees emphasized the positive impact of the mentoring relationship on career planning (77.2%) and research (75.0%). Conclusions Medical students with strong academic performance as defined by their grades are more likely to participate in formal mentoring programs. Mentoring relationships between faculty and medical students are perceived as a mutually satisfying and effective instrument for key issues in medical students’ professional development. Practical implications Mentoring relationships are a highly effective means of enhancing the bidirectional flow of information between faculty and medical students. A mentoring program can thus establish a feedback loop enabling the educational institution to swiftly identify and address issues of medical students. PMID:22989620

  12. Effects on populations of exposure to low levels of ionizing radiation: implications for nuclear energy and medical radiation. The 1979 report of the Advisory Committee on the Biological Effects of Ionizing Radiation (The BEIR Report)

    International Nuclear Information System (INIS)

    Fabrikant, J.I.

    1979-04-01

    The following aspects of the 1979 BEIR report are described: societal decision-making; nuclear energy needs and medical care services; epidemiological and experimental studies; public acceptance; concept of risks to health; risk estimates and cost-benefit analysis; and comparison of risks. Other topics discussed are as follows: need for advisory committees on radiation; value of the BEIR report; health effects of low levels of ionizing radiation; determination of radiation risk estimates; and quantitation of radioinduced cancer risk estimates

  13. Medical Applications

    CERN Document Server

    Biscari, C.

    2014-12-19

    The use of accelerators for medical applications has evolved from initial experimentation to turn-key devices commonly operating in hospitals. New applications are continuously being developed around the world, and the hadrontherapy facilities of the newest generation are placed at the frontier between industrial production and advanced R&D. An introduction to the different medical application accelerators is followed by a description of the hadrontherapy facilities, with special emphasis on CNAO, and the report closes with a brief outlook on the future of this field.

  14. Medical Applications

    International Nuclear Information System (INIS)

    Biscari, C; Falbo, L

    2014-01-01

    The use of accelerators for medical applications has evolved from initial experimentation to turn-key devices commonly operating in hospitals. New applications are continuously being developed around the world, and the hadrontherapy facilities of the newest generation are placed at the frontier between industrial production and advanced R&D. An introduction to the different medical application accelerators is followed by a description of the hadrontherapy facilities, with special emphasis on CNAO, and the report closes with a brief outlook on the future of this field

  15. Medical emplotment

    DEFF Research Database (Denmark)

    Mønsted, Troels Sune

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

  16. Misconceiving medical leadership.

    Science.gov (United States)

    Parker, Malcolm

    2013-01-01

    Medical leadership and leadership education have recently emerged as subjects of an expanding though as yet uncritical literature. Considerable attention is being given to the development of courses and electives, together with some proposals for generalizing these offerings to all medical students and doctors. This article briefly sketches this development and its derivation from business and corporate leadership models and accompanying literature, and subjects its adoption by medicine to critical scrutiny. Putative motivations for these developments are discussed, and an alternative explanation is offered, tied to the loss of physician status. The nature of leadership as complex, emergent, and unpredictable has been ignored in the promotion of medical leadership and leadership training, and this is reflected in the false assumption that leadership in medicine is something that can be taught. Although the leadership literature is beginning to recognize these complex aspects of leadership, so far their implications have not been acknowledged. This article aims to stimulate further analytic discussion of this under-theorized aspect of medicine.

  17. Significance evaluation in factor graphs

    DEFF Research Database (Denmark)

    Madsen, Tobias; Hobolth, Asger; Jensen, Jens Ledet

    2017-01-01

    in genomics and the multiple-testing issues accompanying them, accurate significance evaluation is of great importance. We here address the problem of evaluating statistical significance of observations from factor graph models. Results Two novel numerical approximations for evaluation of statistical...... significance are presented. First a method using importance sampling. Second a saddlepoint approximation based method. We develop algorithms to efficiently compute the approximations and compare them to naive sampling and the normal approximation. The individual merits of the methods are analysed both from....... Conclusions The applicability of saddlepoint approximation and importance sampling is demonstrated on known models in the factor graph framework. Using the two methods we can substantially improve computational cost without compromising accuracy. This contribution allows analyses of large datasets...

  18. Significant Lactic Acidosis from Albuterol

    Directory of Open Access Journals (Sweden)

    Deborah Diercks

    2018-03-01

    Full Text Available Lactic acidosis is a clinical entity that demands rapid assessment and treatment to prevent significant morbidity and mortality. With increased lactate use across many clinical scenarios, lactate values themselves cannot be interpreted apart from their appropriate clinical picture. The significance of Type B lactic acidosis is likely understated in the emergency department (ED. Given the mortality that sepsis confers, a serum lactate is an important screening study. That said, it is with extreme caution that we should interpret and react to the resultant elevated value. We report a patient with a significant lactic acidosis. Though he had a high lactate value, he did not require aggressive resuscitation. A different classification scheme for lactic acidosis that focuses on the bifurcation of the “dangerous” and “not dangerous” causes of lactic acidosis may be of benefit. In addition, this case is demonstrative of the potential overuse of lactates in the ED.

  19. Medical negligence

    African Journals Online (AJOL)

    Enrique

    19. SA JOURNAL OF RADIOLOGY • August 2004. Abstract. The progress made in diagnostic and therapeutic medicine has resulted in an increase in the number of malprac- tice suits brought against medical practitioners. To constitute negligence it must be shown that the conduct of the accused did not measure up to the.

  20. Medical Devices

    NARCIS (Netherlands)

    Verkerke, Gijsbertus Jacob; Mahieu, H.F.; Geertsema, A.A.; Hermann, I.F.; van Horn, J.R.; Hummel, J. Marjan; van Loon, J.P.; Mihaylov, D.; van der Plaats, A.; Schraffordt Koops, H.; Schutte, H.K.; Veth, R.P.H.; de Vries, M.P.; Rakhorst, G.; Shi, Donglu

    2004-01-01

    The development of new medical devices is a very time-consuming and costly process. Besides the time between the initial idea and the time that manufacturing and testing of prototypes takes place, the time needed for the development of production facilities, production of test series, marketing,

  1. Medical Malpractice

    DEFF Research Database (Denmark)

    Grembi, Veronica

    2014-01-01

    MM first came to the attention of policy makers primarily in the USA where, from the 1970s, healthcare providers denounced problems in getting insurance for medical liability, pointing out to a crisis in the MM insurance market (Sage WM (2003) Understanding the first malpractice crisis of the 21th...

  2. Medical marijuana

    Science.gov (United States)

    ... different amounts of cannabinoids. This sometimes makes the effects of medical marijuana hard to predict or control. The effects also ... wasting syndrome) Severe muscle spasms Multiple sclerosis Side Effects ... physical symptoms from using marijuana include: A fast or irregular heartbeat Dizziness Slow ...

  3. [Medical geography].

    Science.gov (United States)

    Hauri, D

    2007-10-17

    Hippocrates already noted that geographical factors such as climate, relief, geology but also settlement patterns had influenced the distribution of diseases. The task of medical geography is to investigate the associations between geographical factors and diseases. Thereby, geographic techniques and concepts are applied on health problems. Of particular importance is the mapping of diseases whose causes are environmental-related. In addition, epidemiological, ecological but also social scientific studies play an important part in the investigation of the associations between geographical factors and diseases. In order to understand the associations between the spatial distribution of diseases and environmental exposures, geographic information systems as well as statistical analyses have recently become more important. Some authors regard medical geography merely as supporting discipline of medicine. Nevertheless, as men and environment future and as they play an important part in the diffusion of diseases being regarded as defeated, medical geography will play an important part concerning medical questions. Especially travel medicine will rely on geographic knowledge, if a patient has to be consulted who plans to travel to an unknown country of which knowledge on the geographical distribution and ecology of diseases will be necessary.

  4. Formalising medical quality indicators to improve guidelines

    NARCIS (Netherlands)

    Van Gendt, Marjolein; Ten Teije, Annette; Serban, Radu; Van Harmelen, Frank

    2005-01-01

    Medical guidelines can significantly improve quality of medical care and reduce costs. But how do we get sound and well-structured guidelines? This paper investigates the use of quality indicators that are formulated by medical institutions to evaluate medical care. The main research questions are

  5. Exploration Medical System Demonstration

    Science.gov (United States)

    Rubin, D. A.; Watkins, S. D.

    2014-01-01

    BACKGROUND: Exploration class missions will present significant new challenges and hazards to the health of the astronauts. Regardless of the intended destination, beyond low Earth orbit a greater degree of crew autonomy will be required to diagnose medical conditions, develop treatment plans, and implement procedures due to limited communications with ground-based personnel. SCOPE: The Exploration Medical System Demonstration (EMSD) project will act as a test bed on the International Space Station (ISS) to demonstrate to crew and ground personnel that an end-to-end medical system can assist clinician and non-clinician crew members in optimizing medical care delivery and data management during an exploration mission. Challenges facing exploration mission medical care include limited resources, inability to evacuate to Earth during many mission phases, and potential rendering of medical care by non-clinicians. This system demonstrates the integration of medical devices and informatics tools for managing evidence and decision making and can be designed to assist crewmembers in nominal, non-emergent situations and in emergent situations when they may be suffering from performance decrements due to environmental, physiological or other factors. PROJECT OBJECTIVES: The objectives of the EMSD project are to: a. Reduce or eliminate the time required of an on-orbit crew and ground personnel to access, transfer, and manipulate medical data. b. Demonstrate that the on-orbit crew has the ability to access medical data/information via an intuitive and crew-friendly solution to aid in the treatment of a medical condition. c. Develop a common data management framework that can be ubiquitously used to automate repetitive data collection, management, and communications tasks for all activities pertaining to crew health and life sciences. d. Ensure crew access to medical data during periods of restricted ground communication. e. Develop a common data management framework that

  6. Library school education for medical librarianship.

    Science.gov (United States)

    Roper, F W

    1979-10-01

    This paper reviews the current situation in library school education for medical librarianship in the United States and Canada based on information from a questionnaire sent to teachers of courses in medical librarianship in accredited library schools. Since 1939, when the first course devoted entirely to medical librarianship was offered at Columbia University, courses have been introduced into the curricula of at least forty-seven of the ALA-accredited library schools. In 1978 there were seventy courses available through forty-seven library schools. Possibilities for specialization in medical librarianship are examined. Course content is reviewed. Implications of the MLA certification examination for library school courses are explored.

  7. Patient safety and technology-driven medication

    DEFF Research Database (Denmark)

    Orbæk, Janne; Gaard, Mette; Keinicke Fabricius, Pia

    2015-01-01

    ways of educating nursing students in today's medication administration. AIM: To explore nursing students' experiences and competences with the technology-driven medication administration process. METHODS: 16 pre-graduate nursing students were included in two focus group interviews which were recorded...... for the technology-driven medication process, nursing students face difficulties in identifying and adopting best practices. The impact of using technology on the frequency, type and severity of medication errors; the technologies implications on nursing professionalism and the nurses ability to secure patient...

  8. Library School Education for Medical Librarianship *

    Science.gov (United States)

    Roper, Fred W.

    1979-01-01

    This paper reviews the current situation in library school education for medical librarianship in the United States and Canada based on information from a questionnaire sent to teachers of courses in medical librarianship in accredited library schools. Since 1939, when the first course devoted entirely to medical librarianship was offered at Columbia University, courses have been introduced into the curricula of at least forty-seven of the ALA-accredited library schools. In 1978 there were seventy courses available through forty-seven library schools. Possibilities for specialization in medical librarianship are examined. Course content is reviewed. Implications of the MLA certification examination for library school courses are explored. PMID:385086

  9. The historical significance of oak

    Science.gov (United States)

    J. V. Thirgood

    1971-01-01

    A brief history of the importance of oak in Europe, contrasting the methods used in France and Britain to propagate the species and manage the forests for continued productivity. The significance of oak as a strategic resource during the sailing-ship era is stressed, and mention is made of the early development of oak management in North America. The international...

  10. Medical speciality choice: does personality matter?

    LENUS (Irish Health Repository)

    Lydon, S

    2015-03-01

    There has been increasing interest in the personalities of doctors. This study examined whether personality differed based upon gender, level of training or medical speciality among 200 physicians and 134 medical students. Post-internship doctors scored significantly higher on conscientiousness (p = .001) than those pursuing basic medical training. Among those pursuing basic medical training, females scored significantly higher than males on agreeableness (p < .001) and conscientiousness (p = .001). Among post-internship respondents, females scored significantly higher on agreeableness (p = .004). There were no personality differences between post-internship doctors working in different specialities. However, among those pursuing basic medical training, those interested in person-focused medical specialities scored significantly higher on extraversion (p < .001), conscientiousness (p = .001), and lower on neuroticism (p = .01) than those who had no strong preference. These results suggest that there is no unique personality profile associated with medical practice, or medical speciality. Instead, it appears that medical school may shape personality.

  11. NCRP report 160 and what it means for medical imaging and nuclear medicine.

    Science.gov (United States)

    Bolus, Norman E

    2013-12-01

    The purpose of this paper is to briefly explain report 160 of the National Council on Radiation Protection and Measurement and the significance of the report to medical imaging as a whole and nuclear medicine specifically. The implications of the findings of report 160 have had repercussions and will continue to affect all of ionizing radiation medical imaging. The nuclear medicine community should have an understanding of why and how report 160 is important. After reading this article, the nuclear medicine technologist will be familiar with the main focus of report 160, the significant change that has occurred since the 1980s in the ionizing radiation exposure of people in the United States, the primary background source of ionizing radiation in the United States, the primary medical exposure to ionizing radiation in the United States, trends in nuclear medicine procedures and patient exposure, and a comparison of population doses between 2006 and the early 1980s as outlined in report 160.

  12. The somatically significant dose, SSD, and analog of the GSD, the genetically significant dose

    International Nuclear Information System (INIS)

    Beentjes, L.B.; Duijsings, J.H.

    1992-01-01

    The medical applications of radiation comprise three main fields namely: Diagnostic Radiology, Radiotherapy and Nuclear Medicine. With the new weighting factors of ICRP (IC91a) the effective dose due to medical applications can be established. I is common to separate the effective dose into the genetic part and the somatic part, SED. In dealing with gonad doses it is important to account for the age of the person at the time of exposure as this will influence the number of children still to be expected from that person. The resulting dose will then be called the genetically significant dose, GSD. In a similar fashion this age factor will be important in considering the chance of tumor induction. The age of patients differs considerably from the average age of the general population. This age difference has to be accounted for if a comparison is to be made with other sources of radiation. This justifies establishing a somatically significant dose, SSD. The reduction of the SED value to a SSD for the medical field due to this phenomenon is .6 for diagnostic radiology, .5 for nuclear medicine and .3 for radiotherapy. Also the extension to more organs at risk, which result in a larger number of weighting factors published by ICRP (IC91a) tends to lower the calculated effective doses. (author)

  13. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1994-03-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (October - December 1993) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  14. Synthetic definition of biological significance

    International Nuclear Information System (INIS)

    Buffington, J.D.

    1975-01-01

    The central theme of the workshop is recounted and the views of the authors are summarized. Areas of broad agreement or disagreement, unifying principles, and research needs are identified. Authors' views are consolidated into concepts that have practical utility for the scientist making impact assessments. The need for decision-makers and managers to be cognizant of the recommendations made herein is discussed. Finally, bringing together the diverse views of the workshop participants, a conceptual definition of biological significance is synthesized

  15. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1992-11-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (July - September 1992) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  16. Medical imaging

    CERN Document Server

    Townsend, David W

    1996-01-01

    Since the introduction of the X-ray scanner into radiology almost 25 years ago, non-invasive imaging has become firmly established as an essential tool in the diagnosis of disease. Fully three-dimensional imaging of internal organs is now possible, b and for studies which explore the functional status of the body. Powerful techniques to correlate anatomy and function are available, and scanners which combine anatomical and functional imaging in a single device are under development. Such techniques have been made possible through r ecent technological and mathematical advances. This series of lectures will review both the physical basis of medical imaging techniques using X-rays, gamma and positron emitting radiosiotopes, and nuclear magnetic resonance, and the mathematical methods used to reconstruct three-dimentional distributions from projection data. The lectures will trace the development of medical imaging from simple radiographs to the present-day non-invasive measurement of in vivo biochemistry. They ...

  17. Medical imaging

    International Nuclear Information System (INIS)

    Elliott, Alex

    2005-01-01

    Diagnostic medical imaging is a fundamental part of the practice of modern medicine and is responsible for the expenditure of considerable amounts of capital and revenue monies in healthcare systems around the world. Much research and development work is carried out, both by commercial companies and the academic community. This paper reviews briefly each of the major diagnostic medical imaging techniques-X-ray (planar and CT), ultrasound, nuclear medicine (planar, SPECT and PET) and magnetic resonance. The technical challenges facing each are highlighted, with some of the most recent developments. In terms of the future, interventional/peri-operative imaging, the advancement of molecular medicine and gene therapy are identified as potential areas of expansion

  18. Medication Errors - A Review

    OpenAIRE

    Vinay BC; Nikhitha MK; Patel Sunil B

    2015-01-01

    In this present review article, regarding medication errors its definition, medication error problem, types of medication errors, common causes of medication errors, monitoring medication errors, consequences of medication errors, prevention of medication error and managing medication errors have been explained neatly and legibly with proper tables which is easy to understand.

  19. PS-022 Complex automated medication systems reduce medication administration error rates in an acute medical ward

    DEFF Research Database (Denmark)

    Risør, Bettina Wulff; Lisby, Marianne; Sørensen, Jan

    2017-01-01

    Background Medication errors have received extensive attention in recent decades and are of significant concern to healthcare organisations globally. Medication errors occur frequently, and adverse events associated with medications are one of the largest causes of harm to hospitalised patients...... cabinet, automated dispensing and barcode medication administration; (2) non-patient specific automated dispensing and barcode medication administration. The occurrence of administration errors was observed in three 3 week periods. The error rates were calculated by dividing the number of doses with one...

  20. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1993-09-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (April--June 1993) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  1. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1990-05-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (January--March 1990) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. Also included are a number of enforcement actions that had been previously resolved but not published in this NUREG. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  2. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1991-05-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (January--March 1991) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  3. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1991-02-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (October--December 1990) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  4. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1990-03-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (October--December 1989) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  5. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1990-11-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (July--September 1990) and includes copies of letters, notices, and orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  6. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1992-08-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (April--June 1992) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  7. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1990-09-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (April--June 1990) and includes copies of letters, notices, and orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  8. Clinical significance of neonatal menstruation.

    Science.gov (United States)

    Brosens, Ivo; Benagiano, Giuseppe

    2016-01-01

    Past studies have clearly shown the existence of a spectrum of endometrial progesterone responses in neonatal endometrium, varying from proliferation to full decidualization with menstrual-like shedding. The bleedings represent, similar to what occurs in adult menstruation, a progesterone withdrawal bleeding. Today, the bleeding is completely neglected and considered an uneventful episode of no clinical significance. Yet clinical studies have linked the risk of bleeding to a series of events indicating fetal distress. The potential link between the progesterone response and major adolescent disorders requires to be investigated by prospective studies. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  9. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1993-06-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (January--March 1993) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  10. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1992-05-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (January--March 1992) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  11. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1993-12-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (July--September 1993) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  12. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1993-03-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (October--December 1992) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  13. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1991-07-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (April-June 1991) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  14. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1991-11-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (July--September 1991) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  15. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1992-03-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (October--December 1991) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  16. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1989-06-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (January--March 1989) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. Also included are a number of enforcement actions that had been previously resolved but not published in this NUREG. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  17. Enforcement actions: Significant actions resolved

    International Nuclear Information System (INIS)

    1989-12-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (July--September 1989) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  18. Short Communication: Significance for pasture production in the ...

    African Journals Online (AJOL)

    Short Communication: Significance for pasture production in the southern Cape coastal region of naturalized rhizobia nodulating the strain specific Medicago ... The significance of naturalized strains of M. polymorpha in the production of medic pastures in some soils of the southern Cape coastal region is discussed.

  19. Readmissions of medical patients

    DEFF Research Database (Denmark)

    Cooksley, T.; Nanayakkara, P. W. B.; Nickel, C. H.

    2016-01-01

    of readmission but have not been validated in international populations. AIM: To perform an external independent validation of the HOSPITAL and LACE scores. DESIGN: An unplanned secondary cohort study. METHODS: Patients admitted to the medical admission unit at the Hospital of South West Jutland (10...... power of both scores decreased with increasing age. CONCLUSION: Readmissions are a complex phenomenon with not only medical conditions contributing but also system, cultural and environmental factors exerting a significant influence. It is possible that the heterogeneity of the population and health...

  20. Moral significance of phenomenal consciousness.

    Science.gov (United States)

    Levy, Neil; Savulescu, Julian

    2009-01-01

    Recent work in neuroimaging suggests that some patients diagnosed as being in the persistent vegetative state are actually conscious. In this paper, we critically examine this new evidence. We argue that though it remains open to alternative interpretations, it strongly suggests the presence of consciousness in some patients. However, we argue that its ethical significance is less than many people seem to think. There are several different kinds of consciousness, and though all kinds of consciousness have some ethical significance, different kinds underwrite different kinds of moral value. Demonstrating that patients have phenomenal consciousness--conscious states with some kind of qualitative feel to them--shows that they are moral patients, whose welfare must be taken into consideration. But only if they are subjects of a sophisticated kind of access consciousness--where access consciousness entails global availability of information to cognitive systems--are they persons, in the technical sense of the word employed by philosophers. In this sense, being a person is having the full moral status of ordinary human beings. We call for further research which might settle whether patients who manifest signs of consciousness possess the sophisticated kind of access consciousness required for personhood.

  1. The public health implications of asthma.

    Science.gov (United States)

    Bousquet, Jean; Bousquet, Philippe J; Godard, Philippe; Daures, Jean-Pierre

    2005-07-01

    Asthma is a very common chronic disease that occurs in all age groups and is the focus of various clinical and public health interventions. Both morbidity and mortality from asthma are significant. The number of disability-adjusted life years (DALYs) lost due to asthma worldwide is similar to that for diabetes, liver cirrhosis and schizophrenia. Asthma management plans have, however, reduced mortality and severity in countries where they have been applied. Several barriers reduce the availability, affordability, dissemination and efficacy of optimal asthma management plans in both developed and developing countries. The workplace environment contributes significantly to the general burden of asthma. Patients with occupational asthma have higher rates of hospitalization and mortality than healthy workers. The surveillance of asthma as part of a global WHO programme is essential. The economic cost of asthma is considerable both in terms of direct medical costs (such as hospital admissions and the cost of pharmaceuticals) and indirect medical costs (such as time lost from work and premature death). Direct costs are significant in most countries. In order to reduce costs and improve quality of care, employers and health plans are exploring more precisely targeted ways of controlling rapidly rising health costs. Poor control of asthma symptoms is a major issue that can result in adverse clinical and economic outcomes. A model of asthma costs is needed to aid attempts to reduce them while permitting optimal management of the disease. This paper presents a discussion of the burden of asthma and its socioeconomic implications and proposes a model to predict the costs incurred by the disease.

  2. Assisted Reproductive Technologies : Implications for Women's ...

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

    Assisted Reproductive Technologies : Implications for Women's Reproductive Rights and Social Citizenship. There is a general perception that assisted reproductive technologies (ARTs) affect only a small number of affluent women in India. However, the ART industry - tied as it is to the vigorously pushed medical tourism ...

  3. The nuclear and its psychological implications

    International Nuclear Information System (INIS)

    Blanc, D.

    2001-01-01

    From the 13. to 15. january 1977, the S.F.R.P. has organised at Paris, with the patronage of The National Institute of Health and Medical Research, the French Society of Radiology, a colloquium devoted to the nuclear and its psycho-implications sociological. It is a second edition, realised at the demand of the Antoine Beclere Center. (N.C.)

  4. Does the legalization of medical marijuana increase completed suicide?

    Science.gov (United States)

    Rylander, Melanie; Valdez, Carolyn; Nussbaum, Abraham M

    2014-07-01

    Suicide is among the 10 most common causes of death in the United States. Researchers have identified a number of factors associated with completed suicide, including marijuana use, and increased land elevation. Colorado is an ideal state to test the strength of these associations. The state has a completed suicide rate well above the national average and over the past 15 years has permitted first the medical and, as 2014, the recreational use of marijuana. To determine if there is a correlation between medical marijuana use, as assessed by the number of medical marijuana registrants and completed suicides per county in Colorado. The number of medical marijuana registrants was used as a proxy for marijuana use. Analysis variables included total medical marijuana registrants, medical marijuana dispensaries per county, total suicide deaths, mechanism of suicide death, gender, total suicide hospitalizations, total unemployment, and county-level information such as mean elevation and whether the county was urban or rural. Analysis was performed with mixed model Poisson regression using generalized linear modeling techniques. We found no consistent association between the number of marijuana registrants and completed suicide after controlling for multiple known risk factors for completed suicide. The legalization of medical marijuana may not have an adverse impact on suicide rates. Given the concern for the increased use of marijuana after its legalization, our negative findings provide some reassurance. However, this conclusion needs to be examined in light of the limitations of our study and may not be generalizable to those with existing severe mental illness. This finding may have significant public health implications for the presumable increase in marijuana use that may follow legalization.

  5. Reasons and remedies for under-representation of women in medical leadership roles: a qualitative study from Australia.

    Science.gov (United States)

    Bismark, Marie; Morris, Jennifer; Thomas, Laura; Loh, Erwin; Phelps, Grant; Dickinson, Helen

    2015-11-16

    To elicit medical leaders' views on reasons and remedies for the under-representation of women in medical leadership roles. Qualitative study using semistructured interviews with medical practitioners who work in medical leadership roles. Interviews were transcribed verbatim and transcripts were analysed using thematic analysis. Public hospitals, private healthcare providers, professional colleges and associations and government organisations in Australia. 30 medical practitioners who hold formal medical leadership roles. Despite dramatic increases in the entry of women into medicine in Australia, there remains a gross under-representation of women in formal, high-level medical leadership positions. The male-dominated nature of medical leadership in Australia was widely recognised by interviewees. A small number of interviewees viewed gender disparities in leadership roles as a 'natural' result of women's childrearing responsibilities. However, most interviewees believed that preventable gender-related barriers were impeding women's ability to achieve and thrive in medical leadership roles. Interviewees identified a range of potential barriers across three broad domains-perceptions of capability, capacity and credibility. As a counter to these, interviewees pointed to a range of benefits of women adopting these roles, and proposed a range of interventions that would support more women entering formal medical leadership roles. While women make up more than half of medical graduates in Australia today, significant barriers restrict their entry into formal medical leadership roles. These constraints have internalised, interpersonal and structural elements that can be addressed through a range of strategies for advancing the role of women in medical leadership. These findings have implications for individual medical practitioners and health services, as well as professional colleges and associations. Published by the BMJ Publishing Group Limited. For permission to use

  6. The Structure of Medical Decisions

    DEFF Research Database (Denmark)

    Austin, Laurel C.; Reventlow, Susanne; Sandøe, Peter

    2013-01-01

    ) an individual for a population-based intervention. Analysis of these situations facilitates examination of intuitive probabilistic reasoning. Drawing on evidence in related literature, we discuss some implications of decision-makers imposing the wrong structure or probabilistic reasoning when making medical......Increasingly, medical choices involve deciding whether to look for evidence of undetected, asymptomatic conditions, or increased risk of future conditions (i.e. screening). Those who screen at sufficiently high risk face decisions about interventions to prevent or postpone the onset of possible......, but not certain, future symptomatic conditions. Other preventive decisions include whether or not to accept population-based intervention, such as vaccination. Using decision trees, we model the normative structures and associated uncertainties that underlie five medical decision situations, each of which...

  7. The significance of small streams

    Science.gov (United States)

    Wohl, Ellen

    2017-09-01

    Headwaters, defined here as first- and secondorder streams, make up 70%‒80% of the total channel length of river networks. These small streams exert a critical influence on downstream portions of the river network by: retaining or transmitting sediment and nutrients; providing habitat and refuge for diverse aquatic and riparian organisms; creating migration corridors; and governing connectivity at the watershed-scale. The upstream-most extent of the channel network and the longitudinal continuity and lateral extent of headwaters can be difficult to delineate, however, and people are less likely to recognize the importance of headwaters relative to other portions of a river network. Consequently, headwaters commonly lack the legal protections accorded to other portions of a river network and are more likely to be significantly altered or completely obliterated by land use.

  8. No significant fuel failures (NSFF)

    International Nuclear Information System (INIS)

    Domaratzki, Z.

    1979-01-01

    It has long been recognized that no emergency core cooling system (ECCS) could be absolutely guaranteed to prevent fuel failures. In 1976 the Atomic Energy Control Board decided that the objective for an ECCS should be to prevent fuel failures, but if the objective could not be met it should be shown that the consequences are acceptable for dual failures comprising any LOCA combined with an assumed impairment of containment. Out of the review of the Bruce A plant came the definition of 'no significant fuel failures': for any postulated LOCA combined with any one mode of containment impairment the resultant dose to a person at the edge of the exclusion zone is less than the reference dose limits for dual failures

  9. Ritual Significance in Mycenaean Hairstyles

    Directory of Open Access Journals (Sweden)

    Hsu, Florence Sheng-chieh

    2012-04-01

    Full Text Available Although the frescoes excavated from Bronze Age sites on the Greek mainland provide evidence for female figures in the Mycenaean society, the hairstyles of these figures have not been studied in detail. As in many other ancient cultures, hairstyles were not only an exhibition of beauty and fashion, but they also represented certain age groups or a person’s social status. The Mycenaeans inherited many of their hairstyles from their Minoan predecessors, although differences existed as well. It is also possible there may have been a shift in meaning for seemingly similar looking hairstyles from the Minoan to the Mycenaean periods. Female figures, which compose most of the Mycenaean figures in frescoes known to date, are fine examples for discussing the artistic representation and potential significance of Mycenaean hairstyles. By comparing with Minoan hairstyles, discussions of Mycenaean examples lead to conclusions in the relationship between hairstyles and ritual activities in the Mycenaean society.

  10. The energetic significance of cooking.

    Science.gov (United States)

    Carmody, Rachel N; Wrangham, Richard W

    2009-10-01

    While cooking has long been argued to improve the diet, the nature of the improvement has not been well defined. As a result, the evolutionary significance of cooking has variously been proposed as being substantial or relatively trivial. In this paper, we evaluate the hypothesis that an important and consistent effect of cooking food is a rise in its net energy value. The pathways by which cooking influences net energy value differ for starch, protein, and lipid, and we therefore consider plant and animal foods separately. Evidence of compromised physiological performance among individuals on raw diets supports the hypothesis that cooked diets tend to provide energy. Mechanisms contributing to energy being gained from cooking include increased digestibility of starch and protein, reduced costs of digestion for cooked versus raw meat, and reduced energetic costs of detoxification and defence against pathogens. If cooking consistently improves the energetic value of foods through such mechanisms, its evolutionary impact depends partly on the relative energetic benefits of non-thermal processing methods used prior to cooking. We suggest that if non-thermal processing methods such as pounding were used by Lower Palaeolithic Homo, they likely provided an important increase in energy gain over unprocessed raw diets. However, cooking has critical effects not easily achievable by non-thermal processing, including the relatively complete gelatinisation of starch, efficient denaturing of proteins, and killing of food borne pathogens. This means that however sophisticated the non-thermal processing methods were, cooking would have conferred incremental energetic benefits. While much remains to be discovered, we conclude that the adoption of cooking would have led to an important rise in energy availability. For this reason, we predict that cooking had substantial evolutionary significance.

  11. Antihypertensive Medications Adherence Among Nigerian ...

    African Journals Online (AJOL)

    Hospital, Ogbomosho, 2Goshen Heart Clinic, Osogbo, 3Department of Economics, Osun State University, Osogbo, Nigeria ... significant impact of antihypertensive medication adherence.[13]. The level of information provided to patients may also impact ..... Muntner P. New medication adherence scale versus pharmacy.

  12. Clinical Significance and Characteristic Clinical Differences of Cytolytic Vaginosis in Recurrent Vulvovaginitis.

    Science.gov (United States)

    Yang, Shuhua; Zhang, Yuexiang; Liu, Ying; Wang, Jianhong; Chen, Shuqin; Li, Shuxia

    2017-01-01

    The study aimed to evaluate whether cytolytic vaginosis (CV) has important clinical implications for recurrent vulvovaginitis and to identify clinical differences between CV and vulvovaginal candidosis (VVC). Medical histories, physical examinations and laboratory findings were used to diagnose and assess the prevalence rates of various vulvovaginal infections among 536 women with recurrent vulvovaginitis. Chi-square and Fisher exact tests were used to compare age, menstrual cycle phase at episode onset, symptoms/signs of infection and discharge characteristics between CV and VVC with single infection. Among the 484 women with a single-infection recurrent vulvovaginitis, the prevalence of CV (n = 143; 26.7%) was second only to VVC (n = 196; 36.6%). CV symptoms occurred predominantly during the ovulatory and luteal phases. Meanwhile, VVC episodes were not concentrated premenstrually, but rather occurred throughout the menstrual cycle. Significant differences were found in the vaginal pH, discharge characteristics and frequency of inflammatory symptoms between the 2 groups. CV is clinically important, because it is a common cause of recurrent vulvovaginitis. To distinguish CV from VVC, gynecologists should consider the patient's medical history, physical and laboratory findings, vaginal pH and vaginal discharge characteristics. © 2016 S. Karger AG, Basel.

  13. Emergency Medicine Resident Perceptions of Medical Professionalism.

    Science.gov (United States)

    Jauregui, Joshua; Gatewood, Medley O; Ilgen, Jonathan S; Schaninger, Caitlin; Strote, Jared

    2016-05-01

    Medical professionalism is a core competency for emergency medicine (EM) trainees; but defining professionalism remains challenging, leading to difficulties creating objectives and performing assessment. Because professionalism is dynamic, culture-specific, and often taught by modeling, an exploration of trainees' perceptions can highlight their educational baseline and elucidate the importance they place on general conventional professionalism domains. To this end, our objective was to assess the relative value EM residents place on traditional components of professionalism. We performed a cross-sectional, multi-institutional survey of incoming and graduating EM residents at four programs. The survey was developed using the American Board of Internal Medicine's "Project Professionalism" and the Accreditation Council of Graduate Medical Education definition of professionalism competency. We identified 27 attributes within seven domains: clinical excellence, humanism, accountability, altruism, duty and service, honor and integrity, and respect for others. Residents were asked to rate each attribute on a 10-point scale. We analyzed data to assess variance across attributes as well as differences between residents at different training levels or different institutions. Of the 114 residents eligible, 100 (88%) completed the survey. The relative value assigned to different professional attributes varied considerably, with those in the altruism domain valued significantly lower and those in the "respect for others" and "honor and integrity" valued significantly higher (p<0.001). Significant differences were found between interns and seniors for five attributes primarily in the "duty and service" domain (p<0.05). Among different residencies, significant differences were found with attributes within the "altruism" and "duty and service" domains (p<0.05). Residents perceive differences in the relative importance of traditionally defined professional attributes and this may

  14. Career exploration behavior of Korean medical students

    Directory of Open Access Journals (Sweden)

    Hyejin An

    2017-09-01

    Full Text Available Purpose This study is to analyze the effects of medical students’ social support and career barriers on career exploration behavior mediated by career decision-making self-efficacy. Methods We applied the t-test to investigate the difference among the variables based on gender and admission types. Also, we performed path analysis to verify the effect of perceived career barriers and social support on career exploration behavior with career decision efficacy as a mediator. Results First, we noted statistically significant gender and admission type difference in social support, career barriers and career exploration behaviors. Second, social support and career barriers were found to influence career exploration behavior as a mediating variable for career decision-making self-efficacy. Conclusion Social support and career barriers as perceived by medical students influenced their career exploration behavior, with their decision-making self-efficacy serving as a full mediator. Therefore, this study has educational implications for career program development and educational training for career decision-making self-efficacy.

  15. Career exploration behavior of Korean medical students.

    Science.gov (United States)

    An, Hyejin; Lee, Seung-Hee

    2017-09-01

    This study is to analyze the effects of medical students' social support and career barriers on career exploration behavior mediated by career decision-making self-efficacy. We applied the t-test to investigate the difference among the variables based on gender and admission types. Also, we performed path analysis to verify the effect of perceived career barriers and social support on career exploration behavior with career decision efficacy as a mediator. First, we noted statistically significant gender and admission type difference in social support, career barriers and career exploration behaviors. Second, social support and career barriers were found to influence career exploration behavior as a mediating variable for career decision-making self-efficacy. Social support and career barriers as perceived by medical students influenced their career exploration behavior, with their decision-making self-efficacy serving as a full mediator. Therefore, this study has educational implications for career program development and educational training for career decision-making self-efficacy.

  16. Worker radiological protection: occupational medical aspects

    International Nuclear Information System (INIS)

    Cardenas Herrera, Juan; Fernandez Gomez, Isis Maria

    2008-01-01

    Radiation exposures experienced by workers are widely explained. The first evidences of biological effects, the implications for human health and the radiological protection have been covered. The conceptual structure that covers the radiological protection and adequate protection without limiting benefits, the scientific basis of radiology, the benefits and risks of the radiological protection are specified. The effective per capita doses are exposed in medical uses both for Latin America and for other regions in the average radiology, dental radiology, nuclear medicine and radiotherapy. The manners of occupational exposures in the medicine are presented. Industrial uses have also its average effective dose in the industrial irradiation, industrial radiography and radioisotopes production. Within the natural radiation the natural sources can significantly contribute to occupational exposure and have their average effective dose. Occupational medical surveillance to be taken into industrial sites is detailed. In addition, the plan of international action for the solution of dilemmas of occupational exposures is mentioned and the different dilemmas of radioactive exposure are showed. The external irradiation, the acute diseases by radiations, the cutaneous syndrome of the chronic radiation, the radioactive contamination, the internal radioactive contamination, the combined lesion and accidental exposures are also treated [es

  17. Clearing the smoke around medical marijuana.

    Science.gov (United States)

    Ware, M A

    2011-12-01

    The hazy world of "medical marijuana" continues to cry out for clear data on which to base medical decision making and rational policy design. In this issue of Clinical Pharmacology & Therapeutics, Abrams and colleagues report that vaporized cannabis does not meaningfully affect opioid plasma levels and may even augment the efficacy of oxycodone and morphine in patients with chronic non-cancer pain. This Commentary considers the implications of this work for clinical practice and further research initiatives.

  18. Medical education in Ecuador.

    Science.gov (United States)

    Joffre, Carrillo P; Delgado, Belgica; Kosik, Russell Olive; Huang, Lei; Zhao, Xudong; Su, Tung-Ping; Wang, Shuu-Jiun; Chen, Qi; Fan, Angela Pei-Chen

    2013-12-01

    Ecuador, the smallest of the Andean countries, is located in the northwest portion of South America. The nation's 14.5 million people have a tremendous need for high quality primary care. To describe the profound advances as well as the persistent needs in medical education in Ecuador that have occurred with globalization and with the modernization of the country. Through an extensive search of the literature; medical school data; reports from the Ecuador Ministry of Public Health and Ministry of Education; and information from the National Secretary of Higher Education, Science, and Innovation (SENESCYT), the medical education system in Ecuador has been thoroughly examined. The National System of Higher Education in Ecuador has experienced significant growth over the last 20 years. As of 2009 the system boasts 19 medical schools, all of which offer the required education needed to obtain the title of Physician, but only 12 of which offer postgraduate clinical training. Of these 19 universities, nine are public, five are private and self-financed, and five are private and co-financed. Post-graduate options for medical students include: (1) Clinical specialization, (2) Higher diploma, (3) Course specialization, (4) Master's degree, and (5) PhD degree. The rapid growth of Ecuador's system of medical education has led to inevitable gaps that threaten its ability to sustain itself. Chief among these is the lack of well-trained faculty to supply its medical schools. To ensure an adequate supply of faculty exists, the creation of sufficient postgraduate, sub-specialization, and PhD training positions must be created and maintained.

  19. Prevalence of Medical Disorders in Pregnancy in Ebonyi State ...

    African Journals Online (AJOL)

    Background: Pregnancy is a physiological state, but when associated with an underlying medical disorder, it has a large ..... bacteriuria in pregnant women versus inpatient treatment ... implication of routine screen for asymptomatic bacteria.

  20. Social, Psychological, and Medical Aspects of Chronic Pain.

    Science.gov (United States)

    Sparks, Jayne A.; Clark, Donald W.

    1981-01-01

    Discusses certain factors that contribute to the development of chronic pain. Psychosocial factors are explored with a summary of their implications for treatment. Medical treatment for chronic pain is reviewed and holistic treatment is surveyed. (Author)

  1. Medical robotics

    CERN Document Server

    Troccaz, Jocelyne

    2013-01-01

    In this book, we present medical robotics, its evolution over the last 30 years in terms of architecture, design and control, and the main scientific and clinical contributions to the field. For more than two decades, robots have been part of hospitals and have progressively become a common tool for the clinician. Because this domain has now reached a certain level of maturity it seems important and useful to provide a state of the scientific, technological and clinical achievements and still open issues. This book describes the short history of the domain, its specificity and constraints, and

  2. Significant biases affecting abundance determinations

    Science.gov (United States)

    Wesson, Roger

    2015-08-01

    I have developed two highly efficient codes to automate analyses of emission line nebulae. The tools place particular emphasis on the propagation of uncertainties. The first tool, ALFA, uses a genetic algorithm to rapidly optimise the parameters of gaussian fits to line profiles. It can fit emission line spectra of arbitrary resolution, wavelength range and depth, with no user input at all. It is well suited to highly multiplexed spectroscopy such as that now being carried out with instruments such as MUSE at the VLT. The second tool, NEAT, carries out a full analysis of emission line fluxes, robustly propagating uncertainties using a Monte Carlo technique.Using these tools, I have found that considerable biases can be introduced into abundance determinations if the uncertainty distribution of emission lines is not well characterised. For weak lines, normally distributed uncertainties are generally assumed, though it is incorrect to do so, and significant biases can result. I discuss observational evidence of these biases. The two new codes contain routines to correctly characterise the probability distributions, giving more reliable results in analyses of emission line nebulae.

  3. Astrobiological significance of chemolithoautotrophic acidophiles

    Science.gov (United States)

    Pikuta, Elena V.; Hoover, Richard B.

    2004-02-01

    For more than a century (since Winogradsky discovered lithautotrophic bacteria) there has been a dilemma in microbiology about life that first inhabited the Earth. Which types of life forms first appeared in the primordial oceans during the earliest geological period on Earth as the primary ancestors of modern biological diversity? How did a metabolism of ancestors evolve: from lithoautotrophic to lithoheterotrophic and organoheterotrophic or from organoheterotrophic to organautotrophic and lithomixotrophic types? At the present time, it is known that chemolithoheterotrophic and chemolithoautotrophic metabolizing bacteria are wide spread in different ecosystems. On Earth the acidic ecosystems are associated with geysers, volcanic fumaroles, hot springs, deep sea hydrothermal vents, caves, acid mine drainage and other technogenic ecosystems. Bioleaching played a significant roel on a global geological scale during the Earth's formation. This important feature of bacteria has been successfully applied in industry. The lithoautotrophs include Bacteria and Archaea belonging to diverse genera containing thermophilic and mesophilic species. In this paper we discuss the lithotrophic microbial acidophiles and present some data with a description of new acidophilic iron- and sulfur-oxidizing bacterium isolated from the Chena Hot Springs in Alaska. We also consider the possible relevance of microbial acidophiles to Venus, Io, and acidic inclusions in glaciers and icy moons.

  4. Determining Semantically Related Significant Genes.

    Science.gov (United States)

    Taha, Kamal

    2014-01-01

    GO relation embodies some aspects of existence dependency. If GO term xis existence-dependent on GO term y, the presence of y implies the presence of x. Therefore, the genes annotated with the function of the GO term y are usually functionally and semantically related to the genes annotated with the function of the GO term x. A large number of gene set enrichment analysis methods have been developed in recent years for analyzing gene sets enrichment. However, most of these methods overlook the structural dependencies between GO terms in GO graph by not considering the concept of existence dependency. We propose in this paper a biological search engine called RSGSearch that identifies enriched sets of genes annotated with different functions using the concept of existence dependency. We observe that GO term xcannot be existence-dependent on GO term y, if x- and y- have the same specificity (biological characteristics). After encoding into a numeric format the contributions of GO terms annotating target genes to the semantics of their lowest common ancestors (LCAs), RSGSearch uses microarray experiment to identify the most significant LCA that annotates the result genes. We evaluated RSGSearch experimentally and compared it with five gene set enrichment systems. Results showed marked improvement.

  5. Statistically significant relational data mining :

    Energy Technology Data Exchange (ETDEWEB)

    Berry, Jonathan W.; Leung, Vitus Joseph; Phillips, Cynthia Ann; Pinar, Ali; Robinson, David Gerald; Berger-Wolf, Tanya; Bhowmick, Sanjukta; Casleton, Emily; Kaiser, Mark; Nordman, Daniel J.; Wilson, Alyson G.

    2014-02-01

    This report summarizes the work performed under the project (3z(BStatitically significant relational data mining.(3y (BThe goal of the project was to add more statistical rigor to the fairly ad hoc area of data mining on graphs. Our goal was to develop better algorithms and better ways to evaluate algorithm quality. We concetrated on algorithms for community detection, approximate pattern matching, and graph similarity measures. Approximate pattern matching involves finding an instance of a relatively small pattern, expressed with tolerance, in a large graph of data observed with uncertainty. This report gathers the abstracts and references for the eight refereed publications that have appeared as part of this work. We then archive three pieces of research that have not yet been published. The first is theoretical and experimental evidence that a popular statistical measure for comparison of community assignments favors over-resolved communities over approximations to a ground truth. The second are statistically motivated methods for measuring the quality of an approximate match of a small pattern in a large graph. The third is a new probabilistic random graph model. Statisticians favor these models for graph analysis. The new local structure graph model overcomes some of the issues with popular models such as exponential random graph models and latent variable models.

  6. Statistical Significance for Hierarchical Clustering

    Science.gov (United States)

    Kimes, Patrick K.; Liu, Yufeng; Hayes, D. Neil; Marron, J. S.

    2017-01-01

    Summary Cluster analysis has proved to be an invaluable tool for the exploratory and unsupervised analysis of high dimensional datasets. Among methods for clustering, hierarchical approaches have enjoyed substantial popularity in genomics and other fields for their ability to simultaneously uncover multiple layers of clustering structure. A critical and challenging question in cluster analysis is whether the identified clusters represent important underlying structure or are artifacts of natural sampling variation. Few approaches have been proposed for addressing this problem in the context of hierarchical clustering, for which the problem is further complicated by the natural tree structure of the partition, and the multiplicity of tests required to parse the layers of nested clusters. In this paper, we propose a Monte Carlo based approach for testing statistical significance in hierarchical clustering which addresses these issues. The approach is implemented as a sequential testing procedure guaranteeing control of the family-wise error rate. Theoretical justification is provided for our approach, and its power to detect true clustering structure is illustrated through several simulation studies and applications to two cancer gene expression datasets. PMID:28099990

  7. Exploration Medical System Demonstration Project

    Science.gov (United States)

    Chin, D. A.; McGrath, T. L.; Reyna, B.; Watkins, S. D.

    2011-01-01

    A near-Earth Asteroid (NEA) mission will present significant new challenges including hazards to crew health created by exploring a beyond low earth orbit destination, traversing the terrain of asteroid surfaces, and the effects of variable gravity environments. Limited communications with ground-based personnel for diagnosis and consultation of medical events require increased crew autonomy when diagnosing conditions, creating treatment plans, and executing procedures. Scope: The Exploration Medical System Demonstration (EMSD) project will be a test bed on the International Space Station (ISS) to show an end-to-end medical system assisting the Crew Medical Officers (CMO) in optimizing medical care delivery and medical data management during a mission. NEA medical care challenges include resource and resupply constraints limiting the extent to which medical conditions can be treated, inability to evacuate to Earth during many mission phases, and rendering of medical care by a non-clinician. The system demonstrates the integration of medical technologies and medical informatics tools for managing evidence and decision making. Project Objectives: The objectives of the EMSD project are to: a) Reduce and possibly eliminate the time required for a crewmember and ground personnel to manage medical data from one application to another. b) Demonstrate crewmember's ability to access medical data/information via a software solution to assist/aid in the treatment of a medical condition. c) Develop a common data management architecture that can be ubiquitously used to automate repetitive data collection, management, and communications tasks for all crew health and life sciences activities. d) Develop a common data management architecture that allows for scalability, extensibility, and interoperability of data sources and data users. e) Lower total cost of ownership for development and sustainment of peripheral hardware and software that use EMSD for data management f) Provide

  8. Cooperative epistemic work in medical practice

    DEFF Research Database (Denmark)

    Bansler, Jørgen P.; Havn, Erling Carl; Schmidt, Kjeld

    2016-01-01

    We examine an important part of the medical record that has not been studied extensively: physicians’ clinical notes. These notes constitute an explanatory medical narrative that documents the patient’s illness trajectory by combining each physician’s notes into a common text. Although several pr....... We conclude by discussing the implications of this research for the design of Electronic Medical Record (EMR) systems.......We examine an important part of the medical record that has not been studied extensively: physicians’ clinical notes. These notes constitute an explanatory medical narrative that documents the patient’s illness trajectory by combining each physician’s notes into a common text. Although several...... prior CSCW studies have addressed the role of the medical record in patient care, they have not dealt specifically with the role, structure, and content of these notes. In this article, we present a detailed analysis of a set of physicians’ clinical notes recording the acute hospitalization...

  9. Medical robotics.

    Science.gov (United States)

    Ferrigno, Giancarlo; Baroni, Guido; Casolo, Federico; De Momi, Elena; Gini, Giuseppina; Matteucci, Matteo; Pedrocchi, Alessandra

    2011-01-01

    Information and communication technology (ICT) and mechatronics play a basic role in medical robotics and computer-aided therapy. In the last three decades, in fact, ICT technology has strongly entered the health-care field, bringing in new techniques to support therapy and rehabilitation. In this frame, medical robotics is an expansion of the service and professional robotics as well as other technologies, as surgical navigation has been introduced especially in minimally invasive surgery. Localization systems also provide treatments in radiotherapy and radiosurgery with high precision. Virtual or augmented reality plays a role for both surgical training and planning and for safe rehabilitation in the first stage of the recovery from neurological diseases. Also, in the chronic phase of motor diseases, robotics helps with special assistive devices and prostheses. Although, in the past, the actual need and advantage of navigation, localization, and robotics in surgery and therapy has been in doubt, today, the availability of better hardware (e.g., microrobots) and more sophisticated algorithms(e.g., machine learning and other cognitive approaches)has largely increased the field of applications of these technologies,making it more likely that, in the near future, their presence will be dramatically increased, taking advantage of the generational change of the end users and the increasing request of quality in health-care delivery and management.

  10. Risk control and the minimum significant risk

    International Nuclear Information System (INIS)

    Seiler, F.A.; Alvarez, J.L.

    1996-01-01

    Risk management implies that the risk manager can, by his actions, exercise at least a modicum of control over the risk in question. In the terminology of control theory, a management action is a control signal imposed as feedback on the system to bring about a desired change in the state of the system. In the terminology of risk management, an action is taken to bring a predicted risk to lower values. Even if it is assumed that the management action taken is 100% effective and that the projected risk reduction is infinitely well known, there is a lower limit to the desired effects that can be achieved. It is based on the fact that all risks, such as the incidence of cancer, exhibit a degree of variability due to a number of extraneous factors such as age at exposure, sex, location, and some lifestyle parameters such as smoking or the consumption of alcohol. If the control signal is much smaller than the variability of the risk, the signal is lost in the noise and control is lost. This defines a minimum controllable risk based on the variability of the risk over the population considered. This quantity is the counterpart of the minimum significant risk which is defined by the uncertainties of the risk model. Both the minimum controllable risk and the minimum significant risk are evaluated for radiation carcinogenesis and are shown to be of the same order of magnitude. For a realistic management action, the assumptions of perfectly effective action and perfect model prediction made above have to be dropped, resulting in an effective minimum controllable risk which is determined by both risk limits. Any action below that effective limit is futile, but it is also unethical due to the ethical requirement of doing more good than harm. Finally, some implications of the effective minimum controllable risk on the use of the ALARA principle and on the evaluation of remedial action goals are presented

  11. Medical revolution in Argentina.

    Science.gov (United States)

    Ballarin, V L; Isoardi, R A

    2010-01-01

    The paper discusses the major Argentineans contributors, medical physicists and scientists, in medical imaging and the development of medical imaging in Argentina. The following are presented: history of medical imaging in Argentina: the pioneers; medical imaging and medical revolution; nuclear medicine imaging; ultrasound imaging; and mathematics, physics, and electronics in medical image research: a multidisciplinary endeavor.

  12. Image processing in medical ultrasound

    DEFF Research Database (Denmark)

    Hemmsen, Martin Christian

    This Ph.D project addresses image processing in medical ultrasound and seeks to achieve two major scientific goals: First to develop an understanding of the most significant factors influencing image quality in medical ultrasound, and secondly to use this knowledge to develop image processing...... multiple imaging setups. This makes the system well suited for development of new processing methods and for clinical evaluations, where acquisition of the exact same scan location for multiple methods is important. The second project addressed implementation, development and evaluation of SASB using...... methods for enhancing the diagnostic value of medical ultrasound. The project is an industrial Ph.D project co-sponsored by BK Medical ApS., with the commercial goal to improve the image quality of BK Medicals scanners. Currently BK Medical employ a simple conventional delay-and-sum beamformer to generate...

  13. Challenging the FDA's authority to regulate autologous adult stem cells for therapeutic use: Celltex therapeutics' partnership with RNL Bio, substantial medical risks, and the implications of United States v. Regenerative Sciences.

    Science.gov (United States)

    Drabiak-Syed, Katherine

    2013-01-01

    This Article examines the convergence of three corporations that have attempted to capitalize on translating emerging research into clinical procedures by manufacturing and facilitating the process for patients to obtain mesenchymal stem cell (MSC) injections. Although the Food and Drug Administration (FDA) has asserted its authority to regulate somatic cell therapy products like MSCs under the Public Health Service Act and the Food, Drug, and Cosmetic Act, some manufacturers have attempted to circumvent FDA regulation through various mechanisms and argue that their products do not fall within the definition of a biological product or drug. However, scientific knowledge of using MSCs for clinical therapy remains in its infancy, and MSCs pose a number of serious risks to patients. This Article focuses on the development of Celltex, a company based in Sugar Land, Texas that manufactures and facilitates the injection of autologous MSCs; RNL Bio, a company that licenses its operations technology to Celltex; and Regenerative Sciences, a company based in Broomfield, Colorado that was recently involved in litigation with the FDA. Corporate circumvention of intended regulatory oversight exposes patients to potentially inefficacious products that could contribute to serious medical injuries such as viruses, myocardial infarction, cancer, or death.

  14. Psoriasis causes significant economic burden to patients.

    Science.gov (United States)

    Mustonen, A; Mattila, K; Leino, M; Koulu, L; Tuominen, R

    2014-06-01

    Psoriasis results in expenses to patients from many cost sources. Psoriasis treatments may result in considerable time and traveling costs, yet many studies fail to account for these costs. The objective of this study was to evaluate the multidimensional economic burden of psoriasis to patients. The study was based on 232 Finnish patients with psoriasis or psoriatic arthritis visiting a tertiary level dermatological clinic during a 1-year study period between October 1, 2009 and September 30, 2010. The data were based on a patient questionnaire, clinical data from the medical records and reimbursement data from the Finnish Social Insurance Institution. Item costs were based on true costs charged from the patients and all time cost estimates were based on the Human Capital Approach method. 199 patients with psoriasis and 33 with psoriatic arthritis were included in the study. Total costs were higher for patients receiving traditional systemic medications or phototherapy than those not receiving such treatment. Travel costs and travel time costs accounted for more than 60% of the costs of phototherapy. Skin care at home was time consuming and thus caused significant burden to patients. The majority of the visit costs arose from hospital visits and only a small proportion were attributed to visiting primary health care providers. Visit charges and other patient co-payments were estimated to play a minor role in the total cost of psoriasis incurred by patients, while travel costs and lost time comprised the majority of the costs, which should not be omitted in future studies regarding costs of treatments.

  15. Nonclinical Depression and Anxiety as Predictor of Academic Stress in Medical Students

    Directory of Open Access Journals (Sweden)

    Afsheen Masood

    2016-05-01

    Full Text Available To measure the role of anxiety and non-clinical depression as predictors of academic stress. In this study, supplementary objective had been gauging the prevalence of anxiety and depression among medical students of first year and final year, sought from six major medical colleges of Punjab. Almost all health professionals, no matter to which part of the world they belong to, face anxiety, depression and stress due to the nature of services they have to extend in medical profession such as time-pressures, workload, multiple roles and emotional issues. Quantitative research designed was employed; and cross sectional research design was used to lay out the research. The data was collected from first year and final year medical students. The duration of data collection was from Sep, 2014 to Sep, 2015. In Faculty of Medicine of five leading medical colleges, with total number of 650 students, the prevalence of anxiety and depression was found to be 83.9% and 67.9%, from first year to fourth year respectively, based on the cut-off points of both questionnaires. There was significant association among anxiety, depression and academic stress as computed through Pearson Product Moment Correlation. The regression analyses revealed that depression was significant predictor of academic stress but this was not the same for anxiety. Females were more anxiety and depression prone and reported greater academic stress than males. The study revealed significant distress among medical students, in terms of both anxiety and depression. It was inferred that the depression acts as pertinent predictor of academic stress. Furthermore, it was noticed that the prevalence of symptoms was higher among females. The findings carry significant implications for highlighting the addressing the need for psychological wellbeing of medical students in order to establish conducive environment of learning for medical professionals.

  16. Characterization of medication advertisements in a popular US parenting magazine.

    Science.gov (United States)

    Mongiovi, Jennifer; Cadorett, Valerie; Basch, Corey

    2017-01-01

    Background: Medication advertisements in magazines typically provide minimal educational benefit. This is of particular concern when targeted to caregivers responsible for making major medical decisions for their children. Methods: A cross-section of 72 issues from Parents magazine were collected and categorized by health condition and availability of the medication by prescription or over-the-counter (OTC).The type of medicine, dose, warning label, indication for child or adult, presence of a cartoon character, and the marketing theme used were documented. Chi-square analysis was used to determine significant differences in content. Results: Fewer than 30% (95% CI: 25.4%, 34.5%) of advertisements contained dosage information and approximately 50% (95% CI: 50.3%, 60.2%) contained side effect warnings. The greatest number of advertisements was for cold, cough and flu medications (14.7%; 95%CI: 11.6%, 18.6%). Conclusion: Medicine advertisements often do not include important information that could help consumers make informed decisions and avoid negative implications. Further research is needed to determine the attitudes of consumers to better understand and support consumers 'needs.

  17. Characterization of medication advertisements in a popular US parenting magazine

    Directory of Open Access Journals (Sweden)

    Jennifer Mongiovi

    2017-09-01

    Full Text Available Background: Medication advertisements in magazines typically provide minimal educational benefit. This is of particular concern when targeted to caregivers responsible for making major medical decisions for their children. Methods: A cross-section of 72 issues from Parents magazine were collected and categorized by health condition and availability of the medication by prescription or over-the-counter (OTC.The type of medicine, dose, warning label, indication for child or adult, presence of a cartoon character, and the marketing theme used were documented. Chi-square analysis was used to determine significant differences in content. Results: Fewer than 30% (95% CI: 25.4%, 34.5% of advertisements contained dosage information and approximately 50% (95% CI: 50.3%, 60.2% contained side effect warnings. The greatest number of advertisements was for cold, cough and flu medications (14.7%; 95%CI: 11.6%, 18.6%.Conclusion: Medicine advertisements often do not include important information that could help consumers make informed decisions and avoid negative implications. Further research is needed to determine the attitudes of consumers to better understand and support consumers 'needs.

  18. Adult Neurogenesis in the Mammalian Brain: Significant Answers and Significant Questions

    Science.gov (United States)

    Ming, Guo-li; Song, Hongjun

    2011-01-01

    Summary Adult neurogenesis, a process of generating functional neurons from adult neural precursors, occurs throughout life in restricted brain regions in mammals. The past decade has witnessed tremendous progress in addressing questions related to almost every aspect of adult neurogenesis in the mammalian brain. Here we review major advances in our understanding of adult mammalian neurogenesis in the dentate gyrus of the hippocampus and from the subventricular zone of the lateral ventricle, the rostral migratory stream to the olfactory bulb. We highlight emerging principles that have significant implications for stem cell biology, developmental neurobiology, neural plasticity, and disease mechanisms. We also discuss remaining questions related to adult neural stem cells and their niches, underlying regulatory mechanisms and potential functions of newborn neurons in the adult brain. Building upon the recent progress and aided by new technologies, the adult neurogenesis field is poised to leap forward in the next decade. PMID:21609825

  19. A quantitative systematic review of the efficacy of mobile phone interventions to improve medication adherence.

    Science.gov (United States)

    Park, Linda G; Howie-Esquivel, Jill; Dracup, Kathleen

    2014-09-01

    To evaluate the characteristics and efficacy of mobile phone interventions to improve medication adherence. Secondary aims are to explore participants' acceptability and satisfaction with mobile phone interventions and to evaluate the selected studies in terms of study rigour, impact, cost and resource feasibility, generalizability and implications for nursing practice and research. Medication non-adherence is a major global challenge. Mobile phones are the most commonly used form of technology worldwide and have the potential to promote medication adherence. Guidelines from the Centre for Reviews and Dissemination were followed for this systematic review. A comprehensive search of databases (PubMed, Web of Science, CINAHL, PsycInfo, Google Chrome and Cochrane) and bibliographies from related articles was performed from January 2002-January 2013 to identify the included studies. A quantitative systematic review without meta-analysis was conducted and the selected studies were critically evaluated to extract and summarize pertinent characteristics and outcomes. The literature search produced 29 quantitative research studies related to mobile phones and medication adherence. The studies were conducted for prevention purposes as well as management of acute and chronic illnesses. All of the studies used text messaging. Eighteen studies found significant improvement in medication adherence. While the majority of investigators found improvement in medication adherence, long-term studies characterized by rigorous research methodologies, appropriate statistical and economic analyses and the test of theory-based interventions are needed to determine the efficacy of mobile phones to influence medication adherence. © 2014 John Wiley & Sons Ltd.

  20. Physiology of school burnout in medical students: Hemodynamic and autonomic functioning

    Directory of Open Access Journals (Sweden)

    Ross W. May

    2016-09-01

    Full Text Available This study investigated the relationship between burnout and hemodynamic and autonomic functioning in both medical students (N = 55 and premedical undergraduate students (N = 77. Questionnaires screened for health related issues and assessed school burnout and negative affect symptomatology (anxiety and depression. Continuous beat-to-beat blood pressure (BP through finger plethysmography and electrocardiogram (ECG monitoring was conducted during conditions of baseline and cardiac stress induced via the cold pressor task to produce hemodynamic, heart rate variability, and blood pressure variability indices. Independent sample t-tests demonstrated that medical students had significantly higher school burnout scores compared to their undergraduate counterparts. Controlling for age, BMI, anxiety and depressive symptoms, multiple regression analyses indicated that school burnout was a stronger predictor of elevated hemodynamics (blood pressure, decreased heart rate variability, decreased markers of vagal activity and increased markers of sympathetic tone at baseline for medical students than for undergraduates. Analyses of physiological values collected during the cold pressor task indicated greater cardiac hyperactivity for medical students than for undergraduates. The present study supports previous research linking medical school burnout to hemodynamic and autonomic functioning, suggests biomarkers for medical school burnout, and provides evidence that burnout may be implicated as a physiological risk factor in medical students. Study limitations and potential intervention avenues are discussed.